Spiking and hypos since using libre

[Greys]

Hi @Greys. Not sure I can add much to others comments but just a few thoughts:

It's beginning to sound like your basal isn't correct.
I think you might also have an issue with waiting an hour after waking up before you eat anything which could be causing your liver to dump glucose.
Exercising before eating will mess with your levels too.
To go from 6.0 to over 12.0 before you've even eaten anything is a red flag for this.
If this were me, I would bolus immediately after waking and eat within about 30 minutes. Your glucose levels should increase by about 2-3 mmol/L at the most. I'd exercise 2 hours after eating when levels were at their highest to prevent hypos.

Finally, did I read correctly that you are bolusing at a 1:1 ratio? That seems quite high. Is that normal for this type of insulin? I'm on Humalog and using 1:7 ratios for all meals. If I take more insulin than that I am almost guaranteed to have a hypo if I do any sort of exercise at all.

I think all those things need looking at.

You mentioned not exercising on a full stomach but could you wait a couple of hours after eating and then exercising? If I exercise after my bolus has worn off (equivalent to you doing this pre-breakfast), my glucose levels can go up.

Hi. Thanks for your reply. I'll take your comments on board and try exercising a couple of hours after eating. I don't exercise before breakfast btw, but I do before lunch. However just gone for my after work walk. Started with a reading of 12.3 and now I'm 3.7. I'm surprised a simple walk would make me decrease this much and 5 hours after I've taken fiasp.
My ratio isn't that high. 1:1 equals 1 unit of insulin to every 1cp. 1 cp equals 10g of carbs.

 

[rebrascora]

The drop may well be down to your exercise earlier, particularly if it was high intensity or a muscle burn workout. Exercise will continue to affect your BG levels for up to 24 hours afterward.
Thanks for clarification on your insulin:carb ratio.
You have given us all quite a lot to discuss today, one way or another! Thanks for provoking an exchange of views. I think we may have all learned something from this thread.

 

[pm133]

@pm133 1:1 is a pretty standard ratio for quick acting insulin. It actually means 1 unit of insulin for every 10g carbs not 1g because they are referred to as Carb Portions or CPs in DAFNE terms. Your ratio I assume is in reality 1:0.7? ie 1 unit of insulin to every 7g carbs which is higher... ie you need more insulin for the amount of carbs.

Ah OK thanks. I always referred to that as 1:10 but that makes sense now.

 

[pm133]

Not everyone uses the DAFNE terms and I find it can be a bit confusing. For that reason, I usually try to put the units in eg I’d say that as 1:10g, and 1:8g, etc. Confusingly, some people call a Carb Portion 15g. There’s also another way I’ve seen people use that apparently also came from DAFNE (?) and swaps the two around.

I’ve always used 1 unit to X amount of carbs and that way was taught for many years, and still is by DSNs in many areas. I find it more intuitive, but that might just be me.

Like @pm133 I too read 1:1 as 1 unit to 1g. Although that seems high, it’s not impossible with IR, including in pregnancy. A friend had that ratio near the end of pregnancy.

Diabetes is always fun! Particularly if you like Maths!

Fortunately I do like maths :-D
A lot.
I probably shouldn't admit this but I regularly take a maths book to bed with a notepad and a pen.
I suspect that I have destroyed my "cool" image now lol.

 

[Greys]

The drop may well be down to your exercise earlier, particularly if it was high intensity or a muscle burn workout. Exercise will continue to affect your BG levels for up to 24 hours afterward.
Thanks for clarification on your insulin:carb ratio.
You have given us all quite a lot to discuss today, one way or another! Thanks for provoking an exchange of views. I think we may have all learned something from this thread.

Yes, I have learned a lot today, thank you everyone and now i need to get on top of it all. Felt a bit stressed this afternoon from all this new information and what I need to try, so add that into the mix, it may account for my rising levels this afternoon. It was so much easier when I didn't work from home, but my entire routine has changed and factor in the libre and new insulin, I need to do some tweaking.

 

[pm133]

Hi. Thanks for your reply. I'll take your comments on board and try exercising a couple of hours after eating. However just gone for my after work walk. Started with a reading of 12.3 and now I'm 3.7. I'm surprised a simple walk would make me decrease this much and 5 hours after I've taken fiasp.
My ratio isn't that high. 1:1 equals 1 unit of insulin to every 1cp. 1 cp equals 10g of carbs.

How far are you walking and how long does it take you?
I see drops from 13.0 to 5.0 sometimes but I walk fairly briskly for about an hour and cover around 2 to 3 miles. It could be that you need a bit less bolus insulin.

I had a wee Google and it seems fiasp lasts up to 7 hours before dying away so I imagine there is probably still some in your system. My Humalog would have been long gone by then.

 

[rebrascora]

If it is any consolation is is pretty likely that you were also spiking with your previous insulin just that without Libre to see it your were blissfully unaware. There is so much information that it can get overwhelming so give yourself a few days before you experiment again if you like. Take things in your own time and we will be here when you need more input/support.

 

[rebrascora]

@pm133
That's interesting. I was under the impression Fiasp also just lasted 5 hours same as NR, but I have read that it can sometimes have a kick in the tail.
A 4 mile brisk walk/run will drop me only maybe 2-3 units at the time but will drop me more later, usually overnight.

@Greys
Bear in mind if you do basal testing it is not just food that you need to abstain from but probably need to consider exercise too and the effects from the previous day not just the day you are testing.

 

[Greys]

How far are you walking and how long does it take you?
I see drops from 13.0 to 5.0 sometimes but I walk fairly briskly for about an hour and cover around 2 to 3 miles. It could be that you need a bit less bolus insulin.

I had a wee Google and it seems fiasp lasts up to 7 hours before dying away so I imagine there is probably still some in your system. My Humalog would have been long gone by then.

I walk briskly for 45 mins. If I were to take less bolus I thought I'd peak more after eating.
Interesting you say fiasp lasts longer than humalog. Maybe I would have been best to stay on humalog as this would prevent me from having night time hypos as well. Had a lot since changing from humalog to fiasp. Only changed as I thought fiasp works quicker and would prevent too many variables, but this hasn't been the case.

 

[Greys]

@pm133
That's interesting. I was under the impression Fiasp also just lasted 5 hours same as NR, but I have read that it can sometimes have a kick in the tail.
A 4 mile brisk walk/run will drop me only maybe 2-3 units at the time but will drop me more later, usually overnight.

@Greys
Bear in mind if you do basal testing it is not just food that you need to abstain from but probably need to consider exercise too and the effects from the previous day not just the day you are testing.

Ok thanks. I'll be a couch potato tomorrow then

 

[Greys]

If it is any consolation is is pretty likely that you were also spiking with your previous insulin just that without Libre to see it your were blissfully unaware. There is so much information that it can get overwhelming so give yourself a few days before you experiment again if you like. Take things in your own time and we will be here when you need more input/support.

Thank you

 

[Kaylz]

Ok thanks. I'll be a couch potato tomorrow then

Wouldn't say that was what to do really, for a basal test if you've got a routine then its best to stick to that as that's the basal for your routine, so if you do exercise at a certain time most days then its best to stick to that, many have a fine basal set but see higher levels on days they are less active due to this which is fine if your on a more flexible basal but not so great for the likes of me on Tresiba xx

 

[pm133]

I walk briskly for 45 mins. If I were to take less bolus I thought I'd peak more after eating.
Interesting you say fiasp lasts longer than humalog. Maybe I would have been best to stay on humalog as this would prevent me from having night time hypos as well. Had a lot since changing from humalog to fiasp. Only changed as I thought fiasp works quicker and would prevent too many variables, but this hasn't been the case.

Right. So this explains the big drop you are seeing.
Your brisk walk will compensate for the reduction in insulin. You need to reduce insulin if you are doing anything energetic like that or you'll have hypos because your glucose consumption will increase considerably. I would consider experimenting with 1:11 and then 1:12 to see if that stopped some of the hypos. I would sort the basal at the same time.

I must admit that I am holding off on things like CGMs and pumps because it took so much effort to control things with Humalog bolus and Abasaglar basal for a relatively small amount of hassle and I don't fancy having to mess around again just to save on injections.

 

[grovesy]

As I understand it, the Portions/Exchanges came first, then those faded. When I was diagnosed, although in a way portions were still used because my carb list had ‘how to make up 10g of carbs’ and ‘how to make up 15g carbs’ etc, so you could look through the list and plan your meals, the focus was more on grams overall eg you’d be told to eat 40g carbs for breakfast. We were on twice daily insulin then, of course.

Then with the advent of MDI and adjusting bolus insulin, your meal amounts would be converted into a ratio eg 1 unit of insulin covers 10g carbs, so if you wanted 50g carbs for breakfast not 40g carbs, you could then work out the dose.

I don’t understand why DAFNE changed things. Using the previous system would have made more sense, I feel. I mainly see 1:10g but I’m always aware that sometimes we need to check if no units are given - ie gs or CP. Usually it’s 1:Xgs that’s more likely but I think you might be right about @Greys system. I’m totally invested in knowing now

Back in the 70's exchanges were used !

 

[Greys]

Right. So this explains the big drop you are seeing.
Your brisk walk will compensate for the reduction in insulin. You need to reduce insulin if you are doing anything energetic like that or you'll have hypos because your glucose consumption will increase considerably. I would consider experimenting with 1:11 and then 1:12 to see if that stopped some of the hypos. I would sort the basal at the same time.

I must admit that I am holding off on things like CGMs and pumps because it took so much effort to control things with Humalog bolus and Abasaglar basal for a relatively small amount of hassle and I don't fancy having to mess around again just to save on injections.

Ok thanks. I'll see how I go.

 

[helli]

I must admit that I am holding off on things like CGMs and pumps because it took so much effort to control things with Humalog bolus and Abasaglar basal for a relatively small amount of hassle and I don't fancy having to mess around again just to save on injections.

The value of a CGM or Libre is not saving insulin but to know what is going on between finger pricks to be able to adjust your insulin (you may need more or less insulin or insulin at different times), in order to improve your time in range and reduce you Hb1Ac without more hypos.

 

[pm133]

The value of a CGM or Libre is not saving insulin but to know what is going on between finger pricks to be able to adjust your insulin (you may need more or less insulin or insulin at different times), in order to improve your time in range and reduce you Hb1Ac without more hypos.

I meant to add that as well. I am quite happy to test 8 times a day manually to get a good enough picture of what is going on for now. If my Hb1Ac shows up higher than it needs to be then I'll probably make the switch.

 

[Kaylz]

I meant to add that as well. I am quite happy to test 8 times a day manually to get a good enough picture of what is going on for now. If my Hb1Ac shows up higher than it needs to be then I'll probably make the switch.

It isn't quite as simple as that for many, yes in Scotland it does seem easier to obtain the Libre on prescription and we'll even prescribe it to insulin dependant Type 2's whereas England don't but for many its a long fight and wait to get the privilege of the Libre on prescription

 

[trophywench]

Sorry to come back onto the '10g CHO equals one exchange/portion' discussion, but the words 'ration' and 'line' are also used. Ration I had heard before in this context but line was a completely new one on me when I moved to Coventry in 1998!

 

[trophywench]

Oh - no mathematician here but good grief, we learned above plateaux at junior school and then more of the same at senior school in geography and if you can't recognise a spike just by the shape of it, let's see if you can feel 'a sharp scratch' from this fork I'll obligingly dig in your hand, shall we?

(A plateau in Spanish is 'un mesa' - the same word as for 'a table'.)