Hi there, newly diagnosed type 1.

[rebrascora]

Absolutely.... sounds like you have it cracked! With the Freestyle Libre system. We have a range of between 3.9 and 10.0 and we are looking to stay within that range 75% of the time. Obviously, with just a few finger pricks, you don't really know what your levels are doing the rest of the time, whereas with the Libre it is sampling your levels every few minutes, so you get a much better view of your whole BG profile over 24 hours but from the readings you are getting so far, you are doing really great!!

 

[Pat91]

Absolutely.... sounds like you have it cracked! With the Freestyle Libre system. We have a range of between 3.9 and 10.0 and we are looking to stay within that range 75% of the time. Obviously, with just a few finger pricks, you don't really know what your levels are doing the rest of the time, whereas with the Libre it is sampling your levels every few minutes, so you get a much better view of your whole BG profile over 24 hours but from the readings you are getting so far, you are doing really great!!

Hi there, thank you for the feedback, that's a relief to know I'm on the right track, how long were you on injections before you switched to libre ? Thanks.

 

[rebrascora]

I started on insulin in March 2019 and whilst I was given the initial nod for Libre on prescription in Feb 2020, it didn't happen due to Covid because training was put on hold. Eventually I decided to self fund the LIbre in June ( no training required when self funding) and did that for 3.5 months (expensive but so worth it) before actually getting it on prescription in October. Learning to interpret the information and not be too hasty in responding to it is very important with Libre as it does provide a lot of info and getting it on prescription is a postcode lottery and depends if you fit NICE criteria and some consultants are keener than others to utilize their "allowance" or so it feels to me. I started testing much more frequently and could demonstrate to my consultant from my BG app on my phone how I was using that extra data along with a food diary to improve my results and that convinced him to offer the Libre on prescription... I went into the appointment armed with a lot of points as to why I wanted it and it would be helpful and I fully expected that I would need to fight my corner quite hard for it and possibly be refused but he could see that I had a good grasp of what I was doing and not over reacting to information from finger pricks and he agreed without me having to put forward my case to any extent. I was over the moon when I left the appointment, but it took another 8 months to actually get them on prescription, so you have to be prepared to be a patient and even then a bit of badgering doesn't go amiss. In the current climate with the NHS, things are generally progressing much slower and that is understandable, so you may have to get used to finger pricking for a while longer yet.... or self fund... but do be aware that some people have struggled to get it on prescription once they have started self funding.... which shouldn't happen, but has to at least a couple of forum members. Mine had been agreed in principle so I had nothing to lose in self funding (short term) after that (other than the money of course.... which started off as some birthday money and then I dug into some savings because I didn't want to be without it after that).

Anyway, hope that info helps.

 

[helli]

Hi there, thank you for the feedback, that's a relief to know I'm on the right track, how long were you on injections before you switched to libre ? Thanks.

Libre is not an alternative to injections.
Libre is a glucose monitor - some see it as an alternative to finger pricking although I still prick my finger a few times a day.
As @rebrascora mentioned, it allows you to see what happens to your blood sugars all the time rather than just the moments in time when you prick your finger. It does this by taking a measurement every 5 minutes and showing the blood sugar roller coaster on a graph.
Availability of these on prescription does not seem to be related to how long you have had diabetes but more related to what your postcode is. There are some NICE guidelines such as how many times per day you test. I would recommend asking about these when you next talk to your diabetes nurse.

The alternative to injections are insulin pumps.
Again it varies how quickly after diagnosis you may get one of these but they are pretty expensive so it is more down to the need rather than the duration.

 

[trophywench]

Errr - Libre is simply not all that accurate for me - I would never trust it to base my treatment on.

It can be a full 2.0 different to my BG reported by my meter. It will report that I am mid 3s and therefore hypo, when by actual BG is sitting comfortably in the high 4s and sometimes, low to middle 5s. What it does help with though, is seeing trends more easily so eg how long it took for your BG to increase to 9.1, how long it stays at that level, how long it takes it to get back to around 5 thereafter. Then we have to fathom out whether we need an adjustment to our bolus for brekkie, or whether we need extra basal insulin working at that time of day. These are not primary school calculations, they are at least A level ones if not university degree level ones. And you have only started at Nursery school very recently .........

There is no quick fix for most things - not a permanent fix anyway (but there are often quicker things we can do as a temporary measure) so model yourself on the tortoise instead of the hare. Slow but sure usually gets us there quicker in the finish - because we learn to understand why and how on the way and can use that info to apply to the next prob.

 

[helli]

Errr - Libre is simply not all that accurate for me - I would never trust it to base my treatment on.

There have been many discussions on this and I realise how hard it is to plough through the many threads to find it again.

Some people are just not compatible with Libre, some people are not like the Factory Man they use for the factory calibration (there are ways around this), some sensors have problems (Abbott will replace them) and there are limitations with all CGMs including Libre (less accurate during the first 24 hours, less accurate when high and low, readings are about 15 minutes behind "reality") but bearing this in mind, I am confident with bolusing from my sensor but not correcting highs and lows.

Furthermore, Libre 2 has just been released and is said to be more accurate.

Some of this is education (I learnt about the limitations from social media rather than any formal training) and some of this is personal preference.
But as one of the main criteria is reducing the number of finger pricks, NICE seem to be of the opinion it is accurate enough.

 

[grovesy]

There have been many discussions on this and I realise how hard it is to plough through the many threads to find it again.

Some people are just not compatible with Libre, some people are not like the Factory Man they use for the factory calibration (there are ways around this), some sensors have problems (Abbott will replace them) and there are limitations with all CGMs including Libre (less accurate during the first 24 hours, less accurate when high and low, readings are about 15 minutes behind "reality") but bearing this in mind, I am confident with bolusing from my sensor but not correcting highs and lows.

Furthermore, Libre 2 has just been released and is said to be more accurate.

Some of this is education (I learnt about the limitations from social media rather than any formal training) and some of this is personal preference.
But as one of the main criteria is reducing the number of finger pricks, NICE seem to be of the opinion it is accurate enough.

I like your thinking we are not all like the Factory Man.

 

[Inka]

Hi there and good morning everyone, thank you for the kind words and advice it is very much appreciated, I have been eating before bed normally a sandwich, last night I checked my BG at 9pm after having my dinner at 5pm. At 6.7 I just had 1 digestive instead of the sandwich and set my alarm for 1.15am my levels were 4.6 to my relief, so in theory could I repeat this every night a d be confident my readings will stay around the same at night as. When I woke this morning they were still 4.6. had my Weetabix and 10 units of Nova, checked at 10am , so 2hrs 30 mins after breakfast and my readings were 9.1, is this ok as long as my levels are back down by lunch ? Thank you.

Hi again @Type1Pat For me personally, 4.6 would be slightly too low for nighttime, particularly if I was on injections. I’d rather go through the night on a 6 or around there. Even now I have a pump and can have a more individual basal rate, I would still eat a tiny amount of carbs if I was in the 4s during the night. Perhaps you could go with 1 and a half digestives at bedtime and see how that works?

Yes, I think your 9.1 was very good after breakfast. You seem to be doing very well 🙂

 

[Inka]

Interesting @trophywench My consultant isn’t that impressed with the accuracy of the Libre either and said, like you, it was best to see patterns. I like to keep pretty tight control and she said that the Libre wouldn’t be ideal for that as it’s results weren’t that accurate. Hearing that and realising I’d probably end up finger-pricking anyway, I was put off.

 

[trophywench]

I'm definitely not either - nor Factory Woman.

Remains to be seen whether Libre 2 is more accurate.

 

[rebrascora]

My most recent sensor has not been nearly as accurate as all my previous ones which I felt very comfortable to bolus and correct from but this last one has knocked my confidence a little and I did wonder if they had "changed" the "factory man" used to calibrate it. (Maybe he is off sick with Covid!!) It has given me "LO" readings (which I have never had before) when I have been mid 3s to low 4s (and no compression issues) so I am inclined to think it is just a less that great sensor. Hopefully my next ones will be better. The current one was actually a replacement from Abbott rather than a prescription one.... maybe hot off the press. It is still giving me reasonable readings most of the time but I feel much more inclined to check it more frequently than I have with previous sensors which I maybe only checked 2-3 times during the 14 day period if I felt the reading wasn't compatible with how I felt.

@Type1Pat Apologies, I didn't pick up that yopu were confusing Libre with a pump. I was assuming you meant how long after starting on insulin ie diagnosis.... my introduction to diabetes was slightly different to yours in that I was initially assumed to be Type 2 so I went through the routine of strict low carb diet and oral meds for a few weeks before starting on insulin, so I kind of associate insulin with the beginning of my Type 1 diagnosis rather than when my diabetes symptoms first occurred and therefore I didn't pick up on the nuance of your question and misunderstanding.

 

[grovesy]

I'm definitely not either - nor Factory Woman.

Remains to be seen whether Libre 2 is more accurate.

Well I will starting my first Libre 2 at the end of the week.

 

[helli]

Well I will starting my first Libre 2 at the end of the week.

Please post your experience.
I am looking forward to getting mine - my DSN has said she has written to my GP to get my prescription changed but speed and efficiency are not their string points so I think it will be a while before I get my hands on one.
My current Libre failed this morning so I had to report it to Abbott. They are sending a replacement. I hoped I could convince them to send a Libre 2 but they only replace like for like.

Sorry, long way of saying I am looking forward to reading other's experience of Libre 2.
Maybe I can experience your improved accuracy vicariously.

 

[Pat91]

Libre is not an alternative to injections.
Libre is a glucose monitor - some see it as an alternative to finger pricking although I still prick my finger a few times a day.
As @rebrascora mentioned, it allows you to see what happens to your blood sugars all the time rather than just the moments in time when you prick your finger. It does this by taking a measurement every 5 minutes and showing the blood sugar roller coaster on a graph.
Availability of these on prescription does not seem to be related to how long you have had diabetes but more related to what your postcode is. There are some NICE guidelines such as how many times per day you test. I would recommend asking about these when you next talk to your diabetes nurse.

The alternative to injections are insulin pumps.
Again it varies how quickly after diagnosis you may get one of these but they are pretty expensive so it is more down to the need rather than the dura

Hi again @Type1Pat For me personally, 4.6 would be slightly too low for nighttime, particularly if I was on injections. I’d rather go through the night on a 6 or around there. Even now I have a pump and can have a more individual basal rate, I would still eat a tiny amount of carbs if I was in the 4s during the night. Perhaps you could go with 1 and a half digestives at bedtime and see how that works?

Yes, I think your 9.1 was very good after breakfast. You seem to be doing very well 🙂

Hello again, yes I was a bit weary myself of the low reading will probably have more biscuits like you say before bed, have been speaking to my diabetic nurse contact and he has taken me down from 10 Nova to 8 as I have been too low before my next meal, he has also advised me to slightly adjust my insulin dose by 1 or 2 units if I'm having a bigger portion of carbs. Have also been told if I'm having no carbs with my meal to not have any Nova. My question is do we still need insulin to break down foods with no carbs ? Thanks again.

 

[Pat91]

My most recent sensor has not been nearly as accurate as all my previous ones which I felt very comfortable to bolus and correct from but this last one has knocked my confidence a little and I did wonder if they had "changed" the "factory man" used to calibrate it. (Maybe he is off sick with Covid!!) It has given me "LO" readings (which I have never had before) when I have been mid 3s to low 4s (and no compression issues) so I am inclined to think it is just a less that great sensor. Hopefully my next ones will be better. The current one was actually a replacement from Abbott rather than a prescription one.... maybe hot off the press. It is still giving me reasonable readings most of the time but I feel much more inclined to check it more frequently than I have with previous sensors which I maybe only checked 2-3 times during the 14 day period if I felt the reading wasn't compatible with how I felt.

@Type1Pat Apologies, I didn't pick up that yopu were confusing Libre with a pump. I was assuming you meant how long after starting on insulin ie diagnosis.... my introduction to diabetes was slightly different to yours in that I was initially assumed to be Type 2 so I went through the routine of strict low carb diet and oral meds for a few weeks before starting on insulin, so I kind of associate insulin with the beginning of my Type 1 diagnosis rather than when my diabetes symptoms first occurred and therefore I didn't pick up on the nuance of your question and misunderstanding.

Hi there, that's ok it doesn't take much to confuse me at the minute to be fair .

 

[rebrascora]

My question is do we still need insulin to break down foods with no carbs ? Thanks again.

In the absence of carbs, approx 40% of protein and 10% of fat will be broken down into glucose which will then hit the blood stream. If you take a boiled egg which is almost equal parts fat and protein with about 7g of each in a large egg. 40% of that 7g of protein is about 3g and 10% of the 7g fat breaks down to 0.7g carbs, so about 3.7g carbs from the protein and fat in one egg. Say you have 2 eggs, that is about 7g carbs. Add in a bit of salad for and you might get to 10-15g carbs which means that you are not going to be a long way out when you get to your next meal if you don't inject any bolus insulin. If you do that meal a few times and find you are getting reasonably consistently high readings at your next meal time, then you could perhaps experiment with 1-2 units of insulin for a 2 egg salad and see how that goes. Or do a similar calculation for Tuna or ham if that is your preference with a salad. With fat, you would have to eat an awful lot of fat for the 10% conversion to make a significant difference to your overall BG so mostly we ignore that and just calculate the protein. Do bear in mind that meat and fish and eggs are predominantly water though, so whilst an egg might be 60g in weight only 7g of those are actually protein and it will be the same with tuna and slices of ham or beef etc, so don't make the mistake of weighing the egg or the meat and just taking 40% of that. You have to look up the protein content of that meat or fish and then work out how many grams of protein are in your 3 slices of ham of half a tin of tuna and then work out 40% of that....
Hope that makes sense. It can all get a bit complicated which is why sometimes having regular carb portions with every meal is sometimes easier.

On the other hand, I like to make life as complicated as possible and follow a low carb way of eating, so most of my meals do not contain a main source of carbs. You get used to judging protein, just like you would carbs after a while. The advantage is that if I get it wrong I am not going to get it hugely wrong because it might be the difference between just 2 or 3 units of bolus insulin with a meal, so I can never make a big mistake. I often use just 4 or 5 units of bolus insulin in a day eating like this, so any hypos are not really serious ones and if I go high, it is not hugely high.

 

[Pat91]

In the absence of carbs, approx 40% of protein and 10% of fat will be broken down into glucose which will then hit the blood stream. If you take a boiled egg which is almost equal parts fat and protein with about 7g of each in a large egg. 40% of that 7g of protein is about 3g and 10% of the 7g fat breaks down to 0.7g carbs, so about 3.7g carbs from the protein and fat in one egg. Say you have 2 eggs, that is about 7g carbs. Add in a bit of salad for and you might get to 10-15g carbs which means that you are not going to be a long way out when you get to your next meal if you don't inject any bolus insulin. If you do that meal a few times and find you are getting reasonably consistently high readings at your next meal time, then you could perhaps experiment with 1-2 units of insulin for a 2 egg salad and see how that goes. Or do a similar calculation for Tuna or ham if that is your preference with a salad. With fat, you would have to eat an awful lot of fat for the 10% conversion to make a significant difference to your overall BG so mostly we ignore that and just calculate the protein. Do bear in mind that meat and fish and eggs are predominantly water though, so whilst an egg might be 60g in weight only 7g of those are actually protein and it will be the same with tuna and slices of ham or beef etc, so don't make the mistake of weighing the egg or the meat and just taking 40% of that. You have to look up the protein content of that meat or fish and then work out how many grams of protein are in your 3 slices of ham of half a tin of tuna and then work out 40% of that....
Hope that makes sense. It can all get a bit complicated which is why sometimes having regular carb portions with every meal is sometimes easier.

On the other hand, I like to make life as complicated as possible and follow a low carb way of eating, so most of my meals do not contain a main source of carbs. You get used to judging protein, just like you would carbs after a while. The advantage is that if I get it wrong I am not going to get it hugely wrong because it might be the difference between just 2 or 3 units of bolus insulin with a meal, so I can never make a big mistake. I often use just 4 or 5 units of bolus insulin in a day eating like this, so any hypos are not really serious ones and if I go high, it is not hug

In the absence of carbs, approx 40% of protein and 10% of fat will be broken down into glucose which will then hit the blood stream. If you take a boiled egg which is almost equal parts fat and protein with about 7g of each in a large egg. 40% of that 7g of protein is about 3g and 10% of the 7g fat breaks down to 0.7g carbs, so about 3.7g carbs from the protein and fat in one egg. Say you have 2 eggs, that is about 7g carbs. Add in a bit of salad for and you might get to 10-15g carbs which means that you are not going to be a long way out when you get to your next meal if you don't inject any bolus insulin. If you do that meal a few times and find you are getting reasonably consistently high readings at your next meal time, then you could perhaps experiment with 1-2 units of insulin for a 2 egg salad and see how that goes. Or do a similar calculation for Tuna or ham if that is your preference with a salad. With fat, you would have to eat an awful lot of fat for the 10% conversion to make a significant difference to your overall BG so mostly we ignore that and just calculate the protein. Do bear in mind that meat and fish and eggs are predominantly water though, so whilst an egg might be 60g in weight only 7g of those are actually protein and it will be the same with tuna and slices of ham or beef etc, so don't make the mistake of weighing the egg or the meat and just taking 40% of that. You have to look up the protein content of that meat or fish and then work out how many grams of protein are in your 3 slices of ham of half a tin of tuna and then work out 40% of that....
Hope that makes sense. It can all get a bit complicated which is why sometimes having regular carb portions with every meal is sometimes easier.

On the other hand, I like to make life as complicated as possible and follow a low carb way of eating, so most of my meals do not contain a main source of carbs. You get used to judging protein, just like you would carbs after a while. The advantage is that if I get it wrong I am not going to get it hugely wrong because it might be the difference between just 2 or 3 units of bolus insulin with a meal, so I can never make a big mistake. I often use just 4 or 5 units of bolus insulin in a day eating like this, so any hypos are not really serious ones and if I go high, it is not hugely high.

Blimey defiantly sounds like you know what are you talking about when it comes to this sort of stuff, I think I understand what you are saying and maybe like you say the only way is too slightly tweak insulin doses here and there. Going slightly off topic but say my bloods were nearing low say 5 and I still had 2 hours till dinner would an apple be enough to avoid a hypo? Thanks again and sorry for all the questions .

 

[rebrascora]

An apple is about 15 g carbs depending upon size and type so likely to take your levels up by about 4.5mmols as a rough approximation. So that might take you up form 5 to 9.5 by 2 hours later but it depends upon when you last injected your bolus insulin for the previous meal as to how much is still active in your system and might also take up some of the carbs from the apple. So there might be 2 units of insulin still active in your system when you eat the apple and you end up something like 4.5 before the next meal or there is no active insulin left and you end up in the 9s. Understanding how much insulin may still active in your system is an individual thing which depends on the insulin used and your absorption rate etc and how active you are at that time or if you were very active earlier, which will make you much more responsive to the insulin.... so lots of factors to take intop consideration and only trial and error and lots of documenting food and readings will show you how your body works.
If I am in the 4s I usually just have a single prune and that acts like about 5g carbs, so will take me up into the 5s but then I don't use 8 or 10 units of bolus insulin with a meal, just 2 or 3 so it is very unlikely there will be much left over to send me hypo unless I do a lot of exercise.

No one can really tell you, just your own body and your BG meter, which is where more frequent testing (or Libre) can be so helpful in learning how it works.

 

[grovesy]

Please post your experience.
I am looking forward to getting mine - my DSN has said she has written to my GP to get my prescription changed but speed and efficiency are not their string points so I think it will be a while before I get my hands on one.
My current Libre failed this morning so I had to report it to Abbott. They are sending a replacement. I hoped I could convince them to send a Libre 2 but they only replace like for like.

Sorry, long way of saying I am looking forward to reading other's experience of Libre 2.
Maybe I can experience your improved accuracy vicariously.

I have 4 in the wardrobe, I ordered early as we have been having problems with the post here since Xmas. Though the order came in usal time as they come tracked. The replacement reader came quickly too!

 

[Pat91]

An apple is about 15 g carbs depending upon size and type so likely to take your levels up by about 4.5mmols as a rough approximation. So that might take you up form 5 to 9.5 by 2 hours later but it depends upon when you last injected your bolus insulin for the previous meal as to how much is still active in your system and might also take up some of the carbs from the apple. So there might be 2 units of insulin still active in your system when you eat the apple and you end up something like 4.5 before the next meal or there is no active insulin left and you end up in the 9s. Understanding how much insulin may still active in your system is an individual thing which depends on the insulin used and your absorption rate etc and how active you are at that time or if you were very active earlier, which will make you much more responsive to the insulin.... so lots of factors to take intop consideration and only trial and error and lots of documenting food and readings will show you how your body works.
If I am in the 4s I usually just have a single prune and that acts like about 5g carbs, so will take me up into the 5s but then I don't use 8 or 10 units of bolus insulin with a meal, just 2 or 3 so it is very unlikely there will be much left over to send me hypo unless I do a lot of exercise.

No one can really tell you, just your own body and your BG meter, which is where more frequent testing (or Libre) can be so helpful in learning how it works.

Right ok I see will keep on experimenting and logging my bloods and diet, thank you