Diabetes Greeting

[Damaris]

I would not have known anything about BERTIE if it had not been mentioned on here. The dietitian had mentioned about how many grams of carbs I should be eating per meal and I had been doing that when I was using the finger pricks for the first month but as soon as I went onto the Freestyle Libre 2 I got out of the pattern and was eating less carbs. Is it before every meal you do the insulin you need to wait 15 minutes before eating food?

 

[Spathiphyllum]

I would not have known anything about BERTIE if it had not been mentioned on here.

Same for me!

The dietitian had mentioned about how many grams of carbs I should be eating per meal and I had been doing that when I was using the finger pricks for the first month but as soon as I went onto the Freestyle Libre 2 I got out of the pattern and was eating less carbs. Is it before every meal you do the insulin you need to wait 15 minutes before eating food?

The amount of time you need between injecting and eating will vary! Depending on your own physiology, depending on the time of day, depending on what sort of food you're eating; also depending on what sort of bolus insulin you're using, especially whether it's NovoRapid or Fiasp ...

The only way to find out is by recording in your Logbook and then reviewing and reflecting on what happens with your BG; with any luck, your DSN and/or consultant will also look at and reflect on it! You should eventually be able to see patterns which will help you work out how much time you need to allow for 'pre-bolusing' for different meals.

I only suggested 15 minutes, for every meal, as a starting point; you will probably find, from experience, that you need to allow more than that for some meals, and you may find you need less for others!

Speaking of which-- I need to dine very early today, so I'd best get on with deciding what to eat, working out the carbs, and working out how much to inject and when ... I still miss Planet Pre-Diabetes! ; ) Hope you have a nice dinner and a peaceful evening.

 

[Inka]

I would not have known anything about BERTIE if it had not been mentioned on here. The dietitian had mentioned about how many grams of carbs I should be eating per meal and I had been doing that when I was using the finger pricks for the first month but as soon as I went onto the Freestyle Libre 2 I got out of the pattern and was eating less carbs. Is it before every meal you do the insulin you need to wait 15 minutes before eating food?

No, the time you need to bolus in advance can vary - vary for each meal (ie breakfast, etc), vary depending on your blood sugar, and just change over time. (Type 1 is a bit like that - things change, change back, and then change again.)

If you’re injecting right before your meal, I’d try 5 mins before for a few days and see how it goes, then 10 minutes, etc. You might find you can inject just before eating for some meals (I can for my evening meal). The important thing to remember is it’s what works for you as an individual. As an example, you might find you need 20mins in advance for breakfast, 10 mins for lunch, and 15mins for your evening meal. It’s a case of slow, cautious experimentation. Start with one meal, eg breakfast, and carefully change your injection time for that meal. Once you’re happy with that, move on to another meal.

 

[Damaris]

I think that’s where I’ve been going wrong because I’ve been doing my insulin for meals and then immediately eating my food. Then my sensor alarm goes off when I’m eating my food and I’m like WHY? Then when I check the reading my blood sugar is around 13. I’ll try and do my insulin at earlier times and see if that makes a difference.

 

[Inka]

It’s not necessarily wrong @Damaris 🙂 Sadly there’s no one right way that we can all copy. It’s what suits you and your body. Its normal to spike up when you eat (even in people without diabetes) but there’s a good balance to be found where you inject at the best time to make sure you don’t spike too high (eg 19) and yet don’t drop too low before all your food’s been processed.

In addition, early in diagnosis, people are usually still making some insulin of their own. What happens is this insulin is released too late and sometimes is too much. This can cause a drop later. So, newly diagnosed people might spike to 14 but then drop right down to 3.7 at 3 or 4hrs after the start of their meal. Often that drop is your own insulin kicking in (too much, too late). For that reason, it’s wise to allow a reasonable spike in order to take into account your own insulin. It’s many years since I was diagnosed but I think I was told that spikes up to 13 or so were ok to start with. If your Libre is alarming, simply raise the High alarm to 14 or 15 or whatever. It’s your tool to use as suits you best.

As always, if in doubt err on the side of caution.

 

[Tdm]

I prebolus 25min plus for my morning muselli (my spikiest meal) with an injection into the thigh. Dinner i don't get to prebolus (due to work) but have egg, avo,veggy sausage and find that is i inject into my tummy the insulin gets to work quckest there (esp at the up, just below the ribs). Injecting into buttock leafs to slow release so use those for long lasting insulin.
It may not work same for you but it may be worth using the same area for injection when working out how much you have to prebolus

 

[Spathiphyllum]

Tdm makes a good point, about where you're injecting: in case no one's told you this yet, insulin absorption is fastest when you inject in the abdomen, middling when you inject in the thigh, and slowest when you inject in the buttocks. So where you inject will affect how long you need to pre-bolus.

On Inka's point, "early in diagnosis, people are usually still making some insulin of their own"-- have you had the C-peptide test? If so, that will give you an idea about whether your body is still producing any insulin and if so how much; some people, at the time of diagnosis, are still producing quite a bit of insulin of their own, but others (like me) aren't.

If you're on NovoRapid and injecting and then immediately eating something with easily digestible carbs-- it's no wonder you're spiking. Your body is digesting the carbs very quickly, so the glucose from the digested carbs is entering your bloodstream well before the insulin manages to make its way from your subcutaneous fat into your bloodstream.

With breakfast, this really pisses me off. ; ) I need coffee with lots of milk first thing in the morning, and waiting for it is torture; but, if I don't wait, the glucose from the carbs in the milk just sprints into my bloodstream, and the insulin hasn't got there yet to deal with it. I've switched to Fiasp, as it's a little faster-acting than NovoRapid, so I don't have to wait quite so long ...

That's enough for now! Do let us know how you get on.

 

[Damaris]

I’ve been injecting into my stomach. Changing sides each day as well. No I haven’t had a C-peptide test. Do you think I should ask my diabetic team for one? I’ve taken the advice and am now waiting about 5-10 minutes before having food and doing my insulin and I think it’s helping.

 

[Inka]

I’ve been injecting into my stomach. Changing sides each day as well. No I haven’t had a C-peptide test. Do you think I should ask my diabetic team for one? I’ve taken the advice and am now waiting about 5-10 minutes before having food and doing my insulin and I think it’s helping.

C Peptide tests are usually done if there’s some doubt about the diagnosis. Your diagnosis isn’t in doubt. For older adults, it might be needed more as then they’re more likely to be Type 2 (due to age) and the Type 1 they actually are can come on more slowly too, leading to some doubt about the correct diagnosis (ie what diabetes type they are). So, no, you don’t need one 🙂

You can also inject into your thigh and bum. Ask about where to inject if you’re unsure. It’s good to rotate injection sites as the insulin itself can ‘thicken’ areas over time, affecting absorption. Also, you can think about what you’ll be doing after the injection. For example, if you’re going to be going for a run, you might want to avoid your thigh (because the exercise will speed up absorption) whereas if your high you might want to inject in your tummy because it’s generally faster. Don’t worry too much about it. These are all things you’ll gradually pick up. Focus on the basics for now, like you’ve been doing.

 

[Damaris]

Doing my insulin and then waiting 10-15 minutes seems to be working as my Freestyle Libre Time In Range has gone up to 75%.

 

[rebrascora]

Congratulations! So pleased to hear you are seeing an improvement.

 

[everydayupsanddowns]

Doing my insulin and then waiting 10-15 minutes seems to be working as my Freestyle Libre Time In Range has gone up to 75%.

Amazing @Damaris !

That’s a fantastic result. I remember @SB2015 having exactly the same after seeing big rises in her Libre trace, and then experimenting with dose timing.

 

[SB2015]

That is great news @Damaris . Anything above %70 TIR will have a positive impact.

It makes so much sense to give the insulin time to get active so that it is ready to work in the glucose when it arrives in the system. I do find I need different timings through the day, and it takes time to work these out. A bit of trial and improvement.

Let us know how you get on.

 

[Damaris]

It seems to be I have a good sleep one night and then not much sleep the next night. This happened last night.

 

[Damaris]

I was working today and my blood sugar time in range has improved. My blood Hbac1 reading is this.

 

[Tdm]

It seems to be I have a good sleep one night and then not much sleep the next night. This happened last night.

View attachment 23920

Gosh, you seem to have woking up a lot that night.
I would have popped in a bit of a correction dose, as at those levels you aren't going to sleep well and may be needing the loo. With your libre to alert you should you go low, definitly worth thinking about. Though always check with a fingerprick before you take any extra insulin cos libre does occasionally tell you porkies.
On the plus side, looks like your basal is keeping you pretty level

 

[Lucyr]

It seems to be I have a good sleep one night and then not much sleep the next night. This happened last night.

Why were you scanning all night? Did the bg keep you awake? I wouldn’t normally feel sick at 13, and looking at your phone all night will keep you awake.

 

[Damaris]

I think I might have had my dinner at a later time that night but I’ve had a salad the last 2 nights for dinner and slept right through the night. I had a KFC one evening and it was only after I put my food order in the carbs and Cals app that I discovered if eaten 96 grams of carbs. The Diabetic team set 5 for the low reading and 13 for the high. Will have to get them to adjust them next time I have an appointment.

 

[Lucyr]

I think I might have had my dinner at a later time that night but I’ve had a salad the last 2 nights for dinner and slept right through the night. I had a KFC one evening and it was only after I put my food order in the carbs and Cals app that I discovered if eaten 96 grams of carbs. The Diabetic team set 5 for the low reading and 13 for the high. Will have to get them to adjust them next time I have an appointment.

Why don’t you just adjust it yourself? On my phone press the three lines top left then alarms. If the alarm woke you up all those times then you could have switched the high alarm off overnight or done a correction.

If it wasn’t the alarm that woke you up, then if your having a sleepless night I wouldn’t be constantly scanning the sensor as the light from phone will keep you awake. Obviously if you feel unwell in the night then scan.

 

[Tdm]

High blood sugars will give you a poor night's sleep.
When i was first diagnosed i took my diabetes nurses word as carved in stone truth and didn't want to change things without their agreement. That has...rather changed now.

But you only really take control of your diabetes when you understand and adjust your own doses.
And only you know when you are ready to do that.