I’m exhausted. Basal testing is exhausting. If you read my article from Wednesday on Basal Testing, you know that I have been basal testing for two months. I had planned for this week to be my basal testing postmortem but to be honest, I’m still not done.
I have had diabetes for 19+ years and I have never really had good basal rates. I have had good enough rates, where my A1C has never really been too out of control. Although, my basal rates have always been too high. I remember when I graduated college I went to see a nutritionist that specialized in T1D and she was shocked because my basal rates were 90% of my daily insulin. Basal insulin is supposed to be 40-50% of your daily insulin (except for teenagers whose rates can be slightly higher due to “grazing”). I remember when I met my husband, who is into nutrition and fitness, he was shocked at what I ate. I would eat doritos, high carb desserts, McDonald’s, basically anything and I wouldn’t worry too much about how it affected my blood sugar. In fact, I often barely even bolused for my high carb meals. I didn’t even think it was a big deal and I had no idea why he was so shocked by my eating habits because I needed to eat that way to avoid getting low (something I am still afraid of to date).
Anyway, my nutritionist out of college adjusted my basal rates. My endocrinologist only saw that my A1C wasn’t under 7 and instead of researching why, she just upped my basal rates. I began having to actually account for my carbs and my eating habits started to adjust (which my 29 year old self appreciates now that my metabolism isn’t what it was at 21). I still never did an actual basal test. Sure, I would test one or two times to appease the doctor but never with any consistency nor with any good results. My endocrinologist would look at my blood sugar numbers and make slight tweaks here and there but never made any big adjustments, which I really needed.
Which brings me to this past March. I finally decided I need to get my act together. I was sick of going to the endocrinologist and having her (for some reason all my endocrinologists have been female) yell at me. I have gotten yelled at a lot because I don’t use my bolus wizard. I haven’t used my bolus wizard for two reasons. One, I ALWAYS get low when I use it and two, I HATE being low. Sure, my A1C would be better if I used it, but I always thought about how if I used it, I would end up gaining weight because I would always be treating a low. Sure, I know how to use the bolus wizard. And yes, I think the bolus amounts are correct, although that is something else I need to test. But, I knew that deep down, I never had the correct basal rate so if I were to use the bolus wizard I would end up too low.
Basal testing the past two months has proven that I’m not crazy. My basal rate before testing was 0.8 for all 24 hours. I did 19 fastings over the past two months-NINETEEN! After my many fastings and testings, I am down to 0.4 for the majority of the 24 hours. That’s half the amount of insulin for all you non-mathematicians. When I first started testing, I dropped over 100 points with every single test. Often, I would drop up to 150. I would always have to start my test at least at 250 otherwise I would drop too low.
I started with overnight fasting, which is what most sources recommended. I did that test four times and for some reason I didn’t get good results. Overnight testing is the worst. I got up every 2 hours from 10PM to 8AM and had nothing to show for it. I got discouraged and decided to move on to a different test. I started testing my daytime rate.
For the daytime rate test, I ate breakfast but did not eat again until dinner. This was a hard test for me because I am used to snacking a little bit throughout the day. I started with my 0.8 and dropped from 219 to 82 over 6 hours. You are not supposed to drop more then 30 points. So, I adjusted my rate to 0.7. At 0.7, I dropped from 184 to 119, still too much. At 0.6, I went from 228 to 113 over 8 hours. Again, too much. I finally decided to skip over 0.5 and went to 0.4. At 0.4, I only dropped from 176 to 133-or 43 points. This was still too high of a drop but I can’t imagine going any lower. It took me 5 tests to get to the 0.4.
After the daytime was “complete”, I went on to evening testing. Again, I started at 0.8 and after learning from my daytime test, it only took me four times to get down to 0.4 . Finally, I was back to overnight testing, which meant more exhaustion. This one was harder for me to figure out because of the lovely dawn phenomenon. I was at 0.8 and like before that was too high. After tweaking things a bit, I only lowered it to 0.7 for the majority of the overnight hours but I do start at 0.4, move to 0.5 at midnight and take over at 0.7 at 2AM. These rates seemed to work out.
I mentioned above that I was hoping this week would be my week to reflect on my basal testing with the hope that my blood sugars would instantly be amazing after all of that hard work. Unfortunately, I am still not confident in my rates, so I am still going to spend at least 6 more days testing. I want to do 2 more daytime, evening and overnight tests to make sure it’s all good. One reason for this over analysis is the fact that my blood sugar was high all day today. No matter what I did, my blood sugar stayed in the 200s. I kept correcting for my high and hardly ate any carbohydrates and yet my blood sugar wouldn’t go down. This might not be because of my basal rates and might have more to do with a bad infusion set that I changed last night or a slight cough that could mean I have a cold coming on, but I want to be confident in my rates so I will continue to make sure they are perfect.
Like I said, it’s been quite exhausting. 19 days of fasting, losing sleep and stressing about the right rate; I am pooped. I have never really done this before so I hope that I am getting to the point where I have good rates and all it will take are a few basal tests every so often into the future to be confident enough in my rates to use my bolus wizard so I won’t get yelled at again. I also hope this will help me to get my A1C below seven. I am still amazed that I had to reduce my insulin to half of what I was using but hopefully this will allow me to not worry as much about getting too low.
****Opps…so I wrote this Friday night, meant to review it and post it on Saturday, but I got busy. Then, I meant to post this yesterday, on Mother’s Day, but the day got away from me and next thing I knew it was time for lunch and pedicures with my mom and sister which turned into a cookout at my mom’s later and then Revenge and Once Upon a Time season finales. So, I’m interrupting Diabetes Blog week to finish my basal testing week article :-).