How do I do BI check?

Hi everyone,

Does anyone know if there are any rules/ guidelines on how to do a background insulin check? I know it involves having carbohydrate free meals but not sure over what period of time I should do this for and how often to do blood glucose tests. Is this now taught on DAFNE courses?

Just off now to have a look at the online handbook.

Thanks in advance.

Jean

Are you on once-per-day BI, or multiple injections of BI?

If just the once, then the easiest way is to compare your before bed readings with your before breakfast readings (assuming no CPs or QA at bedtime or overnight). If they differ by more than 1.5, then it indicates that your BI may need adjusting.

Cheers,
Warwick.

Thanks for your reply Warwick.

I am on multiple daily injections of short acting insulin and twice daily injections of long acting insulin (in a morning before breakfast and in an evening before bed).

I have read how some people have carb free meals to check that their background insulin is correct but wanted to make sure I was doing it right before giving it a try. Would I go for a full 24 hours without any carbs and without any short acting insulin?

Thanks.

Hi Jean,

The full 24 hour test isn't really necessary. Identify the problem time of day - morning/afternoon/evening.

Where you would usually have a meal, don't, but take a reading. At the next meal (or before bed if you missed the evening meal), take another reading and compare the two readings. They shouldn't differ by more than 1.5 if your BI is correct.

If you have a hypo or need to correct with QA at any time between the start and end of the test, then it won't be a valid result. And the same applies for if your reading before the meal you are missing is high or low and you need to correct, or eat carbs. In that case, abandon the test, and try again the next day.


So, for example, if you have trouble with your BGs remaining steady in the evenings, at dinner time, don't eat, but take a reading.

At bed time, take another reading and compare it with the reading that you took previously. If it has risen higher than 1.5, then your BI is inadequate. If it has dropped by more than 1.5, then you are taking too much BI.

You can eat at the end of the test, but just remember to take a ppropriate QA with it.

Take BI at your usual times - there is no need to change the timing of it during the test.

During the test, you should only do what you would normally do during that time of day, so don't suddenly start marathon training during the test :-) If you are unusually physically active during your test, then that is likely to influence your BGs. Ditto for if you experience unusual stress.

It is also a good idea to repeat the test if you can on a different day. I am sure that you have experienced the odd way-out result as I have with no known explanation, and it can be good to test a couple of times just to check that it can be repeated with similar results.

Cheers,
Warwick.

Thanks for the advice Warwick. I'm going to give this a try. 😊

Jean 😊

The other thing to do is to look at different times of the day, particularly as with the timing of BI injections you will have a peak in the morning when that dose begins to kick in (typically 2 hours after injection) and the available amount of BI will then drop during the day until it reaches a minimum in the evening around the time you're giving the evening does. NB. This does assume that you don't sleep for 12 hours a day

So if evenings are the main problem, then start be having a carb. free dinner once or twice. Once you're happy that that period is OK, then you could move to a carb. free lunch etc. That way you get all the data, but over a slightly longer period but without having to go carb. free for 24 hours at once. I find that much easier.

I wouldn't totally miss a meal but have a card free meal. If your BG is always high at lunch time, have a card free breakfast if your BG remains high you could be running out of your BI. Not if your on lantus as this lasts for 24hrs it may need increasing. Or have you considered changing your ratio. It's difficult for me to say what to do without seeing a pattern to your overall BGs.