‘dawn phenomenon’

[trophywench]

You do not use Innolet insulin. You use Insulatard insulin. Insulatard insulin has faster acting and slower acting insulins combined within it. You therefore need to discuss completely changing your insulin regime with your Doctor in order to obtain both separately. It will of course entail more jabs every day., so are you prepared for that?

Libre is notoriously unreliable as said when the BG is rapidly changing, but also when the BG is either at the low end of the scale or at the high end.

 

[AnnSebastian]

You do not use Innolet insulin. You use Insulatard insulin. Insulatard insulin has faster acting and slower acting insulins combined within it. You therefore need to discuss completely changing your insulin regime with your Doctor in order to obtain both separately. It will of course entail more jabs every day., so are you prepared for that?

Libre is notoriously unreliable as said when the BG is rapidly changing, but also when the BG is either at the low end of the scale or at the high end.

Whatever.

What on earth is this forum for?

Are you a doctor?

I dipped into Diabetes UK looking for a little moral support and find the majority of vocal users appear to be single minded autocrats - ‘advising people ‘what they need’ ?

Feels as if I’ve been transported to a parallel universe.

 

[Proud to be erratic]

Hi Ann @AnnSebastian,

You said earlier in this thread you were trying to control your spikes My ‘average blood glucose’ is down to 6 - 6.1 (from well over 7) but the spikes just won’t stop. I need to keep the rest of my readings really low to maintain that average and you acknowledged that bolus insulin might be an option.

Would you like to share a screen-shot of a typical day of spikes?

My BG is very spiky, admittedly I have no panc'y so that brittleness is more explainable.

This is mine from the 31st Jan, on a day when I lost control. The early hours crash is inexplicable to me; I struggle to understand what is happening at 1am when I'm asleep. I know my basal is about right from a recent check. Although I tried to diligently monitor and stay in control after I woke, you can see that I lost it midday & around dinner time. The abrupt change at 11 pm is from a switch to a new sensor. The previous one was a bit low all the time but manageable. The new one is excessively high and I'm about to phone Abbott and ask for a new one.

This from the 26th. I tried to be extremely diligent all last week with mixed success. One thing I found has been that, if I can curtail the first spike, then the rest of the day is better. If I'm on the yo-yo then each high produces a rapid crash and a subsequent rebound. So on the 26th I was watching like a hawk and as soon as a fall seemed possible I started taking small snacks; when an arrow up appeared, I immediately "got active" - nothing extreme just moved around, did little jobs, went up and down stairs, basically anything to arrest the up arrow. Of course this is completely unsustainable in the middle or long term, but I wanted to find out if my BG could be better controlled.
Anyway, must phone Abbott.

 

[AnnSebastian]

Hi Ann @AnnSebastian,

You said earlier in this thread you were trying to control your spikes My ‘average blood glucose’ is down to 6 - 6.1 (from well over 7) but the spikes just won’t stop. I need to keep the rest of my readings really low to maintain that average and you acknowledged that bolus insulin might be an option.

Would you like to share a screen-shot of a typical day of spikes?

My BG is very spiky, admittedly I have no panc'y so that brittleness is more explainable.
View attachment 19969
This is mine from the 31st Jan, on a day when I lost control. The early hours crash is inexplicable to me; I struggle to understand what is happening at 1am when I'm asleep. I know my basal is about right from a recent check. Although I tried to diligently monitor and stay in control after I woke, you can see that I lost it midday & around dinner time. The abrupt change at 11 pm is from a switch to a new sensor. The previous one was a bit low all the time but manageable. The new one is excessively high and I'm about to phone Abbott and ask for a new one.
View attachment 19970
This from the 26th. I tried to be extremely diligent all last week with mixed success. One thing I found has been that, if I can curtail the first spike, then the rest of the day is better. If I'm on the yo-yo then each high produces a rapid crash and a subsequent rebound. So on the 26th I was watching like a hawk and as soon as a fall seemed possible I started taking small snacks; when an arrow up appeared, I immediately "got active" - nothing extreme just moved around, did little jobs, went up and down stairs, basically anything to arrest the up arrow. Of course this is completely unsustainable in the middle or long term, but I wanted to find out if my BG could be better controlled.
Anyway, must phone Abbott.

I’m happy to post screenshots of LibreFreestyle data - it doesn’t personally identify me - so here we go.

This is an example.
Feeling a little despondent today.
My BG had gone down from 7+ to 6. Today it had risen to 6.1. Not a big increase but when you think you’re getting somewhere?

I made an appointment with my ‘new’ diabetes nurse for tomorrow to check out the option of adding some ‘fast acting’ insulin to deal with it.

However, I have a feeling that I might be told I would need to be referred to a ‘hospital consultant’ for anything more complicated than straightforward long acting insulin

Now I’ve started to ‘take back control’ myself that’s not what I really want. .

Anyone have any experience / advice on options in NHS Primary Care Diabetes services?

 

[Proud to be erratic]

View attachment 19972

I’m happy to post screenshots of LibreFreestyle data - it doesn’t personally identify me - so here we go.

So it's difficult to do anything about the 3 am spike, although it looks as though you were slightly high at midnight; perhaps a little activity before turning in might nudge that start point down, thus take out or soften that sleep spike. Clearly the one you would liked to have caught is the 1.30pm spike, which means diligent monitoring and getting active as soon as you spot the upturn. [Or bolus insulin, possibly once/if you have that regime change.] The rest of the afternoon and eve seem good, reflecting your control. It depends slightly how accurate that sensor was to actual BG and whether those 2 brief dips towards hypo were actual hypos or just "brief forays". Personally I wouldn't be concerned about that afternoon eve period - but I've had a lot worse.

This is an example.
Feeling a little despondent today.
My BG had gone down from 7+ to 6. Today it had risen to 6.1. Not a big increase but when you think you’re getting somewhere?

Really sorry you feel a bit despondent and I empathise, 2 steps forward and 1 back, etc. I assume your nos of 7+, 6 and 6.1 are your average BGs. I think its best to look at longer term trends, ie at least 30 days and better 90 days. I find all sorts of outside factors affect any one day and think only longer term trends are truly valid. But that's just my opinion.

I made an appointment with my ‘new’ diabetes nurse for tomorrow to check out the option of adding some ‘fast acting’ insulin to deal with it.

However, I have a feeling that I might be told I would need to be referred to a ‘hospital consultant’ for anything more complicated than straightforward long acting insulin

Now I’ve started to ‘take back control’ myself that’s not what I really want. .

I understand that resistance to feeling you need to surrender some of your DM management to others. But on the other hand if that specialist is on the ball, the gain far outweighs the loss. And you don't have to implement all of their recommendations if some feel inappropriate; but if you do need insulin changes then you need the expert help and authorisation. I used to service and repair my cars, but the onboard technology now makes that impossible so I had no choice and now, secretly, am happy to let someone else have dirty hands! Keep persisting, you do seem to be getting there.

 

[AnnSebastian]

So it's difficult to do anything about the 3 am spike, although it looks as though you were slightly high at midnight; perhaps a little activity before turning in might nudge that start point down, thus take out or soften that sleep spike. Clearly the one you would liked to have caught is the 1.30pm spike, which means diligent monitoring and getting active as soon as you spot the upturn. [Or bolus insulin, possibly once/if you have that regime change.] The rest of the afternoon and eve seem good, reflecting your control. It depends slightly how accurate that sensor was to actual BG and whether those 2 brief dips towards hypo were actual hypos or just "brief forays". Personally I wouldn't be concerned about that afternoon eve period - but I've had a lot worse.

Really sorry you feel a bit despondent and I empathise, 2 steps forward and 1 back, etc. I assume your nos of 7+, 6 and 6.1 are your average BGs. I think its best to look at longer term trends, ie at least 30 days and better 90 days. I find all sorts of outside factors affect any one day and think only longer term trends are truly valid. But that's just my opinion.

I understand that resistance to feeling you need to surrender some of your DM management to others. But on the other hand if that specialist is on the ball, the gain far outweighs the loss. And you don't have to implement all of their recommendations if some feel inappropriate; but if you do need insulin changes then you need the expert help and authorisation. I used to service and repair my cars, but the onboard technology now makes that impossible so I had no choice and now, secretly, am happy to let someone else have dirty hands! Keep persisting, you do seem to be getting there.

It’s not so much about surrendering control - more about having taken back control but being left with one loose end. If I’d had a consultant before I would probably feel worse - if I had kept ‘underachieving’.

I’m pretty self-sufficient (ie stubborn) I tend to set my own agenda. With research of course.

There’s probably a big difference in NHS services depending on post codes. Also a difference in policy / objectives in different NHS trusts.

I was in a bit of a rut, but I’ve turned things around quite a bit - on my own initiative - but I predict a primary care ‘diabetes nurse’ won’t have much, if any experience of LibreFreestyle or similar so I’m keeping my expectations low.

 

[AnnSebastian]

It’s not so much about surrendering control - more about having taken back control but being left with one loose end. If I’d had a consultant before I would probably feel worse - if I had kept ‘underachieving’.

I’m pretty self-sufficient (ie stubborn) I tend to set my own agenda. With research of course.

There’s probably a big difference in NHS services depending on post codes. Also a difference in policy / objectives in different NHS trusts.

I was in a bit of a rut, but I’ve turned things around quite a bit - on my own initiative - but I predict a primary care ‘diabetes nurse’ won’t have much, if any experience of LibreFreestyle or similar so I’m keeping my expectations low.

 

[AnnSebastian]

But - from a totally selfish perspective - if #LibreFreestyle does become available to T2 - being ‘under the care of a consultant’ would earn me some brownie points. Totally mercenary - but unfortunately the way of the modern world.

 

[Proud to be erratic]

I think you should go to your diabetes nurse app't with a determination to get a proper review. I see a few advantages:

Firstly, as you have already said how can you be eligible for Libre 2 if you are not in the system? You are walking proof that diligent use of Libre has been beneficial to you. It's not mercenary, it's what the NHS can do for you, if you become eligible. I am TOTALLY convinced that expenditure on prevention far outweighs the prospective burden on the NHS and Social Services. I've read somewhere in this forum that of the total spend within the NHS on DM, 90% goes into subsequent problems and only 10% goes into everyday treatment. If that is broadly correct, it is shameful.

Secondly, my Endo has provided his contact details and those of his team. If I have a problem that is not necessarily worthy of his attention, I can place it with the team, by phone or email and an enquiry on a Tuesday brought a return phone call earlier on Wednesday; simple problem, simple response.

Thirdly, from what little I know, T2 can be deceptively problematic: your panc'y isn't working properly, for whatever reason and that means you could get a degree of remission, or not (sorry - not being blatantly pessimistic, just realistic). Helps to be "in the system", rather than in a Q for a GP appointment.

Lastly, it's highly unlikely you will get a fast response to a request for a referral. Endos are busy, like so many other specialists and you are alive, coping so not necessarily an urgent case! So a foot in the door can always be withdrawn if you end up solving your own concerns.

Good luck.

 

[AnnSebastian]

I think you should go to your diabetes nurse app't with a determination to get a proper review. I see a few advantages:

Firstly, as you have already said how can you be eligible for Libre 2 if you are not in the system? You are walking proof that diligent use of Libre has been beneficial to you. It's not mercenary, it's what the NHS can do for you, if you become eligible. I am TOTALLY convinced that expenditure on prevention far outweighs the prospective burden on the NHS and Social Services. I've read somewhere in this forum that of the total spend within the NHS on DM, 90% goes into subsequent problems and only 10% goes into everyday treatment. If that is broadly correct, it is shameful.

Secondly, my Endo has provided his contact details and those of his team. If I have a problem that is not necessarily worthy of his attention, I can place it with the team, by phone or email and an enquiry on a Tuesday brought a return phone call earlier on Wednesday; simple problem, simple response.

Thirdly, from what little I know, T2 can be deceptively problematic: your panc'y isn't working properly, for whatever reason and that means you could get a degree of remission, or not (sorry - not being blatantly pessimistic, just realistic). Helps to be "in the system", rather than in a Q for a GP appointment.

Lastly, it's highly unlikely you will get a fast response to a request for a referral. Endos are busy, like so many other specialists and you are alive, coping so not necessarily an urgent case! So a foot in the door can always be withdrawn if you end up solving your own concerns.

Good luck.

Thank you. That’s the kindest reply I’ve read to a post so far. Yes, you are absolutely right. I’ll push for a referral to a ‘specialist.
Ann

 

[AnnSebastian]

I think you should go to your diabetes nurse app't with a determination to get a proper review. I see a few advantages:

Firstly, as you have already said how can you be eligible for Libre 2 if you are not in the system? You are walking proof that diligent use of Libre has been beneficial to you. It's not mercenary, it's what the NHS can do for you, if you become eligible. I am TOTALLY convinced that expenditure on prevention far outweighs the prospective burden on the NHS and Social Services. I've read somewhere in this forum that of the total spend within the NHS on DM, 90% goes into subsequent problems and only 10% goes into everyday treatment. If that is broadly correct, it is shameful.

Secondly, my Endo has provided his contact details and those of his team. If I have a problem that is not necessarily worthy of his attention, I can place it with the team, by phone or email and an enquiry on a Tuesday brought a return phone call earlier on Wednesday; simple problem, simple response.

Thirdly, from what little I know, T2 can be deceptively problematic: your panc'y isn't working properly, for whatever reason and that means you could get a degree of remission, or not (sorry - not being blatantly pessimistic, just realistic). Helps to be "in the system", rather than in a Q for a GP appointment.

Lastly, it's highly unlikely you will get a fast response to a request for a referral. Endos are busy, like so many other specialists and you are alive, coping so not necessarily an urgent case! So a foot in the door can always be withdrawn if you end up solving your own concerns.

Good luck.

An admission.

I didn’t make it to the appointment.
Was feeling demotivated.
Started to fall off the wagon - my ‘average’ BG went back up to 6.1 from 6. First time I’d gone backwards since I started Libre. I think stress has more impact on BG than I realised.

Anyway - I’ll spend a little time trying to get back on track - and then try again.

Thanks again for your moral support.

 

[Leadinglights]

An admission.

I didn’t make it to the appointment.
Was feeling demotivated.
Started to fall off the wagon - my ‘average’ BG went back up to 6.1 from 6. First time I’d gone backwards since I started Libre. I think stress has more impact on BG than I realised.

Anyway - I’ll spend a little time trying to get back on track - and then try again.

Thanks again for your moral support.

There is really no difference between 6 and 6.1 or 2 or 3 or 4 etc or 6 and 5.9, 8. 7 etc. Most instruments unless they cost thousands of pound are not that accurate.

 

[AnnSebastian]

There is really no difference between 6 and 6.1 or 2 or 3 or 4 etc or 6 and 5.9, 8. 7 etc. Most instruments unless they cost thousands of pound are not that accurate.

Libre sensor has been pretty consistent so far. It provides a variety of graphs reflecting the scans I make during the day over periods of ‘7, 14, 30 and 90 days.

I can’t see why it should suddenly malfunction and give me a reading that doesn’t merge with the last three months. It’s now on 6.3 average for the past 7 days - I’m afraid to open the ‘estimated A1C’ page in case it’s gone back to 6+.

 

[AnnSebastian]

… And climbing - up to 7.
I need food. I’ll get back on the wagon in a couple of days.

 

[Proud to be erratic]

An admission.

I didn’t make it to the appointment.
Was feeling demotivated.
Started to fall off the wagon - my ‘average’ BG went back up to 6.1 from 6. First time I’d gone backwards since I started Libre. I think stress has more impact on BG than I realised.

Anyway - I’ll spend a little time trying to get back on track - and then try again.

Thanks again for your moral support.

You are welcome.

… And climbing - up to 7.
I need food. I’ll get back on the wagon in a couple of days. View attachment 20001

From here your graph looks great. 100% in target and no veering towards hypo. Potential hyper at mid-day avoided; well done.

 

[AnnSebastian]

You are welcome.

From here your graph looks great. 100% in target and no veering towards hypo. Potential hyper at mid-day avoided; well done.

It would have been perfect six weeks ago. But I’ve steadily reduced my daily BG average from way over 7 to 6.1 over the past three months. Estimated A1C right down to 5.9. / 41. I was gradually lowering my ‘target range’ as well Just feels like I’ve got to start all over again.

 

[Lucyr]

Sounds less like “starting again” and more like just making some tweaks that may be needed? It’s not much that you’re looking to change your bgs by so hopefully not too many changes needed.