Just those 3 words are enough to send a Type1Momma running for the hills – screaming!
Seriously! Overnight Basal Testing is hard going, exhausting, repetitive, frustrating, controversial and brutal. Yet it is also essential, informative, important – pivotal – NOT OPTIONAL.
A lot of Diabetics do not, nor have they ever done Overnight Basal Testing.
Upon diagnosis the Endocrinologist / Diabetic Nurse will give you an amount of insulin to take as a starting point (based on weight and DOH guidelines) and then they (T1’s) follow it, they adjust sometimes if their numbers are out and they manage because that’s what they were told to do.
But, without Overnight Basal Testing you will never actually know if your basal insulin is right and you’ll never be in full control without knowing!
It is so important I can’t even tell you.. And if you’ve never done it – you should! The control you can achieve from nailing your overnight basal (and then the day follows on) is excellent and considering we spend (if we are lucky) a looooong time in bed (upto 50% of our lives). Children should spent 10-12hrs and an adult anywhere from 8-10hours in a 24hr cycle – it’s a lot of time and it NEEDS to be right – for the sake of your health!
Imagine your blood sugars being funky for 50% of your life – not good for your health long term is it? You wouldn’t accept it during your waking hours, so why would you while you sleep?
There is no excuse for running higher at night nor is there for sending a child to bed high. If you go to sleep each night with a blood sugar of 6mmol, you are almost double the amount HIGHER than you need to be to achieve healthy, normal numbers.
When I sleep, my blood sugar ranges from 3.6mmol-4.5mmol. So, why should Carter sleep at 6mmol, just so he doesn’t hypo? The hospital’s recommend you go to bed higher because they expect him to drop overnight – but this is WRONG!
Your baseline should be exactly that, it should keep your blood sugars (at fasting) flat, at a stable level (give or take 0.2-0.4mmol)..
Diabetics DO NOT need to eat food to keep their blood sugars up / eat food to take insulin to correct a high blood sugar. OK, this does happen sometimes because this is Diabetes and not all rainbows and unicorns BUT your baseline should keep you running flat without food or corrections and if it isn’t, then it needs changing.
Imagine if you’re ill or sick, you need to rely on your baseline to keep you safe whilst you’re unable to eat. If you NEED to eat to prevent hypos and you’re vomiting and can’t keep food down – you’re gonna be in trouble!
So, do some Basal Testing – we do! And that’s another way we can ensure Carter’s blood sugars are well managed, because as he sleeps, his baseline keeps him stable and flat and within a healthy, normal parameter. (It also does this during the day too).
Dr Bernstein recommends Overnight Basal Testing and random daytime fasting testing too and he has full, clear explanations in his book and on his YouTube University Video Tutorials.
I have done this many times for Carter, his needs fluctuate as he is a child. He is a pre-teen and his growth hormones currently come and go – soon he will hit puberty and THEN I am advised, it will be a whole new ball-game BUT there is still NO EXCUSE to jeopardise good blood sugar control – it just takes more insulin and commitment. Work harder for a while – live longer!
A couple of weeks ago Carters control went a bit wonky for a couple of days (growth hormones), I always correct initially with his fast acting insulin, if I was constantly changing his baseline (basal) he’d be in a mess, so I note the changes, watch for patterns and then make adjustments after I notice a few days trends. This is the best way and what Bernstein recommends also.
So, I did that. Tested, Recorded, Reviewed, Planned, Researched, Tested again, Reviewed again, Planned again.. and then I realised: something needed to change.
I had to do an Overnight Basal Test for Carter because although we had super fab control during the day, at around 3pm and 3am he would drop too low and require glucose to recover and he was becoming unpredictable – unpredictable numbers are never good, too many highs and too many lows, you’re heading towards the rollercoaster and that . is . BAD. He wasn’t dropping super low (was between 3.5 and 3.6mmol): too low for me to be comfortable sleeping through – just in case. Now remember; Carter has some Beta Cell Function, he is still honeymooning and we are working bloody hard to preserve what little function his beta cells have – it is healthier and safer and Bernstein also predicts with good control, the honeymoon can be preserved indefinitely – that’s the aim!
So, we Overnight Basal Tested (or rather I did). Whist the world slept; I made my baby bleed every 30mins for 12 hours (heart-breaking and exhausting but essential):
I learnt a lot – he did hypo – although – that night – he corrected himself. Maybe he would do this every night? But I daren’t risk it. I know he can, his alpha cells do work, but they are unpredictable so I can’t rely on them to correct him ALL the time and nor can I stay awake every night to apprehend it and jump in. I need to stop him dropping too low so he doesn’t need to depend on me, or them. AND because he’s still honeymooning, the better control he has – the more the Beta Cells kick out THEREFORE, he can sometimes drop lower, not because of his insulin, but because the pancreas has a party and kicks out insulin on its own accord (thanks but arrgrhhhh!!)!!!!
So, you have to be vigilant and critical when reviewing the data:
· I learnt that yet again, diabetes is a pain in the ass!
· That a 4way Levemir split is pretty close to perfect BUT not sustainable AND with a couple of days of such good control, his requirements will drop anyway so no need for 4 separate shots long-term (for now).
· His numbers were really good and had been ok (ish) during the test.
· The spikes he’s been having seem consistent with food &bolus opposed to baseline dosages, therefore I need to look at the bolus insulin (fast acting food covering insulin) rather than his baseline.
Now, I can’t give him enough fast acting insulin all at once – it’s designed to cover carbs and sugar remember (recommended deadly diet of diabetic death)!!! So, I split it, he takes ½ with his meal and ½ a while after (usually 2-3hours) to cover the protein his body will convert into glucose during digestion (via a process called gluconeogenesis) the body is clever like that – makes its own energy and fuel! We do NOT need to eat carbohydrates or sugar or glucose – we c n make our own and Diabetics cannot metabolize sugar, so WHY do they still keep telling them to eat it? URGH!!!
I was confident Carters baseline wasn’t right for him BUT from the test I learnt that: I got it wrong?!!
BUT, what I did also do is look at the profile of his Levemir (long lasting insulin) based on this activity profile chart:
I married up his lowest readings and the time he administers the insulin and worked out his activity rate (he is textbook for the recommended peaks and troughs). Then I was able to count back and work our when his cross-overs would be, and, how I need to reduce down the rate to prevent his hypo’s but keep him steady enough so as the insulin is tailing off, he won’t go high before the next dose is working effectively. So I looked at the cross overs and found that maybe an 8 hour split would create an even and effective flat-line (on paper):
Worth a try!!!
Also remember: I have to give this a few days to fully change in his system, as it’s a long lasting insulin it will linger for longer and therefore it’s recommended to give it 3 days to see true changes. I did that and we were good.
So, we now split Levemir 3 times daily and taking the smaller amounts every 8hours over a 24hour period and so far, it has been MUCH more effective!
In fact: Carter recently had the best numbers and 24hr profiles on his Dexcom that he has EVER had! They fell lovely in-line with his D’Versary! On the day 12months prior he was dying and diagnosed T1 Diabetic, he had a running baseline better than a normal non-diabetic! WOW!
However, I still have HUGE issues with his fast acting Insulin. It is far too pungent v’s the profile of his food.
Novarapid is designed to cover fast release carbohydrates and complex carbs at that, those with a high GI and far too much sugar for a T1 to ever consume.!!! It is not suitable for Carter BUT the Department of Health refuse to accept that and expect me to feed him carbs to compensate ‘feed the insulin’ in what world is that sane?!
We eat protein, veggies and dairy, slow, low GI, no sugars or complex carbs – the polar opposite to what his insulin is designed for but exactly what a T1 should only ever consume!!!. Actrapid a slower acting insulin, is designed for slower release glucose foods and as such, will effectively cover proteins as they digest (and are made into glucose), yet they won’t prescribe him that. As much as Actrapid is used with great prevalence in the Hospitals, he can’t get that cos it’s not ‘standard protocol’… According to our medical team, as per the DOH: every other Type1 Diabetic in the U.K eats only complex carbs?!! So, my boy is penalised and has to go without – without a drug that is readily available (and used in hospitals because of its reliability and less aggressive nature), because he does his best to manage his health?! I think not!!
It really makes my teeth itch!
I have also been advised to stop getting my hopes up; that if I ask enough and prove my knowledge and experience so that I won’t overuse it or use it incorrectly and hurt him because it won’t change the fact that they will never prescribe it. Because newer insulins are what they use now (newer, to cover fast foods in a changing – obese society with massive prevalence of Diabetic Complications – see a problematic pattern here?!!).. It makes me so frustrated and deflated and all things ated!!!!
I can do things like this to better manage Carters health til I’m worn out, exhausted and gone. I will and I am – for him. But, if no one listens to us and the D.O.H won’t change their protocols and his Drs and Nurses won’t care enough to support us; it won’t ever change a thing… I find that unacceptable!!
It’s almost enough to make you wonder why you bother?! When you’re so completely knackered that you dread the next day or the next meal because you have to try and make the square peg fit the round hole and your fingers are sore and bleeding and the peg – no matter how hard you push, just does not have the capacity to comply. It’s enough to throw the damn peg in the bin and just not bother anymore. BUT, then you remember, you are keeping your child healthy, alive and safe, free from the painful, deadly complications badly controlled diabetes causes. You see someone who’s child eats chips and sweets and a ‘normal kid first diabetes 2nd – don’t treat them like they’re different’ you see their photo of the Dexcom they share and you realise WOW – I am doing the right thing – that rollercoaster – MAN!!!
And THAT is enough to keep you awake for always!
Because they are worth it!
And hopefully one day, someone will realise – and help us!
Carter’s baseline has been brilliant for the last 3 weeks. He does have fluctuations – more so at school with activity and emotions (sending him higher) and his school are slack in checking him (they just don’t do it) so some days when he gets home the first thing he does is have to take corrective insulin to bring him back into range. I can’t cover that with his baseline because it’s not every day this happens. BUT today I noticed that it has happened EVERYDAY this week, so maybe tomorrow, if it happens again, I will give him more insulin and see how he is the following day?
Diabetes is a constantly moving target – seriously, the baseline although a set dose, changes so frequently, with sickness, the weather, activity, emotions – soooo many things. And therefore the only way to know it’s right and it’s working properly for you is to fast and test regularly and to do Overnight Basal Testing, Daytime Testing and go from there. Test, Chart, Review, Change, Dose, Retest – Repeat.
Set the time, get the test strips, the pen and paper and go for it.. You can do it and you will be so glad you did.
When you start seeing numbers like these (it’s much easier than you think):
You’ll never look back!
Be Happy 🙂