The #1 mistake I see people with diabetes make
Nothing is more frustrating as a person with diabetes (PWD) than waking up to your CGM alarm throughout the night. That grating, honking alarm that rips you out of your sleep and into the kitchen for a juice box. This shouldn’t be happening regularly, but for many PWD it’s an accepted experience.
90% of the time these overnight lows are due to an overly aggressive basal rate. This is the number one mistake I see PWD and their endocrinologists making whenever they come to me for diabetes self management counseling. For one reason or another, the endo or the PWD increases the basal rate to a point where the PWD’s BG is tanking at night which means this person isn’t getting any sleep or they’re so afraid of going low now that they binge prior to going to bed.
Is this something you’re experiencing? Let’s talk about how to fix that!
Basal Rate Basics
A basal rate is the insulin that is meant to keep your blood glucose steady during a fasted state (no food or bolus insulin on board). It can be given via long acting insulin like Lantus, Toujeo, Levemir, or Tresiba or through a basal profile on an insulin pump.
Basal insulin typically makes up about half of the total daily insulin needs in a PWD. If there is a variance in this percentage, this is a flag for further investigation. Has this person’s needs changed due to insulin resistance? Stress? Illness? Of course, this rule isn’t absolute and it will vary from person to person, but it is a good baseline when figuring out your basal rate.
How to Test Your Basal Rate
Periodic basal rate testing is an extremely important part of a PWD’s routine. If your basal rates are off in any way, it’s going to make carb counting, bolusing, sleeping, and exercising way more difficult. Basal rates are the foundation of an insulin regimen and it’s worth it to make sure they’re correct.
The easiest way to see if your basal rate is working is by observing your overnight blood glucose readings. You’re likely fasted and relaxed at this time, so it’s a great way to get a baseline basal rate.
If you notice a rise or drop of 30mg/dL (1.6mmol) or more, this is a place to note and means your basal rate may need some adjusting.
For example, I notice my client’s BG drop from 200 to 100mg/dL overnight. At first glance, we’re thrilled, right? We went to bed above target and woke up in target range. But what happens when this person goes to bed at 150mg/dL? If their basal rate is dropping them 100mg/dL, then they’re going to end up with an urgent below target reading. This tells me that their basal rate needs to be decreased.
Basal rates are never to be used to correct a below or above target blood glucose. They are designed to keep you steady — end of story.
Free Basal Testing Tool
If you’re interested in running some fasted basal tests, click here to download a tool that I use with my clients. You can use this and discuss your findings with your doctor.
