BG PATTERNS FOR TYPE 1 - HELP WITH

[Lucyr]

@rebrascora @Lucyr also anyone else

View attachment 17108

4 scans a day is very low I’d say if you’re using the sensor full time, and so you aren’t capturing all the data. You need to scan first thing when you get up and last thing before bed as well as regularly during the day.

From the low number of scans and the type of questions you’re asking I’d suggest you aren’t scanning much as you don’t seem to understand how to use the data. I’d recommend that you do all the online diabetes and libre training that is available. Asking questions here is good but it’s really no substitute for learning more yourself and being able to make better and more confident insulin decisions.

 

[mum2westiesGill]

@mum2westiesGill

If you want to see patterns then go to the Libre app and in the same drop down list that you found the time in target there is an option to see "Daily Patterns". This will give a cumulative graph of your daily patterns. There's also a useful graph of each day's individual graph that can be viewed. I have been using the Libre on and off (self funded) since it came out, until I got it on prescription about 18 months ago. I had also taken part in a number of research trials on it conducted by my clinic. It was only after I got it on prescription that I realised there was an online course on it. I learned a lot on the course that I hadn't really known before. If you'd like to take it, then it can be found here at the Libre Academy.

By the way, this nurse who says you have erratic control, is she at the GP's surgery or is she at the hospital clinic?

FWIW I think you are doing very well, but do need to iron out those hypos a bit.

Hi @Pattidevans - thank you for the link for the libre academy which I'm going to do.

The nurse is at a hospital clinic.

 

[mum2westiesGill]

4 scans a day is very low I’d say if you’re using the sensor full time, and so you aren’t capturing all the data. You need to scan first thing when you get up and last thing before bed as well as regularly during the day.

From the low number of scans and the type of questions you’re asking I’d suggest you aren’t scanning much as you don’t seem to understand how to use the data. I’d recommend that you do all the online diabetes and libre training that is available. Asking questions here is good but it’s really no substitute for learning more yourself and being able to make better and more confident insulin decisions.

How many times a day would you say to scan starting from the first scan when I get up? Can you suggest something (maybe a timetable) for me so I can get as much data as possible?

 

[pm133]

20/5/2021
7:43am - 3.9 - waking - had 4 jelly babies to treat hypo
8:07 - 7.6 - 15 minute hypo check
9:11am - 10.4 - breakfast - 2 potato cakes - 3.4 cp or 34g carbs

I'm having some problems following this.
What time did you bolus for your breakfast?
Is that 10.4 before you started eating or after you had eaten your breakfast?
What was the time between eating breakfast and getting that 10.4?

If you had a 10.4 and then added breakfast, then I think that is explaining the highs you are experiencing around mid-day. That is a very high number to start eating at and I;d be wanting that down below 8 first.

I'm, also wondering whether your reading of 3.9 is actually a hypo at all. Did you confirm it with a finger prick test? If not, that might explain why you are getting to 10.4 before breakfast.

 

[Lucyr]

How many times a day would you say to scan starting from the first scan when I get up? Can you suggest something (maybe a timetable) for me so I can get as much data as possible?

I don’t really think it’s appropriate to give a timetable. The scans should be driven by when you are going to act on the data, not just be to capture the data.

You need to scan at least every 8 hours to capture the data. You should then also be scanning when you are thinking about eating something to see the value and direction of BG which helps you decide what to eat and how long to prebolus, then around exercise to check if your bg needs any adjustment to prepare for exercise, after meals if youve guessed carbs or eaten something new and want to see how that is affecting your bg for whether any adjustment needed, when you feel off, the list could go on forever. When to scan is an intuitive thing based on what information you need in the moment not a timetable.

 

[pm133]

How many times a day would you say to scan starting from the first scan when I get up? Can you suggest something (maybe a timetable) for me so I can get as much data as possible?

I'm probably a very bad example because I really like scanning but I'm scanning about 20-30 times per day. I just love using this thing.

I like early warning of spikes, I test before all meals, 2 hours after all meals, 4 hours after all meals, before getting in the car, before and after walking the dog. First thing in the morning, last thing at night, at any time I feel a bit weird, if I wake up in the middle of the night and a host of other times as well.

I tend to observe and reflect on the results and the trends. I very rarely react unless it's jumping on my bike for a short burst.

If you are not checking at least 8 times per day then you aren't using the device properly. Maybe it's because you don't understand what it is doing for you and the online courses you've been directed to will definitely help you. Other than advising on the number of scans you need to be doing and recommending the online course, I am not in a position to recommend anything to you. My recording history is provided only as an example. You need to work out your own routine based on what the device is telling you about your levels and the lifestyle you lead.

 

[Bruce Stephens]

How many times a day would you say to scan starting from the first scan when I get up? Can you suggest something (maybe a timetable) for me so I can get as much data as possible?

At least every 8 hours (the sensor only remembers the last 8 hours so you don't want to allow more than 8 hours to pass without a scan). But as many extra times as is convenient.

The same Sensor Usage page that shows how many scans a day you're doing shows the percentage of data captured. (Mine says 33 scans per day and 97% over the past 7 days. It's 100% for 14, 30, 90 days.)

 

[rebrascora]

I use mine to bolus for meals instead of finger pricking once I have established that a sensor is working reliably and I might not finger prick for several days if I am confident that the sensor is within a reasonable range of finger prick BG levels. I scan if I wake up through the night, I scan as soon as I wake up on a morning. I use that reading to decide my breakfast bolus because I usually bolus for breakfast as soon as I wake up and I log that insulin on the Libre log against that reading. I then scan regularly every 5-10 mins after injecting to see when the insulin is kicking in, what my Foot on the Floor syndrome is doing and when it is a good time to eat my breakfast.... I personally need about 45mins pre-bolus time for breakfast to prevent my BG spiking so I keep checking whilst I have my coffee and get my breakfast ready and the Libre will show me when the insulin is starting to kick in it is the best time to start eating, to prevent my BG either spiking or dropping too low
I record my food (carbs) on the reader at the point I start eating so I can look back and see when I injected the insulin and then see how long later it was when I ate the meal. Basically I use the Libre as a means of logging my food and exercise and insulin. I scan after the meal to see how well I timed it so that if I didn't quite get it right I know that I need to leave it a little longer or l;ess long between injecting and eating next time. I scan before during and after exercise. If my reading is over 8 at meal times I inject insulin and then scan frequently to see when it falls to about 6 and eat then to prevent a spike. Eating when your BG is above 8 is never a good idea although I appreciate there are times when it can't be avoided, most times with the help of Libre it can. You get a much better understanding of how quickly or slowly your insulin works and an intuitive sense of Insulin on board and whether it will be enough or you need a correction... at least I have and it is very rare that I over correct because I understand how the Libre works and how my body works.
Obviously I scan before I drive. I scan if I don't feel right and if I am hypo I scan regularly afterwards although it may take half an hour to show I have recovered, rather than the 15 mins it takes to show with a finger prick, but it can help to head off a double dip an hour or two later if you keep a closer eye on things once you have recovered.

Like @pm133 I like scanning and knowing what my levels are doing.... It is a bit addictive and I treat it rather like a very slow computer game. It may seem excessive but there are times when I scan 30+x a day and I would be very disappointed if I didn't capture 100% of data. I don't act on a lot of the information I get from scanning but it builds an understanding of how my BG and insulin and food work. I then have more knowledge to improve my Time in Target which is the ultimate goal because that means I have better diabetes management.

The above is just what I do and everyone is different but at the moment you don't really seem to understand what to do to reap the huge benefits of Libre. Hopefully some online education will help you get a lot more from it.

 

[helli]

I would be scanning at least
- when I get up (or may be just before)
- when I am going to bolus (at least every meal)
- before exercise (including when you are starting your job with lunchtime cover and any housework)
- after exercise as exercise could affect your readings
- before driving - my understanding is this is a legal requirement because you must not drive when hypo and must treat anything below 5 before driving.
- before going to bed so you don't go to bed too high or too low
- when you feel "off" - maybe feeling hypo or feeling you are too high
- if I wake up in the middle of the night. Waking when unplanned is often a symptom of high or low readings for me

 

[mum2westiesGill]

I'm having some problems following this.
What time did you bolus for your breakfast?
Is that 10.4 before you started eating or after you had eaten your breakfast?
What was the time between eating breakfast and getting that 10.4?

If you had a 10.4 and then added breakfast, then I think that is explaining the highs you are experiencing around mid-day. That is a very high number to start eating at and I;d be wanting that down below 8 first.

I'm, also wondering whether your reading of 3.9 is actually a hypo at all. Did you confirm it with a finger prick test? If not, that might explain why you are getting to 10.4 before breakfast.

Hi @pm133 - I bolused for breakfast at 9:11am.
The 10.4 was just before I started eating breakfast.
The 10.4 was when I tested and bolused at 9:11am.

I couldn't really wait for it to drop to below 8 because I was getting ready for work - I go out of the house at 11:00am.

The reading of 3.9 was a finger prick test.

 

[mum2westiesGill]

Bolus time 13:59pm - 7.3 finger prick - 6.4 cp or 64g of carbs - lunchtime

 

[PattiEvans]

@Pattidevans Just to clarify, Gill has already posted attachments of her "Daily Patterns" reports on this thread but it seems like her data is missing from 9pm to 3am which suggests that she isn't scanning frequently enough.

I agree that she would most likely benefit from some online training/study at the Libre Academy to get more benefit from her Libre use and I also agree that she is doing very well and the nurse should be much more encouraging instead of making negative remarks which don't seem to be evidenced by the data that we are seeing.

I did see those screen shots but was on my way out so didn't analyse them too closely. There seemed to be a lack of info there to report a pattern. I do hope Gill knows when to scan now. I do it all the time. I do not have to have an excuse to do it!

 

[Bruce Stephens]

I do not have to have an excuse to do it!

I'm sure I saw one video where there was advice only to scan when you expect to make some choice based on what you see. That always seemed daft to me, so I also scan often. (And there's at least one paper showing more frequent scanning correlates with better control. I don't find that at all persuasive about causality but it at least suggests there's not much harm in scanning frequently.)

There's a book (and website, etc.) based on the idea, Sugar Surfing

 

[rebrascora]

Hi @pm133 - I bolused for breakfast at 9:11am.
The 10.4 was just before I started eating breakfast.
The 10.4 was when I tested and bolused at 9:11am.

I couldn't really wait for it to drop to below 8 because I was getting ready for work - I go out of the house at 11:00am.

The reading of 3.9 was a finger prick test.

So basically you are saying that you injected your bolus at 9.11 am and then ate breakfast straight afterwards.... ie you did not pre bolus at all? With a reading of 10.4 and no prebolus time your levels are going to shoot up into the mid teens and then come back down which is not ideal.
Do you understand about pre bolusing Gill? Ie injecting insulin 15-20 mins before you eat to give the insulin time to start making it's way into your blood stream before the carbs spike you too high. Breakfast time is often when pre blolusing is most important and as I say, I have found for me it takes 45 mins in the morning before breakfast.... so I inject my bolus insulin 45mins before I am going to eat breakfast. It is usually just 15-20 mins at other times of the day but breakfast is a lot longer. I worked this out because I keep scanning with my Libre after I inject the insulin to see when it starts lowering my levels and once my levels start to drop I know the insulin is starting to work and I eat my food and then the food and the insulin hit the blood stream at pretty much the same time and your levels don't spike. You can scan every 2-3 mins if you want, so that you can spot it as soon as it starts to kick in. Once you do this a few times you will get to know how long after injecting you can eat your meal ie your prebolus time interval

If that doesn't make sense, please ask as I am not sure I have explained it very well.

 

[pm133]

Hi @pm133 - I bolused for breakfast at 9:11am.
The 10.4 was just before I started eating breakfast.
The 10.4 was when I tested and bolused at 9:11am.

I couldn't really wait for it to drop to below 8 because I was getting ready for work - I go out of the house at 11:00am.

The reading of 3.9 was a finger prick test.

Hi Gill,
So I would have bolused for my breakfast at 8.07 once you had that reading of 7 after the hypo and then eaten breakfast once the insulin kicked in.
I am not sure 4 jelly babies was needed. Probably one would have done.
I would also be looking at my basal.

 

[mum2westiesGill]

Hi Gill,
So I would have bolused for my breakfast at 8.07 once you had that reading of 7 after the hypo and then eaten breakfast once the insulin kicked in.
I am not sure 4 jelly babies was needed. Probably one would have done.
I would also be looking at my basal.

Hi @pm133 - thanks for your reply. Why would you be looking at the Tresiba (my basal)?

 

[mum2westiesGill]

20/5/2021 - continued
13:59pm - 7.4 - before lunch - salmon sandwich on 2 rounds hovis med white 3.6 cp or 36g carbs, batchelors cup a soup 1.2 cp or 12g carbs, 1 chocolate mini roll 1.6 cp or 16g carbs
16:45pm - 10.4 - 3 hours post lunch
19:36pm - 5.3 - before tea - 10.3 cp or 103g carbs
20:57pm - 4.9 after meal blood test - 3.7 on freestyle libre - had 2 bags of crisps 1.8 cp or 18g of carbs
22:59pm - 8.5 finger prick - 8.3 on freestyle libre bedtime

21/5/2021
7:33am - 4.7 - waking finger prick - 4.2 on freestyle libre
9:02am - 8.8 - breakfast finger prick - 4 units humalog then waited until
9:34am - 4.8 - ate breakfast - 2 rounds hovis 3.6 cp or 36g carbs
10:10am - 3.2 - has the waiting for breakfast not been the right thing for me to do? With humalog you can inject and eat straight away

 

[mum2westiesGill]

20/5/2021
10:33am - 7.5 - 15 minute hypo check finger prick - 7.1 on freestyle libre and rising quickly

 

[pm133]

Hi @pm133 - thanks for your reply. Why would you be looking at the Tresiba (my basal)?

Because you are waking up with hypos.

 

[pm133]

21/5/2021
7:33am - 4.7 - waking finger prick - 4.2 on freestyle libre
9:02am - 8.8 - breakfast finger prick - 4 units humalog then waited until
9:34am - 4.8 - ate breakfast - 2 rounds hovis 3.6 cp or 36g carbs
10:10am - 3.2 - has the waiting for breakfast not been the right thing for me to do? With humalog you can inject and eat straight away

After taking the 4 units at 9.02, did you keep continuously monitoring your levels, as @rebrascora suggested, until they started to drop? Not sure why you waited until you were at 4.8 to start eating.
It looks like you've waited too long to eat.
You'll need to tweak that.