My 24 Hour Fast With Type 1 Diabetesby Gina Capone Patient Expert
Fasting for 24 hours with type 1 diabetes? Yes, I know what you are thinking right now. No way, no how. I can't fast, I have diabetes. I have to eat, or my blood sugar will drop. Are you nuts?
These are the exact things I was thinking when I was told by the CDE's at the Diabetes Research Institute a couple of months ago, when they said we would be doing a 24 hour fasting. Quite frankly, I was having heart palpitations just thinking about it.
At the end of Day 3 we were given our guidelines for the fasting.
The purpose of the test was to test our basals, so the only insulin we were allowed to use over the next 24 hours was our basal insulin. If we were on a pump we would only rely on our basal settings. People that used Lantus via injection would inject a normal dose at the usual time.
During the entire time of the fast we would measure our blood sugars every 2-4 hours and correct hypoglycemia (below 70 mg) or hyperglycemia (250 mg only for this test). We would correct hyperglycemia with our high blood glucose ratio, and hypoglycemia with glucose tablets only. Blood sugar levels had to be above 120 mg at bedtime. If you had to correct more than twice during the fast you would suspend the fast and adjustments would be made to your individual insulin regime the next couple of days.
The only foods we were allowed to have were:
Sugar free hard candy
Sugar free jello (4oz)
Sugar free gum
Coffee (black and sweetened with splenda or equal)
Tonic water, sugar free
Broth - Chicken/Beef
They gave us sugar-free jello packs of 6 and broth to take home with us. I was not a resident of Florida and was staying at the local hotel so that came in handy. We left the DRI facility at around 5 pm. My blood sugar was at 263 so I took a correction bolus.
Two hours later, I checked my blood sugar at 7 pm and I was already at 95. I had dropped 168 points in two hours. My correction should have only dropped me 40 points, and I was getting really hungry, too. So, I had some jello and tried out the broth that they gave me, but...to put it lightly"it was nasty
My mom and sister were with me and they were hungry so I told them to go out to eat without me that I would just catch up on some work (and daydream about eating delicious hamburgers and french fries, LOL). My mom was very nervous about the 24 hour fast and didn't want to leave me alone, but I assured her that I would be fine (and showed her that I had tons of glucose at my finger tips!).
One hour later at 8 pm I started having symptoms of low blood sugar (of course when I am alone). It started with spots in my eyes then shaking. I checked my blood and I was at 47. I started freaking out a little bit but, had my glucose close by so I took in about 30 carbs (each bottle of glucoshot is 15 g.) My CGM was on as well, and it was beeping like mad. After 15 minutes I checked my blood sugar again, and it was back up to about 100 and I felt better. After that, I followed the fasting guidelines for the duration of the fast.
During the entire night I was checking my blood sugar every 2-4 hours and recording them on a sheet (I slept very little that night), as well as watching for symptoms of high or low blood sugar. To my surprise, my blood sugars were holding steady in the 109-112 range the entire night. I couldn't believe it! I was up all night worrying that I was just going to bottom out, but it never happened. I have to admit I was very excited about this test and that I made it through, but it wasn't over 'til 2 pm the next day.
The next day we reviewed everyone's blood sugar logs and found out how everyone did. I was the only one who had steady blood sugars the entire night, and two people had to stop their fasting because of hypoglycemia and one person had to stop because of hyperglycemia.
As we went over everyone's blood sugar logs, I was still checking my blood sugar levels and I held steady at 75 mg until 12:30pm when I bottomed out at 66 mg. I took in 15 carbs and it went back up pretty quickly. At 2 pm, the fast ended and we all went to lunch together. Yes, we were ALL starving and munched like kings and queens!
My learnings from the fast: fasting offers you the best way to test out your basal rates and to determine that it is not absolutely necessary to eat in order to prevent hypoglycemia. If your basal insulin is correct, your blood sugars should remain stable throughout the 24 hour period of the test. The mastering your diabetes program defines "stable" as maintaining a blood sugar level within 30 points plus or minus your starting blood sugar.
The other reason for this kind of testing is to reassure you that you are able to fast for religious holidays, specialized medical testings, and more.
I would never have thought fasting was possible unless I actually went through the guided fast at MYD. It provided me with confidence and so much important data that I never would have gotten without a 24 hour fast. Do not try fasting without the consent and guidance of your medical team - it is imperative that they are aware and on-call if you need their assistance.