Monday, January 14, 2008

To test or not to test?

I have a confession to make.

Riley has been on the pump for almost 2 years and I have never ever done a basal test.

When Riley started on the pump in March of 2006 his endo looked at his average daily dose and set his basals from that. For the next month or so she had me checking his sugar but even when he was high in between meals not correct. That way I was able to see if his basal was bringing him back down to range or not.

After we got a good basal rate going I have just adjusted here and there. If he has a string of highs around the same time every day I'll increase his basal a bit a couple of hours before the highs start. If he's having lows I do the same except I decrease basals.

Riley started on the pump when he was 3. Dr. M did not want him to miss meals or snacks.

So, I've never had him fast to test his basals. Am I the only one?

I've thought about it before but what's got me thinking about it again is
this post by Carey over at dlife. He's wondering about how people are able to skip meals while on the pump.

I don't think Riley could skip a meal. His basals are kind of set up to accommodate snack and meals. Does that even make sense?

I had thought about asking his endo about testing his basals at his appointment last month but then I thought, why really bother? Riley eats at about the same time every day. He eats snack at the same time every day. The only exception is on the weekends he eats breakfast about an hour to an hour and half later and if he does it much later he skips snack and eats a little bit earlier lunch.

But, Carey's post got me thinking. It would be really nice to sleep in later on Saturdays. Or, Riley is going to see a play next month with his class. It is in the morning so the rest of his class will skip snack. I told his teacher it's important that Riley still receive a snack. It would be nice if he didn't have to do that.

Then I think, why mess with what is working? Riley's A1C is 7.3, down from 7.8 in September. And, to be honest, I have been very very pleased with his sugars as of late. He had a few lows a couple of days in a row, but none for the past few days. And, I really can't remember the last time he had a sugar in the 300s and I can only remember a couple in the 200s over the last several days.

The pump is a great tool. I want to get full benefits from it. If I can improve control by making better use of it that's what I want to do.

Is basal testing necessary when what you're doing seems to be working?

I'd like to hear your thoughts on this.


Caro said...

No Penny, I don't think it is necessary if what you are doing is working.

Personally I skip meals to test basals, but that is because I skip meals, or rather eat them at widely varying times, very frequently. It is important to me to be able to do this, and important for me to know that if I have to work through my lunch hour finishing off an endodontic procedure, I won't be putting myself or the patient at risk by doing so.

But for anyone who tends to eat on a regular schedule, I don't think it matters if part of the basal covers food, or part of the food bolus covers basal, so long as it works.

I hear what you are saying, though, about it being nice to skip snacks or sleep in. My suggestion would be, rather than formal basal testing, to see what happens if you do those things. Perhaps have Riley skip a snack on a day when he is home with you and busy doing something else. It may be that he stays steady. If he doesn't, rather than alter the basals and carb ratios for something that sounds like an infrequent occurence, you may be able to work out a temp basal that should be run if he's not getting a snack.

Just some thoughts. The bottom line is, we all have to do what works for us and what brings the minimum amount of disruption into our lives.

Shannon said...

We did a formal basal test a few times over the course of the past 4 years. The first time was to set it up when he went on the pump, and the next was for some other reason that I can't remember, and the third was because he must've hit a growth spurt that sent him over that threshold of going from toddlerhood to boyhood.

This is a tricky question because his A1C's are fine, but technically he should be able to get along fine between meals without having to snack. But, if Brendon goes without a meal, we test him and adjust his insulin accordingly because no matter what, his insulin needs are based on meals.

I guess it depends on what you're willing to put up with. If you want a more casual schedule, then do the formal test so that you don't have to worry about the timing of snacks and whether or not he feels like eating.

Or, if you're happy with the way things are now, stick with what you have.

Either way, his A1C's should be fine, but I know it's nerve wracking to mess with something that you've been comfortable with.

Do I have your head spinning? Mine is.

Shannon said...

1 more cent to add:

For me, it all comes down to "choice" and not being a slave to a schedule. I want to be on a schedule because I want to be, not because his insulin demands that I be on one (the way being on shots demanded).

Did that make sense?

Allison said...

I definitely skip meals, especially on the weekend when I won't wake up until after lunch, and even then sometimes I won't eat anything until the late afternoon. I think testing basal rates is much more important, as Caro said, when you are on an irregular schedule, which is very common for an adult or a teenager. Young children are pretty regimented with when they wake-up and go to bed, so it probably isn't as big of a deal. You technically aren't supposed to have your basals as a part of your meal boluses, just because it makes changes in calculations more tricky, but then again, I'm not sure if I would want a four year old to go six or seven hours without eating, which is often what you have to do when you do basal tests.

Jillian said...

Stick with what's working until it doesn't any more. I'm sure basal testing will be come something you need as Riley gets older.
I haven't done a basal test yet, but I have done adjustments to my basals. I can usually see the problem and like you I just make the adjustment. I've skipped a few meals since I started pumping with no problem. My basal rates are not really set around food though, they are more set on what I know about how my body tends to work during the day. For instance no matter if I eat dinner or not in those after dinner hours my blood sugar goes ridiculously high. Hence an increased rate around that time. Do what works for you, diabetes is definitely not something you can control using any one method.

By the way, congrats on what sound like stellar numbers lately!

Donna said...

I've never done an official basal test. But I do skip meals on occasion & things work out okay. But mine are set up more like Jillians - just based on how my body responds during different parts of the day.

If you're happy with how things are going, I wouldn't mess with anything - unless you just want to. Like the old saying goes, If it ain't broke, don't fix it.

Good luck on whatever you decide to do.

Scott K. Johnson said...

It all boils down to getting the numbers you want (or as close as you can get).

It is hard to introduce change when everything sounds like it's working so well, but then again it depends on how important it is for his BG's to stay steady if he skips a meal or snack (or if it is delayed).

So my answer is "it depends". :-)

Bad Decision Maker said...

I'm not that into basal testing, I usually don't do them. I don't like to put that stress on my mind/body, and I'm 22 years old, so I can especially imagine not wanting to do that to a kid. It also doesn't seem that accurate to me, just one day of data. I also think that if you are meticulous about carb counting (or make yourself be meticulous for a week to check things out), you should be able to see patterns and adjust basals that way.

Also... the other thing with basal tests... there's so many variables!! I feel like they can't be that accurate. Food is only one variable - what about exercise, stress (even minor short bouts of stress or pain could affect blood sugar), amount of sleep, etc.? Especially for a kid, I would think just the stress/schedule change of skipping a meal would change blood sugars a little.

Of course, what I'm doing now is NOT working, and the diabetes educator I saw today instructed me to do basal tests. Which makes sense because things are so out of whack with my blood sugars, but I think I have bigger problems (like insulin not absorbing, bad timing of exercise/snacks, etc.) than needing a 10% tweak in my basal. My basal being 10% too low, if it is, does NOT result in the 300s I've been having.

Sarah said...

As an adult, basal testing is important to me. It is important to me because I got on a pump to get away from scheduled meals and what would happen (lows) if I didn't eat at the right time. The pump gave me back flexibility that I had lost at diagnosis. I can't say what is most important for your little guy, as he is 6 and I am 29, and my little girl who is 4 isn't on a pump. I just know they are important for me. Maybe in your situation if it isn't important now, it might be later.

Anonymous said...

are there any natural remedies for type 2 that are safe for children? have you looked into any of them?

Penny Ratzlaff said...

Raymond B,

First, my son does not have Type 2 diabetes. My son has Type 1 diabetes. There is a difference.

Secondly, there are no natural remedies for Type 1 or Type 2 diabetes. Insulin is as "natural" as it gets.

If my son did not take insulin several times a day he would die.

Thanks anyway.

Major Bedhead said...

Penny, FWIW, I've never done a basal test on O either. I tweak as needed. She's not skipping too many meals and I haven't seen the need to do it yet.