Stumble It!
Basal Testing: A New Kind of Torture
Just when I thought I’d experienced every indignity and inconvenience this disease could dish up, along comes basal testing.
I’ve had the Big D for almost seven years now, and I’ve always been told never to skip meals (a good thing too, because I need my meals!). At the same time, I know you’re supposed to test your basal rates periodically to make sure your background insulin is doing what it’s supposed to. Admittedly, I haven’t ever done that pesky basal testing stuff… until now.
A few weeks ago, I was privileged to start working with well-known certified diabetes educator Gary Scheiner, who is one of our Design Challenge judges this year. Gary offered me his CDE services on a trial basis, as his company is developing some new techniques and wanted a Guinea pig to test them out.
Lucky piggie that I am, my first challenge working with Gary was to start basal testing, “since you can’t start fiddling with bolus adjustments until you’re sure that basals are set right,” as Gary says. Gotcha.
First off was the through-the-night testing segment. I was to eat dinner and dose by 7pm, and then test at 11pm, 2am, 5am and 7am — which wouldn’t have seemed so daunting if my husband didn’t abhor my alarm clock so. It’s a Japanese LCD model I bought off Overstock.com, and the alarm tone is, well… obnoxious. But I like it because of the big, clear, backlit screen and easy-off buttons. You should’ve heard the groans that first night! (not from me)
And too bad for me again because I blew it in Round 1: I was running high all night, and kept administering correction doses, not realizing that that automatically ends the basal test right there. Engaging in Round 2 the very next night took me back to the Infant Days: bleary eyes from being rudely awakened every few hours all night long — ugh! Luckily it went much better, at least on the diabetes side (I was forced to renounce my Japanese alarm clock).
Next, I was supposed to start skipping meals, one by one, for further evaluation of basal rates. Skipping breakfast. Now does that sound simple to you?
It’s sort of equivalent to, I don’t know, say… the end of the world, for me. When Gary asked me not to eat until 1pm, I just about had a conniption fit. I emailed to explain: I’m one of those people who MUST eat right away when I get up in the am … When I have to do fasting lab tests, my hubby practically has to carry me into the building. Not good.
“Be brave,” Gary replied.
Wha? Next email:
Gary, I don’t think you fully understand. This has nothing to do with being ‘brave.’ I talked it over with my husband, and he’s not keen on me doing it — but if so, then we need to plan carefully for a day when he can fully take over feeding the family in the morning and I don’t need to go anywhere. It may take a little time before the ’stars align’ for this.
Guess what? We moved on, to the skipping-dinner-segment.
That went pretty well, since I distracted myself by planning it on a night when hubby and I were invited to a cocktail party. I drank Diet Coke only, and steered far, far away from the food tables. I tested dutifully at 5pm, 7pm, 9pm, and 10pm. After that I was allowed to eat. Tuna salad never tasted so good.
My BG levels dropped off a little too sharply at the end, so we reduced my basal from 9-10pm. That’s some serious fine-tuning there, Gary.
Next up, skipping lunch. I am not looking forward to this one, either, in which I’m not to eat or drink anything with calories between 8am and 4pm — with testing at noon, 2pm, and 4pm. I’m hoping for a day with a really good distraction. Any suggestions, my D-Friends?
Whine, whine, whine, I know. I am well aware that most people living with chronic illnesses have bigger problems than being asked to skip a meal now and then. I just find it unusually unpleasant. And it’
s the additive effect that gets to me: the constant testing and dosing and correcting, carrying all the backups, the midnight lows with the sweating and the unwanted eating, and the bouncing back up way too high — not to mention the fact that other people can eat and do as they like without all this crap (just ask Kris Freeman). Grrrrr.
Do not. Like. Basal testing.
Hate. Diabetes.
OK, I’m done for today.
Negativity. Negativity. Negativity. I am truly wanting to find a place that gives us the truth but does not cover it in doom and gloom. I REFUSE to let my diabetic child grow up hating.
Posted by: ryans mom | March 12th, 2010 at 6:55 amI still haven’t done all my basal testing, and been on the pump for almost 2 years now. I keep lying to my endo saying that I’ll do it before the next time I see her.
Posted by: kokernutz | March 12th, 2010 at 7:04 amBeen there, Done that, how the heck did you avoid it for THIS long?! you lucky muffin. I was always told I could eat non-carb things though. which is still food, and food tames the hulk that we become when we totally SKIP meals – which is also frowned upon as diabetic or not.
Posted by: Chris | March 12th, 2010 at 7:06 amWhy skip meals? I was always told to have a zero carb meal instead of skipping it altogether. A salad, ham & eggs, or somesuch works fine.
By the way… the CAPTCHA for this comment was ‘the jabbed’. How wonderfully apt!
George.
Posted by: George Bridgeman | March 12th, 2010 at 7:21 amAmy-
Posted by: k2 | March 12th, 2010 at 7:33 amI feel your basal testing pain and will be in the same exact boat as you VERY soon!
Hang in there, be strong – Gary knows what he’s doing, your in great hands!
Kelly K
I was a client of Gary’s for 2 years in college, and my A1C was the best it had ever been when I was working him. However, my parents were paying for him and now that I’m on my own, he’s a tiny bit out of my price range. I’m thinking about saving up to do another round though. It really is worth it!
Posted by: Allison Blass | March 12th, 2010 at 7:38 amI know a CGM isn’t always a viable option for some, but… what if you get set up on one of those for a few days, and stick to a zero carb diet from 6am to noon the first day, noon to 6pm the second, and 6pm to 12am the third day? That way, you don’t have to get up in the middle of the night, and the food annoyances are kept to a minimum.
My endo has has me do three days on a CGM once a year to evaluate my basal and bolus rates overall, but we’ve never done it just for the basal alone. I might have to try this next time. Certainly couldn’t hurt.
Posted by: Elijah M | March 12th, 2010 at 7:52 amThank GOODNESS my boys didn’t have to fast for basal testing! They. Would. Die. Luckily they get a non carb diet. As I was reading your post though, it occured to me I have never done evening basal testing on them. Weird. I can’t even think why that is so???
Posted by: Meri | March 12th, 2010 at 7:55 amYou know, growing up Jewish and type 1 I always wanted to fast for the high holy holidays but wasn’t allowed because it would be detrimental to my health. When I went on the pump, I was told to fast for 24 hours as a true way to test my basals. I did, and it worked beautifully. That was nearly 8 years ago, your post reminds me that it’s long past time to do that again….
Posted by: Kelsse (Kelsey) | March 12th, 2010 at 8:25 amAmy, how funny… I just did mine too…
http://katieshealthjourney.blogspot.com/2010/03/told-you-so-i-know-my-body.html
I opted for the 24-hour fast… 3 days of 8 hours a day was just too tough for me. And my CDE told me that you can’t eat low-carb stuff like others have mentioned – b/c when you are not eating ANY carbs, the non-carb foods turn into carbs (more than usual) and throw off your results. (Besides, the basic salad has 15-20 carbs…) But, as we all know, everybody is different and require different things. Glad you got the tests done, and know which of your rates were right or off. =)
Posted by: Katie from SF, CA | March 12th, 2010 at 8:42 amI do it annually, when my workout/diet routine changes, and when my control seems out of whack. (That’s usually twice per year). I don’t fast – I just avoid carbs in my meals. I do it in three 8 hour stretches over 4-5 days. Frankly, 6 carb-free meals and 2 sleepless nights per year doesn’t seem like such a bad trade-off for good control…
Posted by: Greg | March 12th, 2010 at 10:20 amGreat post Amy. I’m thrilled to hear you’re working with Gary – he’s a great guy.
Basal testing is a royal PITA isn’t it?
I love that graph in this post – so true!
Posted by: Scott K. Johnson | March 12th, 2010 at 11:12 amSounds like a lot of dramatic complaining to me.
Posted by: Andy | March 12th, 2010 at 12:17 pmThanks for the post. I’m trying to convince my son to use Gary’s services – and the honesty is important too. Good luck Amy. Kudos to you for being open to the support and ultimately feeling best.
Posted by: Ellen | March 12th, 2010 at 1:47 pmRyans mom it sounds and looks like (by use of your caps) that you have some anger which is fine.
Emotions are not right or wrong; they just are. I hope you allow your child to express them – hatred towards diabetes at one time or another may be part of it.
Posted by: another mom | March 12th, 2010 at 4:03 pmAmy, my adult son dreads basal testing, but it does give him good information. Thanks for posting that he’s not alone.
To Ryan’s Mom,
Posted by: Lisa | March 12th, 2010 at 5:12 pmAs a mom of a child with diabetes, I completely understand your desire not to want your child to grow up hating. I very strongly believe it is important to give a child w/ type 1 the message that diabetes will not stop them from pursuing any of their hopes and dreams.
However I also believe that it is OK ( actually more than OK.. necessary) to feel angry, annoyed pissed off at diabetes at times. These are normal emotions to have for someone dealing with a whole lot every second of every day. A healthy child w/ type 1 needs to know that these feelings of frustrations are normal and OK to have and should be able to express these emotions. While I am a positive person and am not advocating walking around “hating” all the time I think it is important to acknowledge that any PWD will get fed up at times and they are allowed to feel angry. I know, as a mom I certainly have those moments where I hate diabetes!
Amy’s site is actually one of the few blogs that I follow regularly and I do not find it negative at all! I find it extremely positive, upbeat, honest and informative. Thank you Amy for showing us different perspectives and for your honesty.
Ryans mom. Please don’t refuse to let your child with diabetes grow up feeling however he or she feels. You won’t change the feelings by “refusing” to let them exist.
Posted by: Jerry Nairn | March 12th, 2010 at 5:48 pmLet the feelings be there.
Concerning negativity, this site is the source of a lot of positivity, but it is Diabetes Mine. Diabetes is a DISease. That’s a negative thing.
The other half of the name is Mine. You may not get that. It applies to me, and to your child.
My diabetes is mine. Don’t try to tell me, or someone else who owns it, how to feel about it.
I think I’ll STICK with STICKING myself for now. Do I really have to go through that just to wear a pump that won’t even test me? No. I’ll wait for an integrated CGM/Pump. It will happen.
Posted by: xim1970 | March 13th, 2010 at 11:26 am@xim1970: I said that for 17 years, until my wife and my CDE got together and convinced me to try an OmniPod. My A1C dropped by two points, and it’s stayed there for three years. You can’t possibly appreciate how much easier a pump will make your life until you use one.
Not for nothing: even when they integrate a pump with a CGM, you’re still going to need to do a finger stick a few times a day to calibrate the thing.
Posted by: Elijah M | March 13th, 2010 at 11:33 amDiabetic for 6 years, never even heard of basal testing, maybe I need a new endo. Lack of sleep does increase by blood sugar, are you sure you are getting accurate results?
Posted by: Maggie | March 13th, 2010 at 5:21 pmMaggie, I think that’s so interesting. I was on a pump for 9 years, through 3 doctors, before I ever heard of basal testing. The 3rd doctor had me do it within months after our first meeting, and it seemed like such an obvious idea, I didn’t understand why no one had asked it of me before then. It was such an eye opener, too!
But yeah.. the lack of sleep followed by no breakfast? Not cool!
Posted by: Kara | March 13th, 2010 at 10:30 pmHaha. I’ve had Type I since March 31, 2002 and I still haven’t done a proper basal rate test. Maybe I’ll do it for my eighth “anniversary” as a way to “celebrate.” Man, diabetes is totally fun and awesome!
Posted by: Kendra | March 14th, 2010 at 6:18 pmI feel for you and your husband. I am not diabetic, but my son is. We will be doing overnight through breakfest basal testing to verify that his basal rates are correct. They are close, but probably need a little tweeking. So my wife does n’t kill me, I will sleep in his room and use my cell phone to alarm.
Posted by: Joe White | March 15th, 2010 at 1:25 pmWow, so many doctors who never even mentioned basal testing – I’m shocked!
@kelsey – actually I’m kind of relieved to be “off the hook” for the High Holy Days
@Andy – you’re on to me.
Posted by: AmyT | March 16th, 2010 at 8:53 amI am soooo with you on this. Hate the basal rate tests! I have to do them again now because I had a baby recently, so things were way different while pregnant. And try fasting when you’re nursing! I’ve never been so hungry in all my life!!!
And I agree with the others… most of the time I’m super positive about life and don’t let the ‘betes get me down. But every now and then I must exclaim to my husband, “I Hate Diabetes!” He gets it. I know you all do, too.
Posted by: strawberry | March 17th, 2010 at 10:00 amAmy – You are in good hands with Gary. I’ve been one of his clients for almost 2 years now. He knows what he is talking about. I’m not fond of the basal tests either, especially the overnight one. BTW…..in his book “Think like a Pancreas” Gary writes that you should not have caffeine during basal testing either.
Posted by: Kathy | March 19th, 2010 at 5:40 amMy endo revised the basal testing form because it caused so many conflicts. I used the revised form to do my basal testing. Yeah, the overnight is tough. The evening test is next worst.
Posted by: miss kitty3 | March 19th, 2010 at 12:47 pmI had to keep reminding myself not to correct BG’s in the 200 range and above. Also that I was doing an overnight basal test. Creature of habit!
Now, my endo wants to see what my basal rates are doing – using the revised form & CGM at the same time. I’m glad its only for 3 days.
Also, I sweat like a I don’t know what in weather higher than 72 degrees. I need IV Prep wipes to prep my skin for the CGM & my pump cannula.
Should be simple but w/ me, always a challenge w/ my diabetes.
I hate basal testing too, but it is soooo worth it! My 5.9% A1C, lack of major hypos, and basically cruising through my days with little worry would not be possible without it.
I’m not sure how much planning is needed to not eat. We test regularly and are therefore prepared for falls.
Posted by: John | May 4th, 2010 at 5:11 am