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Basal Insulin Testing – Why, How & When?
Do you have frequent low blood sugars? Or high? And they all seem to come out of nowhere?
It could be something wrong with your basal insulin, dose or timing! Learn all about basal insulin testing in today’s Type 1 Thursday!
When was the last time you checked you basal insulin settings?
Transcription
If you prefer to read all about basal insulin testing, you can do so below. Enjoy!
Basal Insulin Testing
‘I want to ask you this first, do you perhaps experience frequent hypos or frequent highs that seem to come out of nowhere? They are not really connected to when you’re eating and your bolus insulin, and it’s not really connected to anything else either. So maybe it is something else, could it be? (As we all know, with diabetes, chances are it could be…)
Butt first, hypos, or low blood sugars, never, ever happen because you’re not eating enough food! Hypos always, always, always happen because you’re taking too much insulin for that particular circumstance. That actually leads us back to today’s topic, basal insulin settings and how to check that your basal insulin settings, like your long acting insulin, or basal settings on your pump, are correct for you. Not for anyone else, never ever compare insulin dosages with anyone else. It is what it is for you and if it is correct.
Basal insulin is really key, either is dose or the timing. If you are on MDI, timing of the basal insulin could be a problem. So let’s figure out what it is, how we do it and all this stuff when it comes to basal insulin testing. It’s not necessarily fun, but hey, you know, it needs to be done if you want as good of a control as you can have on your Type 1 Diabetes. Having your basal set properly also helps you bolus correctly for your food or it makes it a lot easier to calculate.
What is a basal insulin test?
The point of basal insulin is to keep your blood sugar stable when you’re not eating, when you’re exercising when you’re not doing anything. It works the same in healthy people, the ones that don’t need to add insulin from the outside. Basal insulin is there to keep your blood sugar very stable during the whole day when you’re not eating, not exercising, not doing anything of the few things that actually help lowering your blood sugar, or any of the 42 or 45, or whatever things that can increase your blood sugar.
What is a basal test? Well, it’s basically to determine what your proper basal setting is, whether you are on a pump or taking long acting insulin. Without the influence of food and without bolus insulin, without exercise.
How to basal insulin test?
How do you do it? Well, trick number 1 is to start at a normal blood sugar level. Don’t start if you’re too high, don’t start if you’re too low, start at a normal that is the baseline of basal insulin testing.
You can either do it in two ways. Either you fast the full 24 hours and get it all out of your system and you have done in one go or you divide it up on 4 days and divide the 24 hours into 6 hour increments, where you fast for 6 hours and then check your blood sugar’s hourly to see what happens to them.
This is also where a CGM is very helpful, although I would not trust it to be exact for all of that, I would also prick my finger a couple of times in those 6 hours or those 24 hours, just so you can actually see what is doing what. If you choose to do it in four days, then you do overnight in one go and then you do a morning session, followed by a day session and then an evening session, so that you get those 24 hours all checked.A suggestion is that you basal insulin test one week and then the next week you do the same, to just double check and fine tune and really tweak your basal insulin (because this is really key for good blood sugar management)
Do & Don’t when Basal Insulin Testing
Don’t eat or take insulin (bolus) 4 hours before you start the test.
You can have water and herbal tea during your fasting hours, anything that’s not caffeinated and nothing that will do a number on your blood sugar. Anything that is neutral is fine.
Don’t eat unless you go too low, if you’re having a hypo. Also, don’t correct unless you go too high. (If you go too low during your your basal insulin testing, it means that you’re taking you’re taking too much basal insulin, whether it isn’t a pump or injections. If you go too high, your basal insulin is sett too low.)
Make sure you’re not sick or on your period or have something going on that you know influences your blood sugars.
It is completely okay to break the test if you have to! If you have a hypo, you have to correct it. It’s fine to break the basal insulin test, you just do it another day instead. And the same if you go too high, it’s fine to break the test, you have a bolus and get on with your day. The main point is that you take care of yourself! The basal insulin test can be done another day instead.
Also, one, one very important tip, is to write down the results, so you have them on paper. It makes it a lot more easy to overview instead of having it in some app and you have go back and forth between resources. Good old pen and paper works the best in this case, I would say.
What are the results of basal insulin testing?
If your blood sugar drops too much, you’re taking too much insulin. You’re taking too much basal for your needs. If your blood sugar goes up too high during the basal insulin test, you’re taking too little basal insulin, and you need to increase it.
If you are an MDI and notice something could be better during these 24 hours, perhaps you need to split to your dose? This is something you can discuss with your doctor. And if you’re on a pump, remember that it’s usually the basal setting that is about an hour to 2 hours before that impacts your blood sugar’s right now, so you have to be a little bit flexible in adjusting this, if you need to.
That was my very short run through on how to basal test your insulin properly.
I want to know from you, when was the last time you basal tested your settings or your dose or timing for that matter?
Let me know in a comment below. I’ll be so happy to chat with you there.
Ps. Want to learn more about basal insulin testing? Check out Dr. Richard Bernstein’s video here!
High or low blood sugars?
How often do I have high/low blood sugars that need treatment? 🤔 A question from the audience!
Learn how I attempt to avoid the high and low blood glucose readings (that are, more or less, a part of life as a Type 1 Diabetic).
What about you? How often do you have highs or lows that require treatment? Let me know in a comment!
Transcription
If you prefer to read the information in the video above, please find a written version right here:
High or Low Blood Sugars?
This week, I have another question from the audience. And it’s a personal one-ish. Well, I don’t want to get your hopes up, it’s not that bad. Actually a normal question, but it is more personal natured one. So I’m looking forward to answering it. Because this person writes:
How often do you have a real low or high blood sugar that you need to correct? Is it rare, or is it part of everyday life?
I thought this question was very, very interesting. And I guess I’m not that open, perhaps, with my blood sugar levels online, because I frankly don’t think it’s very interesting to share them. If you want me to, I could share more of my day to day values. (If you do, please leave me a comment so that I know because I cannot read your thoughts out there! 😃)
High and low blood sugars are of course part of living with Type 1 Diabetes and no one can deny that. The frequency of them, however, can greatly and amazingly be influenced by different lifestyle factors, for example. For me, for example, a low carb lifestyle has really helped to eliminate most highs and lows. I no longer get those extreme highs followed by extreme lows, because I simply follow the law of small numbers so I don’t have that much insulin in my body. And also not that much insulin required, that I get those quick drops. Furthermore, I don’t eat that much sugar and carbs so that I get the high highs. You can do a lot with lifestyle factors!
It’s also a question of definition. For me is low is below 3.2-3.5 mmol/l, which is about 65 mg/dl, and my highs are already around 6.5 mmol/l or 117 mg/dl. It’s really a question of definition. Do you mean those super-highs of 400 mg/dl and then down to 20 (22 mmol/l to 1.3)? Or, do you mean this sort of gradual, just on the verge kind of sugar surfing highs and lows? It differs from person to person.
Basal Testing
The number 1 thing that I would advise people in this situation is to check your basal settings. Whether you have your long acting insulin or an insulin pump with a basal setting, make sure that those dosages are correct. That can save you a lot of trouble! This is something that I do on myself, as well, I make sure that my basal settings are correct (or as correct as they can be because life happens and things go up the wall sometimes) If you want me to do a video about how to basal test properly, then also let me know in a comment!
If your basal dose is correctly set, you also need less corrections to get the results you need. If you’re too low or borderline too low, for example, and your basal isn’t too high so your blood sugar won’t keep going down much further. With the right settings for you, you only need very little carbs to get you back up into a healthy safe range. Same with highs, if you are borderline high, you don’t need that much insulin to get yourself into a nice, safe healthy range again, because your basal insulin is correctly set.
My Trick
I correct before there is a high or a low. Of course when I can, things like sleep, illness, travel, stress and things like this too much work (guilty as charged!) can of course make this a little bit trickier and hinder me from keeping that level of control. But whenever I can, I do react before it the low blood sugar or the high one is a fact.
Managing this before they’re a fact, I cannot say enough that a CGM, a continuous glucose monitoring system, really is worth its weight (well, really is worth its value) in gold, because they’re quite expensive. They’re small, but expensive things. Anyway, they are worth absolute gold so that you can react before there’s a high or there’s a low blood sugar.
CGM’s are of course not exact. I don’t know of any CGM system that is absolutely exact. Especially when my goal range is so small, it is very, very annoying that it is more most often 1-3 mmol/l (18-60 mg/dl) off. It’s not really exact, but it is invaluable to see the trends! Where is your blood sugar trending? If your blood sugar is steady and starts to trend downwards, then you can already treat so that you need a lot less and the the hypo doesn’t become a fact. Or, if you see that you’re trending upwards, you can play with either temporary basal if you are in a pump, or wait it out and see what happens ,or correct with insulin. For the trends, and the CGM is fantastic and I could not recommend any more!
Timing
Reacting in time actually also helps the Standard Deviation of your blood sugar, as well as your Time In Range, which is what reacting in time will help. This will also help your HbA1c. That little trifecta is a fantastic measurement of health for diabetes. And that also is helped by reacting in time so that you don’t go high and don’t go low, but you can react before it is a thing.
Doing it this way, reacting before a high becomes a high or low becomes a low, makes them very rare. It actually makes them more rare than then it would be, if I, for example, added a ton of sugar, or the recommended amount of carbs for example. This is true for me, and I’m not going to talk about anyone else. But for me if I added that, I would have many more highs and I would have many more lows, because I would have to fight the carbs as well as my body with the stress, work, illnesses, and all of the other 45 things that always influence our blood sugar.
This is my Dexcom G6 24 hour curve from 20th February, and I’ve marked where I used my method and reacted before a high was a high and a low was a low:
I want to hear from you:
Do you have highs and lows often and that you need to react to? Or are they rather rare for you? Let me know in a comment. I’d be happy to chat with you there.
Ps! Join me live next time, Thursday’s at 6pm CET on my Facebook or Instagram for another episode of Type 1 Thursday!
Influenza & Type 1 Diabetes?
The influenza & eating very low carb, what happens to blood sugar and ketones? 🤔
That blood sugars can increase when you’re sick is pretty much common knowledge. But by how much, and especially when you normally eat very low carb? What about ketones? Is there a correlation?
All this, and much more, in this week’s episode of Type 1 Thursday!
How do your blood sugars react when you get sick? Let me know!
Transcription
If you prefer a written version of this information, please keep reading:
Influenza & Type 1 Diabetes
Last week, I was very much under the weather, and I did not manage to do anything. Last week, I spent the whole week in bed, because I got a nasty case of the influenza. This never happens to me *touch wood*, I never get sick like that. So it was a first in a good while. I also got a question about this, which is today’s topic on Type 1 Thursday:
As a Type 1 diabetic, eating very low carb, what happens to blood sugars and ketones when I got that sick?
Gina
No. It didn’t go perfectly, let’s just be honest about that. I definitely did not have any smooth CGM lines during last week when I was really, really ill. And it’s not an easy feat to try to get, especially as a Type 1 diabetic, but definitely also as a healthy, “normal” person, whatever you want to call it. What did I do, how did I handle it, and what happened to me? Maybe it can help you, if the influenza gets you, too!
I heard today that just in Switzerland, we have about three virus strains going around right now. That’s a lot! I think I just had one of the influenza strains. Last Tuesday, I was so ill that I thought I had pneumonia. I was 99% sure that I had pneumonia. I went to the doctors to get an X ray, especially to check that it wasn’t pneumonia. Well, it wasn’t. But I really felt that badly. I really am not one of these people who just runs to the doctor for whatever, there has to be a legitimate cause for me to even visit a doctor’s office. That’s how bad I was last week. And I’m amazed at my body for turning something that I thought was pneumonia just a week in a bit ago to standing here. You know, I was fine already last weekend, again, and that is astonishing to me that my body managed to get turned around That will and I would like to thank my wonderful gut bacteria. And I would like to think that I did a few things right, which I will get into a little bit later in this life.
Influenza & Blood Sugar?
But first of all, I wanted to go through what happens to your blood sugar when you get ill, because it will go up. Evidently, your blood sugar will go up, especially if you’re a Type 1 diabetic, because you are, of course a little bit more (I don’t like to say it, but), a little bit more sensitive towards infections that way. Blood sugar goes up, for sure. And what can you do against that? Well, you can actually just manage as well as you can. Increase your basal as much as you dare to until you see an effect. With that in mind, I was on + 200% basal on my insulin pump, and it barely budged from 10-11 mmol/l, around the 200’s mg/dl. That was of course scary for me, as I normally have quite good blood sugars. It was good to to know that it was the infection causing it and nothing that I ate, because I also fasted due to that I had such a sore throat and I was coughing so much that I couldn’t eat anything for four days. I only had broth, tea, soups and water for four days. And I think that also helped to turn the influenza around a little bit quicker.
In addition to this, your bolus is not going to be the same as when you’re not sick. Your corrections and mealtime insulin is not going to be as effective, that ratio will also go up, get worse, and you will need more insulin. I used almost 50 units of insulin in one of the days that when I was the sickest, and that I haven’t done since eating high carb, so it was quite bad.
Remember to hydrate because both having influenza and having that high blood sugars will dehydrate your body. So think about hydrating a lot the whole time, sip small sips even if you have the worst throat ache in the world (like I did!) Also consider adding electrolytes, because that can be something that could help you.
Influenza & Ketones?
What happened to my ketones? Normally my ketones are under 2.5 mmol/l on a very low carb way of eating. And this seems to be a normal thing for me. As soon as they go over I get a little nervous. As ketones are never really a goal for me, I don’t really measure them too often, but when I do, they seem to be staying under the 2.5 mark. Because I was fasting, liquid fasting, and because I was sick, my body needed more energy, and because my blood sugar was maybe a little bit high, and my ketones went up to 4.3 mmol/l.
This was actually nothing that worried me at this point, though, because I didn’t feel worse (I already felt like absolute shit…) But the ketones didn’t actually worry me any extra, because I knew I was doing everything that I could for them to do their job. I just chose to monitor them and as long as they didn’t go higher, didn’t have a panic attack about it, and I didn’t worry about it. My theory is that both blood sugar and ketones go higher, because your body needs more energy to get well again, the immune system needs more energy to kick the nasty bugs that you are fighting. I don’t know, maybe the this is not even true, but if you do know why blood sugar goes up when you are ill, and also ketones, please let me know in a comment! I’d be really interested to know from someone who really knows their stuff.
Influenza Treatment?
How do you treat a really bad influenza, especially as Type 1 diabetic (but also as a normal person)? I would say hydration is definitely the number 1 thing! Your body can survive without food and might actually get healthier quicker without food. But hydration – we need to hydrate a lot. So make sure you flush out those nasty bugs and the high blood sugar. Make sure you hydrate when you get sick!
Also painkillers, I cannot tell you… I don’t normally take painkillers at all. But last week, they were a Godsend. And I had water soluble ones so I didn’t have to swallow any tablets. Absolutely amazing, saved my life.
Throat lozenges with that numbing effect also really helped me to get through the influenza. Along with echinaea, I have a specific one in a alcohol solution that really helps your immune system to get into a higher gear. To sip, I had my beautiful, beloved “throat coat” tea, which I love when I am sick, because it really feels like your throat gets a coat! Also CBD oil, because it is anti inflammatory, and can help with all the mucous-y stuff going on in your face.
So that’s what happened to me last week, I got sick, blood sugar up, ketones up, but I was not worried because I knew my body was just doing its job in trying to make me healthier.
How do you react with your blood sugars when you get sick? And please let me know in a comment somewhere on the inter-webs and I’ll be happy to chat with you there.
Why No Protein Shakes?
Why no protein shakes? 🤔
Type 1 Thursday is here with another question from the audience:
“Hello, I notice that you don’t drink any protein drinks or shakes? Do you think they are unhealthy?”
Hanane
As a short answer, no, I don’t think they’re unhealthy. But I do think there needs to be a need for them, as protein needs are individual. Check out the whole explanation here!
I want to hear from you, do you drink protein shakes? Or do you get your protein from other sources? Let me know in the comments! 🙌
Transcription
If you prefer to read my views on whether protein shakes are good or not, you can find a written version here:
I am so excited, because there is another question from the audience today that I will be answering. If you have any questions that you think that I should be answering on these live chats (that we have every Thursday 6pm on Instagram, and Facebook), please do let me know in a comment somewhere on the interwebs and I’ll be happy to answer them.
To today’s question, it reads like this: “Hello. I noticed that you don’t drink any protein drinks or shakes is that because you think that they are unhealthy?”
Protein is a very individual
Protein threshold is very individual, especially on low carb, but also generally. Maybe on low carb you give a little bit more of a damn about the protein amount, especially if you have read #*#. Richard Bernstein’s book and checked out his Diabetes University. Protein needs are very individual and it can range from anything, for very sedentary people something like 0.8 grams of protein/kilogram body weight, which doesn’t mean 0.8 grams of meat but 0.8 grams of protein, to something more normal, if you are a little bit more active, maybe something like 1.2 grams per kilogram, or maybe 1.3, 1.5. But it can also go as high as something like 2.4 grams per kilogram, up to five grams per kilogram, if you are a super active athlete.
If your main fuel is protein and amino acids, then it is very individual how much you should be eating. This is why I personally don’t need to drink any protein shakes. I am not a very active athlete, well, I try to keep active but not that active. I’m also not a growing child. So I don’t need as much, and I can cover my protein needs with real food. You have to determine for yourself how much protein you need in your individual case.
Protein in Meat
All meat generally contains about 20 grams of protein per 100 grams of meat. Not all meat is protein, and not all protein is meat. Only one-fifth of the meat is actual protein and amino acids. If I eat 400 grams of meat a day, which is possible, not in one sitting, but if I have two sittings, lunch and dinner, which is normal for me. I don’t really have breakfast so I don’t have to pay attention there. If I have two sittings, and I have 200 grams of meat or protein filled food per sitting, that gives me 80 grams of protein for a day. And that would mean that that is 1.3 grams per kilo of body weight that I have (now you can count how much I actually weigh) Personally, I just prefer to get my protein from real foods because I can. And because I don’t have that extra need for protein shakes that you may have, as I said, if you’re a growing child or a very active athlete.
Need for protein shakes?
The short answer to your question is; I don’t think that protein shakes or drinks are unhealthy, per se. I just think that there needs to be a need for it. And in my case, I don’t have that need. Perhaps, in your case, because you are asking, there is a need for it and then you have to determine if that’s true or not for you.
If you do need a protein drink or a shake, I would recommend something that is clean without any sugars and any added stuff. Flavours is one thing, but you can also flavour it with other things like natural cacao powder or something. You don’t have to buy the ready mixed flavoured stuff, but something that is clean without sweeteners and without dextrose, please, because that will mess with your blood sugar, all the ways till Sunday. If I had the need for protein shakes, I would go for something like an egg white protein or a whey protein.
So, in conclusion, no, protein shakes and drinks are not inherently unhealthy. But there needs to be a use for them and a need for them. Thank you so much for your question!
I would love to hear from you – what are your experiences with protein and with protein shakes? Do you drink them? Or do you get the protein that you need from real food? Let me know in a comment below, and I’ll be happy to chat with you there.
Low Blood Sugar and Weight Loss?
How does Low Blood Sugar Affect Weight Loss? 🤔Does it have to? What factors do you have to look out for?
Type 1 Thursday is here!
Do you have experiences with how blood sugars impact weight loss? Share them in a comment!
Thank you so much for watching. Please let me know if you have any questions!
Transcription
If you prefer to read my thoughts on this, here’s a text version on low blood sugar and weight loss:
Blood Sugar and Weight Loss?
This week I’m excited about the new audience question! (If you have any questions that you want to hear my answer to, then please let me know!)
This week’s question comes from Joe, and Joe writes, “how do low blood sugars affect weight loss?” Thank you for the question!
Are you insulin dependent?
A lot of it depends on if you are taking external insulin or not. Because weight loss happens when a) the blood sugar is stable and b) there’s no excess insulin in the body. There are different theories of weight loss, two main ones as I see it, which I’ve talked about before here on Type 1 Thursday. One is the good old calories in vs calories out which we know is maybe not as applicable as they thought that it was. The other one is that it is actually hormone regulated, mainly with insulin as it is the master hormone in the body. If you don’t have excess insulin, and your blood sugar’s are stable, weight loss will occur.
In diabulimia, which is a very, very serious condition to have, which is when you take no insulin to lose weight. But that is not the point of this. This is about healthy, happy weight loss, if that is necessary. This is not an eating disorder thing that I’m talking about. Just to clarify that, and I find that very important because it is a terrible, terrible condition to live with. So, none of that, just healthy healing, healthy weight loss if necessary.
What is a low blood sugar due to?
A low blood sugar is because you took too much insulin for that particular circumstance. For that particular food, for that particular mood, for that particular weather, whatever it is that is influencing your blood sugar, you took too much insulin for that. That’s why you ended up with a low blood sugar, because nothing else lowers blood sugar like insulin does, and nothing else can lower blood sugar lower than it should be in a normal human being than insulin. So, if you are treating diabetes with insulin, does that mean lows are equal to excess insulin? Which then means that it will be a slower weight loss?
Well, actually, not necessarily. It depends on how stable your blood sugars are. If they are jumping like a roller coaster, so that it’s super high and then goes super low (which means that you then have to treat it and then go super high and super low. Again.) That’s a completely different thing than if your blood sugar is really stable. And then sometimes it trends downwards and dips minimally and you can correct it very easily. I’s a completely different thing than if you are all over the place in terms of blood sugar, and are struggling with it. Balanced blood sugar is the key, not a jumpy blood sugar. That’s what we should aim for. And that usually also aids weight goals.
Low Blood Sugar anyway?
You know, we all end up there no matter how good (or whatever) we are as people with diabetes, no matter how well we take care of ourselves, circumstances do change in the body. And lows do happen. They happen to me, they happen to everyone I know who are normally quite well controlled.
The key here is how do you treat it? Do you choose to eat the whole kitchen? So you grab anything from grapes, to peanut butter, to that sugary candy you have in the back somewhere, to snacks, to yoghurt, to honey, to you know the whole nine yards which will end up on this rollercoaster blood sugar ride, which is quite detrimental for your health. And it feels, first and foremost, really, really frickin terrible. So try to avoid it for that reason alone! Or, number two, do you treat low blood sugars targeted with an exact measurement of glucose? Because that doesn’t create the rollercoaster rides. It creates an even curve, even if you do dip a little bit you take a gram, or two grams or three or four, depending on how much you need (and that you need to do a trial and error with). You just come up a little bit again, and then you’re fine. Again, you don’t get those big swings. So that is really important how you treat the low when it does happen.
Correcting a low is of course, necessary, it can and definitely does save your life. So don’t skip it, even if it would potentially kick you out of ketosis, if that is your goal. I’m not saying that ketosis and keto and low carb is everyone’s goal, but if that is what you’re worried about in this question that treating a hypo will kick you out of ketosis or something, don’t be! You really need to save your own life in that case. It doesn’t matter if you get kicked out of ketosis or not. If you are fat-fueled in that way, or you can burn both fat and sugar, you will get back into ketosis very fast afterwards, so don’t worry about it. It really is key that you do take care of this.
The short version of my answer to your question, Joe, is that low blood sugars do not have to affect weight loss at all. It depends on how you treat the low and depends on how stable you are blood glucose is normally and that you don’t have excess insulin in your body.
Hope that helps!
If you have any questions, do let me know. And also do let me know your experiences of blood sugar and weight loss? Have you managed to lose weight, or maybe you don’t manage to lose weight although your blood sugar’s as good as perfect? Let me know in a comment, and I’ll be happy to chat with you there.