A general question about starting on insulin

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Strontium_99

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Type 2
Sorry to ask such a general question, but thought to would be better to ask people who might be able to help.



My wife has had type 2 diabetes for quite a few years now. She has been on all sorts of tablets over the years with varying success, and varying side effects. It was decided a few month back that it was time to move her onto insulin. She has been taking it for about 2 months now. She wears a Libra 2 scanner thing. Sorry, don’t know the technical term They have set her base line to 4.2, and we’ve had the scanner go off a number of times of a night time. Again, sorry about not knowing the technical terms, but she take a long lasting insulin injection first thing in the morning, before breakfast. And a number of injections throughout the day. Her levels are still quite up and down, but in general have come down from where they were.



My question is this. Can taking insulin make you feel unwell. A number of time she has complained of feeling “unwell”. When I ask her to describe how she feels, she can’t quite put her finger on the exact feeling. She does say she feels cold but having sweats at the same time. But she describes it a general unwell feeling. I was just wondering if this is normal? If so, does it go away? Any information would be helpful and most welcome, as she is starting to think it’s not worth staying on insulin if it makes her feel so unwell. Thanks.
 
In my experience, insulin has not made me feel unwell but high and low blood sugars have.
Whenever, your wife feels "unwell" it is important to check her blood sugars with a finger prick if the readings on her Libre do not how high or low.
Cold sweats can be a symptom of hypos. If your wife has experienced high levels for some time, these may be "false lows".

Regarding the night time lows, could these be compression lows: false lows when pressure is applied to the sensor.

I started saying "in my experience", some people have had reactions to some types of insulin. There are alternative insulins available if your wife is reacting to the insulin she has. I suggest looking at the leaflet that comes with the insulin. It will describe potential side effects. Do any of these explain your wife's feelings?
 
My guess would be that your wife feels "unwell" when her levels are dropping fast or go lower than her body is used to. Checking her levels when she feels "unwell" should indicate if this is the case. As mentioned, compression lows during the night are a limitation of the Libre system. If you lie on the arm with the sensor, it cam compress the tissue under the sensor and cause it to give a false low. Gradually, you learn either not to lie on it or to place it on a part of your arm where it doesn't get compressed. Always important to double check any low readings before treating unl;ess you actually feel hypo.
Has your wife been given suitable advice about hypos and how to treat them? ie 15g of fast acting carbs like 3 Jelly Babies or 4-5 glucose tablets when her levels drop below 4 and test again 15 mins later.... with a finger prick ...not Libre to make sure her levels have come back up and if not, have another 15g of fast acting carbs and wait another 15 mins and retest. This is known as the rule of 15 which makes it easy to remember.

It is important to keep hypo treatments close to hand at all times including by the bed and in the living room and in the car if you have one and in her bags and coat pockets and basically never leave the house without them. I also keep some in the bathroom because a hot bath or shower can drop your levels particularly after exercise or just a very active day.
 
Hi @Strontium_99 When you say “they’ve set her baseline” at 4.2, do you mean the level at which the Libre sounds a Low alarm? If so, I’d put that higher. The Libre isn’t very accurate at the low and high ends of the range, and it’s possible that by the time it sounds the Low alarm because your wife is 4.2, she’s actually 2.8 or whatever. Setting the Low alarm higher avoids this.

The unwell feelings she’s having sound as if they could be hypos or false hypos. Another possibility is that her blood sugar is dropping quickly. That can make you feel unwell even if the level it’s at is fine. It’s the fast drop that causes the problem.

I suggest you/she watch her blood sugar closely during the day to get an idea of what it’s doing, and do a fingerprick test whenever she feels funny.
 
Thanks for the info. Sounds like the main advice I'm getting here is don't totally believe the Libra reading.
Inka said:
Hi @Strontium_99 When you say “they’ve set her baseline” at 4.2, do you mean the level at which the Libre sounds a Low alarm? If so, I’d put that higher. The Libre isn’t very accurate at the low and high ends of the range, and it’s possible that by the time it sounds the Low alarm because your wife is 4.2, she’s actually 2.8 or whatever. Setting the Low alarm higher avoids this.

The unwell feelings she’s having sound as if they could be hypos or false hypos. Another possibility is that her blood sugar is dropping quickly. That can make you feel unwell even if the level it’s at is fine. It’s the fast drop that causes the problem.

I suggest you/she watch her blood sugar closely during the day to get an idea of what it’s doing, and do a fingerprick test whenever she feels funny.
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Strontium_99 said:
Thanks for the info. Sounds like the main advice I'm getting here is don't totally believe the Libra reading.
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This is very true. It is unfortunate that your wife’s DSN did not explain this to her.
CGMs like the Libre are fantastic pieces of kit. But only if you understand the limitations.
The main ones are
- compression lows. As mentioned above, CGMs like Libre will report false lows if pressure is applied such as lying on your arm whilst asleep.
- bedding in time. Some of us find our bodies can take one or two days to get used to having and alien object inserted in our arm. The readings during this period are less reliable. This is why some of us apply our new sensor a day or two before activating it. I spend 2 days with a sensor in each arm but only one activated.
- “normal accuracy”. Sensors are designed to be most accurate at “normal” levels. When high (in double figures) or low ( under 4.0), the readings are less accurate. Highs and lows can be exaggerated.
Even Abbott advise to check readings with a finger prick if what Libre reports does not match how you feel.

It is frustrating to have these limitations but you will get used to them and when you should trust Libre and when not too. If in doubt, finger pricks are more accurate.
 
Strontium_99 said:
Thanks for the info. Sounds like the main advice I'm getting here is don't totally believe the Libra reading.
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It's your choice where you set your low alarm. Abbot set it at 3.6 by default and for me that's a good setting as I can go a bit below 3.0 with little effect
 
DaveB said:
It's your choice where you set your low alarm. Abbot set it at 3.6 by default and for me that's a good setting as I can go a bit below 3.0 with little effect
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If you’re actually going below 3.0 with little effect, it sounds like you’ve lost some hypo awareness. That’s not good.
 
DaveB said:
It's your choice where you set your low alarm. Abbot set it at 3.6 by default and for me that's a good setting as I can go a bit below 3.0 with little effect
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I wouldn’t want to be seeing levels below 3.0 with no symptoms, you need to declare that to the DVLA and likely lose your driving licence due to hypo unawareness for a start.
 
See how becoming accustomed to too low levels affects your own judgment, everyone!

At least 20-ish years ago now - when Dr David Cavan was still head honcho at BDEC so he had not joined them then - the European consortium agreed wholeheartedly that ANY blood glucose measurement under 3.3 absolutely and definitely ALWAYS affects the brain whether the person thinks it has or not. This was proven by proper concerted medical research undertaken in each country participating - and which the USA did themselves too. All the Research findings (in plain English not medicalese) were published - and Dr C sent it to DSF - so all us Moderators at least if not the whole membership were able to read it. Brain scans and neuron electrical activity and the lot.

Irrefutably TRUE.
 
Newbie here - Type 2 diabetic for 15 years, had Libre 2 for 2 months now. Woken most nights by low alarm - had NEVER heard about the compression - makes so much sense as when I get up and walk about to get some juice etc it magically goes up by itself!!! Thank you for reassuring me that I'm not going mad (well no more than usual) !
 
AllyM said:
Newbie here - Type 2 diabetic for 15 years, had Libre 2 for 2 months now. Woken most nights by low alarm - had NEVER heard about the compression - makes so much sense as when I get up and walk about to get some juice etc it magically goes up by itself!!! Thank you for reassuring me that I'm not going mad (well no more than usual) !
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I find it frustrating that people use Libre without being told about the limitations. I vaguely understand why Abbott don't want to publicise these but it seems that unless you use Libre (or any CGM) you don't know when it is great and when it isn't because DSNs rarely share this knowledge.
Other things to consider are
- bedding in time. Some of us find our body takes a day or two to get used to a foreign object in our arm which affects the readings made by the sensor. I find applying a new sensor up to 48 hours before activating it can overcome the apparent random number generator caused by this "bedding in" time.
- CGMs are designed to be most accurate at "normal levels" (between about 4.0 and 8.0). Outside of this range, the sensor can exaggerate highs and lows. This is why it is recommended to check with a finger prick before making any corrections (e.g. downing some juice to overcome a hypo).
 
DaveB said:
It's your choice where you set your low alarm. Abbot set it at 3.6 by default and for me that's a good setting as I can go a bit below 3.0 with little effect
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Hi Dave
I would be very concerned if I was having readings of 3.0 or lower (actually for me 4 or lower with no awareness would be a worry). These levels do damage to you and train your body into thinking that they are okay, hence the loss of awareness. You can regain your hypo awareness by running your levels higher for a while. Worth discussing with your team.

As others have said you would not be safe to drive and should lose your licence if you do not have hypo awareness. Even if you don’t declare it, and you are shown to have had this prior to an accident you would be uninsured.
 
Strontium_99 said:
Thanks for the info. Sounds like the main advice I'm getting here is don't totally believe the Libra reading.
Click to expand...
The Libre can be very useful in helping to find out the impact of specific foods, and to look at patterns in your readings. The readings are not as reliable when very high or in hypo territory and the time lag between the sensor readings and BG finger pricks will depend on how speedily your levels are rising/dropping.

There are two different alarms for low readings: one alerting you before a low so that you can head off a hypo before you get below 4.0, and another when you reach the hypo level. Many people using sensors choose a higher level for the ‘alert before’ and this can really help to iron out a lot of hypos, and so ensure that you maintains your hypo awareness.

At the start I was so worried about the long term complications that I happily lived around hypo levels, until I realised the damage this can do as described by the papers @trophywench referred to. I now use my sensor to help me avoid hypos where I can.
 
Strontium_99 said:
Sounds like the main advice I'm getting here is don't totally believe the Libra reading.
Click to expand...
I wouldn't put it that strongly.
I would recommend learning how much of the Libre readings you can trust and what are the limitations (as I mentioned above).

I often read reviews about the Libre being "2 points" out. If your BG is in the teens, this is not a surprise.
I read about Libre constantly alarming with lows throughout the night. Yeah, if you lie on the sensor, you will get compression lows.
And, yes there are some sensor which are faulty and some people for which the "factory calibration" does not work. But if you do the occasional check with a finger prick (making sure your BG is stable and not high or low) you should be able to work out if this is the case for you. It does not mean you have to double check every reading
 
Great for seeing whether something you did an hour (or more) ago is having any effect yet and if so - the one you wanted or not!
 
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