Diabetes And Diagnosis

What is the Basal Rate Testing? The Procedure

Last updated on October 20th, 2022 at 07:58 am

Basal rate testing helps check how well the basal (background) insulin is working. If the basal insulin works effectively, blood glucose levels should remain stable and in target (4–7 mmol) during periods of time when you are not eating, such as overnight, or when there are no carbohydrates on board to affect the blood glucose level. Testing basal rates involves having carbohydrate-free meals and two-hourly testing during the chosen time block.

It is useful to check basal rates at all times, including overnight. Most people will choose to have one carbohydrate-free meal per day to check if basal rates need adjusting rather than do a carbohydrate free day!

When to do basal rate testing?

It is best to choose days that are “normal days” i.e. not days when there has been more activity or exercise than usual or parties or social events. Ensure blood glucose is in target before the beginning of the testing period–ideally between 5 -7mmol/l and definitely less than 14mmol/l. Do not start if a low blood glucose level has been experienced up to 4 hours previously.

Why is basal rate testing so important?

Basal rate testing can help us figure out if we need to make adjustments. Because the foundation of our diabetes management is basal insulin. If our basal insulin isn’t adjusted properly, nothing else works properly. When basal rates are off, it’s like walking through quick and doing a lot of work with little progress, or sinking even deeper into trouble.

  • Having the right basal rate helps keep your blood sugars in the right range
  • overnight and between meals.
  • If your basal rate is too high, your blood sugar could go low (hypoglycemia).
  • If your basal rate is too low, your blood sugar could go too high.
  • Testing your basal rate can help you find the right basal rates for you.

You might only associate basal rate testing with insulin pumps, which is understandable! “Basal Rate” is a phrase typically associated with insulin pumps. But for those who are injecting, you also have a basal rate from your long-lasting insulin! The only difference is that pen-based therapy offers a little less flexibility in making adjustments.

How to prepare for basal rate testing?

  • Ensure the last meal containing carbohydrate was 4 hours prior to the testing time block–4 hours allows all your active bolus insulin to have finished working and for food to be digested
  • Avoid low glycaemic index or high-fat meals such as pizza, curries or pastas as your last meal, as they can continue to affect your blood glucose levels for several hours
  • DO NOT eat any carbohydrate during the testing periods. Carbohydrate-free meals such as plain meat, fish, eggs or cheese with mushrooms and green vegetables i.e. spinach, broccoli (some green vegetables if eaten in larger quantities will contain carbohydrate) is fine. Salads may be eaten, i.e. lettuce, cucumber and celery, but avoiding tomatoes as these contain carbohydrate.
  • Avoid fish or meat with pastry or breadcrumbs/batter
  • You can drink as much as you like but ensure drinks do not contain carbohydrate
  • Test blood glucose levels every two hours during the testing period (until the next meal) and record results.
The levels during this period of basal rate testing
  • Blood glucose levels above target and below 14 mmol/l–do not correct the blood glucose and continue with the basal rate testing–this will allow you to see how the basal insulin changes the blood glucose level.
  • Blood glucose is 14 mmol/l or above–check for ketones. If ketones are less than 0.6 mmol/l, take no action and continue with the basal rate testing. If ketones are greater than 0.6 mmol/l, correct the blood glucose level and treat according to treatment of hyperglycaemia for insulin pump users. Abandon test.
  • Blood glucose level is less than 4.0 mmol/l–treat the hypo in the usual way and abandon the test. If at any point during the testing period a hypo occurs, you need to stop and treat the low blood glucose and abandon the test for that day.
Recommended Basal Rate Testing Times
  • Morning – 6am to 12pm
  • Afternoon – 12pm to 5pm
  • Evening – 4pm to 10pm
  • Overnight – 10pm to 6am
How do I test my basal rate?

Decide which part of the day you want to test.

  • Overnight
  • Morning
  • Afternoon
  • Evening
  1. Start by testing your overnight basal rate.
  2. Do not drink or eat while you are doing the test (including no caffeine).
  3. You will need to check your blood sugar often or wear a glucose sensor.
  4. Only start basal rate testing if your blood sugar is between 5 and 8 mmol/L.
  5. If your blood sugar goes too high or too low, you will need to stop the test
  6. and try again on a different day.
  7. Test each time period on 3 different days.
What do I do after testing my basal rate?

After you test a time 3 times, you can decide if you need to make a change
to your basal rate.

  • If your blood sugar went up by over 2 mmol/L during the time, your basal rate is too low.
  • If your blood sugar went down by over 2 mmol/L during the time, your basal rate is too high.
  • If your blood sugar was stable during the time, you do not need to make any changes.
How do I change my basal rate?

If you think you need to change one of your basal rates, talk to your diabetes specialist doctor or clinic.

  1. Look at what time your blood sugar went up or down by over 2
  2. Change the basal rate before the increase or decrease in your blood sugar
  3. Make a minor changes to your basal rate of 0.025 or 0.05 units per hour.
  4. Retest the new basal rate.

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