Monday, August 22, 2011

Overnight Basal Testing Joy

We started using Apidra in Grace's OmniPod last week. I know some changes needed to happen, we were 'striking the spike' mightily, not getting high after eating, but we were also having some lows from overcorrecting the highs. But, as with all things, diabetic and otherwise, first things first. So, before I start adjusting things willy-nilly, I needed to get some basal testing in.

Overnight basal test last night. Trying to figure out what happens and why BGs shoot up around midnight - 2 am with this new Apidra. Something needs to be adjusted in her basals. So, I thought I would show you what I do to figure it all out.

She ate dinner and had her last bolus about 5 pm. That gave the go ahead for the overnight basal test to begin about 8 pm, and then be checked every 2 hours. I abide by Gary's rules for basal testing - stay within the 80-250 range and once she either dips low, below 80, or goes above 250, stop the test and treat. He has some great information about basal testing here and here. (Lots of info on it in his book Think Like A Pancreas too, which is coming out in a 2nd revised and updated edition in December 2011!)

Here's how it all went down last night:

8 pm - 106
10 pm - 95
12 am - 144
2 am - 213
9 am - woke up - 141

Got my information! She rose the greatest from 12 am - 2 am, but also had a rise from 10 pm - 12 am.
I write it all down and start my math to make sense of it.

8 pm to 10 pm = decrease of -11 (slight decrease, but I am looking for a 30 point jump up or down)
Keep the rate at this time the same

10 pm to 12 am = rise of +49 points (over the 30 point rise that is the parameter)
Raise her basal rate from 9 pm to 11 pm by .5

12 am to 2 am = rise of +69 points (whoa! way over the 30 point rise parameter)
Raise her basal rate from 11 pm to 1 am by .5 to begin with, then 1.0 if needed

So, then I go back to what her basal rates were when we conducted this test:

12 am - 2 am  .50
2 am - 8 am    .40
8 am - 10 pm  .55
10 pm - 12 am  .60

And I adjust accordingly:

12 am - 2 am  increase to .55
2 am - 8 am   keep at .40 (while the rising BG of 141 is above my liking, school will be starting next wk)
8 am - 11 pm  keep at .55, but lengthen the time to 11 pm instead of 10 pm
11 pm - 12 am  increase to .65

This is what it looks like in my log book. Hey, no judgements.

So, the real test is to try and test drive these new overnight basals. Then I will switch to a morning basal test, then a late afternoon/dinner one. Once I get these done, I will then look at I:C ratios once more and correction factors.

Just thought I would fill you in on how I do it. As always, I'm not a doctor, I don't play one on TV, I do know some doctors, but you should always consult yours or your kiddo's before you change anything. 


Joanne said...

That is so interesting... I am impressed at you kick butt adjusting skills! When Elise gets n a pump, I think I should fly you in to help me!

Unknown said...


This how we do it too.

Keep up the great work, Mama. YOU'RE AWESOME :)

Stephanie said...

LOVE this. Thank you for sharing!!

Anna said...

Thanks for sharing this! I was diagnosed at 17, and have done all of the basal testing myself over the years. I often wonder what it would have been like if I were diagnosed at a younger age, and my parents had to step in more - I think you're doing a great job -- thanks for sharing your insights!!

Karen said...

This post could not come at a better time - I've been noticing some weirdness going on with my blood sugars overnight. And since my husband has a business dinner tonight, I'm going to eat my dinner early and run my first ever basal test overnight! Thanks for the links - I have John Walsh's "Pumping Insulin" but I don't have Gary's book. (Will definitely be ordering the updated edition though!!) I'm going to read over the info in those links so I'm extra prepared for tonight. :)

Colleen said...

Wow - you're amazing!
Keep us posted so we can keep learning.

Unknown said...

LOVE IT!!! I cannot wait to see how you like the Apidra Penny...and you will get those basals whipped into shape in no time girl. I feel a strong sense of SAME-SAME here. xo

sheila thomas said...

Thanks for sharing, we are going to be doing overnight basal testing this week, because of morning highs - so this helps!

Amy Lederer said...

I love this and going to model and compare when we do this in the next week or so after things "settle in" a bit with school. . . as if they ever do . . . changes are in the works. GREAT INFORMATION. It's so cool to see how everyone does it and I'm constantly learning!! Thank you!

Tracy1918 said...

Thank you for sharing this. It was interesting to see what you do. When Matthew is high from say, 10- midnight, I ideally just up that segment. But you go back on hour and start there. Interesting. I need to pull out my books. Again!! Thanks Penny! Hope the changes are working. I'm still catching up on blogging!! : )