Comment by garidan on September 30, 2011 at 11:16pm

I wonder if it's right not to eat for so long, perhaps it's bettere to test basal at 8 hours at a time as Walsh and Scheiner say. In real life you eat once in 8 hours.
OK, your basal doesn't have to help your bolus, but if you stay without eating so long your liver has to release more sugar than usual to give you enough energy to move and do your things so what actually are you testing ?
A prolunged fasting changes your body behaviour.

You made me think about it ..... that's only my opinion

Comment by garidan on September 30, 2011 at 11:20pm

To say this in other words: basal test should let you have a basal right to:
- do right CHO counting
- delay lunch safely

Comment by MossDog on October 1, 2011 at 12:15am

Wow Kelly I could be looking at my same exact pattern! My basal rate from 7-12 is .9 and I have to dial it down to .65 at that point to not end up at 40 like that. This had never before been my pattern and one day I started having lows in the afternoon. I really have no explanation for it after looking at all the usual suspects for increased insulin sensitivity. Like you said I would try again to confirm.

Gardian- I do my basal testing usually in 12-16 hour stretches. I have tried them in 8 hour and 24 hour stretches as well. I am sure it is different for everyone but for me my liver and muscles seem to hold on to enough glycogen I never see a depletion enough that it would effect the testing. I once lost my appetite which was not due to illness and did not eat for a good 48 hours. Everything else was normal (work etc..). and about 30 hours is when it got a bit more dicey for me. Technically basal is by definition when you do not eat so I am not quite sure what you mean by all it should accomplish is letting you delay lunch. What if I don't want lunch at all? What if my dog gets hit by a car and I have to rush him to the vet where I sit and wait for 3 hours? Kelly also mentioned that she has gastroparesis which makes perfect sense why she would want to do it in longer than 8 hour stretches. It could potentially take her longer than 8 hours to fully digest a meal making it a gastroparesis test instead of a basal test.

Comment by garidan on October 1, 2011 at 1:02am

About gastroparesis you are right, I agree.
But I don't believe in "by definition" things.
By definition, basal done using levemir or lantus is not a true basal: Kelly can't do what you do with your pump, can't change basal rates by hour.
And even if basal as done by a pump is more like natural basal, it can't be the same because an healthy pancreas in an healthy person changes it's insulin erogation according to your needs, if you sleep or work or exercise, so "by definition" in nature there's no basal actually.
We talk about basal and bolus because we need to overcome our pancreas failure, so everything as to be done to reach our quality of life, not to be compliant to theories by themself.
I just say this because I talk often with endos which forget about the actual aim of the terapy and think only about what you should do according to the average diabetics , who doesn't exist, and abstractions which are useful to understand this world, but are not fixed rules.
Kelly, you could try to lower half unit of levemir in the morning and look if the levemir you do before sleeping at nught is right or could be increased half unit, so the following morning you have the same dose, until lunch when night-levemir is over.

Comment by MossDog on October 1, 2011 at 2:17pm

But that is just the point gardian- You want to make sure that in the abscence of exercise, stress, food etc. you have your base needs set. Once you know this if something out of the ordinary happens you can adjust for that with the starting point of knowing if this event were not happening you would be stable. It allows you to be proactive in other words which is what we all are trying to do.

I think an example migh illustarate the point better. We will start by assuming I have tested my basal and know they are right. Unexpectedly I have a friend come over and ask me to go out on a walk. I know that typically when I go out walking that I need to either eat some carbs or turn down the basal. But if I did not know for sure my basal kept me stable how would I determine what to do to anticipate the change in my blood glucose due to the exercise?

I agree 100% about Doc's in general choosing therapy based on the average diabetic. I can't see how this relates here as Kelly is testing HER basal so it is quite specific and not targeted towards averages.

Kelly- If you confirm the above pattern is actually happening I would love to bounce ideas back and forth on WHY as I can't seem to figure it out in my case.

Comment by Kelly WPA on October 1, 2011 at 4:31pm

Garidan, in my case, I need to do more than just delay lunch safely. I need to be able to skip meals for a full day so I am really testing what I need to test. I have a test coming up that I won’t be able to eat for. I live several hours away from where I am having it done so it won’t be scheduled until around lunch time or later. I have also had several surgeries scheduled for 1 PM and didn’t even leave the hospital till around 4.

I am confused why you don’t think Levemir or Lantus is considered basal? In the book Using Insulin, John Walsh does refer to it as basal. I agree that I can’t change the rates hourly like a pump, but I do take my Levemir in smaller doses three times a day so I am not as fixed in as someone taking a once a day Lantus shot. I also think that if more people on MDI did basal testing, they might get it to work better.

Like MossDog, I agree with you that most doctors go by the average person. I knew a long ago that doesn’t work for me. Doctors had no clue how to help with gastroparesis and they pretty much left me sitting in the corner by myself. The things I have learned I have learned here. No ever doctor suggested I do basal testing to figure out if that was even close. I doubt any doctor would ever suggest doing Levemir three times a day either – I know a couple other people that do that successfully.

I am probably going to end up lowering my morning dose by a ½ unit like you suggested. I don’t think I need to increase at night though. I have tested recently in the middle of the night to make sure I don’t have a problem in the middle of the night, but normally I wake up in the 90s.

Comment by Kelly WPA on October 1, 2011 at 4:38pm

MossDog, that is interesting that you are having the same problem! Normally I take the least amount of insulin in the evenings but it looks like the times are shifting. I need to get far enough in the basal testing to test the evenings because I am not sure if the afternoon lows are causing the evening problems or that is truly a problem. I will keep you posted with new test results.

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