HOWTO profile your Basal Rates. by: Michael A. Robinton, Michael@bzs.org v1.03, Feb 4, 1998 This document describes HOWTO check and set Basal Rates by making repetitive measurements of fasting Blood Sugar levels. ______________________________________________________________________ Table of Contents 1. Introduction 1.1 General Guidelines 1.2 Disclaimer 1.3 Other Blood Sugar related HOWTO's 2. Profiling Basal Rates. 2.1 Preparation before testing your Basal Rates 2.2 Repeatability of the Basal Rate test 2.3 Basal Rate test procedure 3. Copyright Notice ______________________________________________________________________ 1. Introduction Proper Basal Rate settings will keep fasting blood sugar variations within 20 to 30 points during normal day to day activities. Periodic profiling of your Basal Rates allows you to determine if adjustments or additional Basal Rates are needed. This is particularly important for individuals whose routine day-to-day activity changes, for those experiencing hormonal changes (menopause, adolescence, etc...), normal growth spurts experienced by children, pregnancy, and many other variations in the normal course of living our lives. 1.1. General Guidelines Basal Rate testing must be done over a period of several days. Experts in the field advise dividing basal testing into three periods, first correcting basal settings for night time then checking morning/daytime basal rates, followed by afternoon/evening testing. Each phase of testing may take several days (including rest days) to accurately profile and adjust the basal rate for that test period. Remember to always consult your health care team when making changes to your basal rates. Stop the testing if at any time your blood sugar gets too low or too high. The guidelines I use are 65 to 165 points. Below 65 is to low for comfort or safety and above 165, kidneys begin to spill glucose and invalidate the resulting blood sugar changes. You may wish to use other limits, check with your health care advisors. 1.2. Disclaimer The information and procedures contained in this document are provided in the hope that you may find them useful. No guarantee or warranty of accuracy is given, or suitability for use implied by making this information available. Use of the information and procedures is AT YOUR OWN RISK. You should consult with your physician and health care team when making changes to your insulin regimen. 1.3. Other Blood Sugar related HOWTO's o HOWTO estimate new Basal Rates Graphically estimate your basal rates on-line. o HOWTO measure Blood Sugar to Insulin ratio Check your Blood Sugar to Insulin ratio. o HOWTO measure Blood Sugar to Carbohydrate ratio Check Blood Sugar to Carbo ratio. o HOWTO check your RATIOS Check that your Blood Sugar to Insulin, Carbo to Insulin, and Blood Sugar to Carbo ratios are correct. 2. Profiling Basal Rates. 2.1. Preparation before testing your Basal Rates Test your Basal Rates on a day which follows a vanilla day. That is, the previous day should have no insulin reactions, unusual highs or lows, or out of the ordinary physical activity. Prior to and during the testing period, you should not participate in any activites which are out of the ordinary. Do the things you normally do every day. In order for this procedure to work correctly, blood sugar levels must remain stable and constant during the test period. 2.2. Repeatability of the Basal Rate test The Basal Rate measurement should be repeated two or more times on different days to make sure the results are accurate and repeatable. Make changes to basal rates only after successfully repeating the test results. It can be expected that there will be some minor variation in results from day to day. Repeatable test results indicate a true pattern which can then be used to correct basal rates. 2.3. Basal Rate test procedure Measure and record your fasting blood sugar levels over an 8 to 10 hour period every 2 hours. For night time measurements, you may wish to do the test over two nights using a 4 hour measurement interval with the second night's measurements offset 2 hours from the first night. If night time testing is done over two days as described above, you must NORMALIZE the results of the second night as in this example: On the first night, measure blood sugar at 10:00pm (example result 112), then measure at 12:00 midnight, 4:00 am, and again at 8:00am. On the second night, measure at 10:00pm (example result 98), then measure at 2:00am, and again at 6:00am. The second night's results are adjusted up or down by the difference in the 10:00 o'clock results from the first night. To normalize the second nights results, add ( if the first night 10:00 pm reading is greater than the second night ) or subtract ( if the first night 10:00 pm reading is less than the second night ) the difference in the 10:00 pm results (14 points) to each of the results for the second night. The 10:00 pm adjusted results should now be the same for both nights and the remaining second night results will be normalized. This pro- duces a set of results at 2 hour intervals and will not sig- nificantly disturb your sleep pattern. 1. Fast for 4-5 hours prior to beginning the test and do not take any insulin other than that provided by your basal rate. 2. With blood sugars between 90 and 140, start the test and measure your blood sugar levels every 2 hours. If your blood sugar levels fall above or below the guideline limits (65 - 165) correct your blood sugar levels with glucose or insulin and STOP the test. 3. If blood sugar levels exceed the guideline limits, adjust the basal rate for period prior to the out-of-range measurement up or down by 0.1 u/hr., as appropriate, and repeat the test on another day. 4. Repeat this procedure for night time, morning/daytime, and afternoon/evening test periods. 5. Use the Basal Rate Estimator to help you make basal rate adjustments. Be sure to review the results with your health care team when adjusting or adding/removing basal rates. 3. Copyright Notice Copyright (C) 1998, Michael A. Robinton and Insulin Pumpers Permission to use, copy, distribute this document for any purpose is hereby granted, provided that the author's / edi- tor's name and this notice appear in all copies and/or sup- porting documents; and that an unmodified version of this document is made freely available. This document is dis- tributed in the hope that it will be useful, but WITHOUT ANY WARRANTY, either expressed or implied. While every effort has been taken to ensure the accuracy of the information documented herein, the author / editor / maintainer assumes NO RESPONSIBILITY for any errors, or for any damages, direct or consequential, as a result of the use of the information documented herein.