Beaten up by highs and lows

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@DianeD as usual, @Inka and @rebrascora have provided some excellent advice.
I have a couple of little points to add
- do you check your Libre readings against finger pricks? Libre has a tendency to get overexcited when high and suggest I am much higher than a finger prick tells me.
- you mentioned that you have decided to stick with a ratio of 1:10 which is working for some meals. However, have it is common to need different ratios for different meals. Breakfast, for example is the time when we are more likely to be insulin resistant so may need a higher ratio in the morning than other times of the day. As @Inka suggests, mastering g one meal is a great way to start and breakfast is a great meal to start with because it varies less than other meals.
 
helli said:
@DianeD as usual, @Inka and @rebrascora have provided some excellent advice.
I have a couple of little points to add
- do you check your Libre readings against finger pricks? Libre has a tendency to get overexcited when high and suggest I am much higher than a finger prick tells me.
- you mentioned that you have decided to stick with a ratio of 1:10 which is working for some meals. However, have it is common to need different ratios for different meals. Breakfast, for example is the time when we are more likely to be insulin resistant so may need a higher ratio in the morning than other times of the day. As @Inka suggests, mastering g one meal is a great way to start and breakfast is a great meal to start with because it varies less than other meals.
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Yes checking with finger pricks, apart from cutting out with rapid changes it's pretty accurate. Going to keep things simple and take inka's advice re breakfast, can sort the other meals/ratios when/if things level out a bit. Changing more than one thing is too confusing. Going to change by 5 mins every other day to start with.
 
DianeD said:
Sounds like a plan, thank you, I shall let you all know how it goes.

Silly question coming up.
Does it not matter what the peak is then so long as it goes back to prior level? I thought I needed to keep it within the 5 to 10 range
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There are no silly questions 🙂 As you’re recently diagnosed, you’re probably still producing some of your own insulin. This will probably come in a bit late, so, as you can imagine, if you try for too low a spike and then your own insulin kicks in, you’ll go low. When I was first diagnosed I was told to keep spikes below 13, so 11 or 12 was ok as long as it didn’t stay up there for hours. It didn’t. It peaked and came down.
 
Hello @DianeD

Sorry to hear you’ve been having such a rough time with your levels.

Diabetes can be a swine :( Especially in the early ‘honeymoon’ period, which can be rather less than all roses and sunshine that the name suggests for some people, especially if their remaining beta cells ‘help out’ in unpredictable stuttering ways.

Be kind to yourself, and don’t chase after perfection. Just start where you are and try to make small incremental improvements where you can (and firefight the chaos when it happens) 🙂
 
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Tdm said:
Doing too much low carb can make you insulin resistant, though.
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@Tdm, I'm not challenging this observation but I'm wondering what is the source / reference for this? I've not heard this before.

@DianeD, I fully sympathise with your predicament of dashing from high to low and back again. I spent much of my first 12 months on this roller coaster and then I was given Libre 2. This proved to be a complete revelation, allowing me to get some "visible" control over what was previously an unpleasant experience. Just reading through the guidance you are now getting from the forum I certainly can't add to that and wish I'd known about this forum straight after my diagnosis.

One thing I got from Gary Schneider's book "Think Like A Pancreas" (which I found very helpful) was his guidance to always eat at least 30 gms of carbs with every main meal; a snack such as a coffee and a cookie would not be a main meal. This was to prevent your body turning to proteins and fats to increase the glucose content from that meal. That in turn was to reduce the complexity of counting proteins and fats - as well as carbs. 30 gms of carbs was a usable threshold for keeping the counting more straightforward. If you decide that you want to try going very low carb, that does (at least initially) make things a bit more complicated - in my opinion.

[Your brain demands that it gets glucose only, so if there aren't enough carbs bringing in enough glucose for your brain, it will make the liver open its glucose store or your body release glucose from wherever it can be found. Hence converting proteins or fats into glucose. Calculating for those varying food types is an extra task and judging pre-bolus timings has extra challenges.]

So do at least take some reassurance that things do get better; you will develop a sense of what is going on particularly from the Libre 2 graph and the trend arrows and recognise when and how best to correct when going too high or low - ie when going out of range. You will also just gain confidence about taking insulin: about recognising that your basal might need checking or adjusting, about when bolus should be scaled back because of activity and exercise and by how much, about bolus ratios and of course about carb counting - much of which will become 2nd nature (in practice most of us eat meals from a fairly repetitive selection of meal choices and we just steadily get to "know" how much bolus is needed). This is definitely not saying it will all become perfect ... I certainly haven't reached that point and I suspect no-one on this forum has either. I'm just trying to say it does get better! But this is a marathon and it does take time.

And while I'm writing this Mike @everydayupsanddowns has effectively pre-empted me - I, as a relative newcomer, can but confirm all that he has said! Good luck.
 
everydayupsanddowns said:
I think @Inka may have a source / reference ?
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It’s called physiological insulin resistance. I’m not sure there’s one source. It’s a well-known side effect of very low carb. The body thinks it’s starving so becomes more insulin resistant to help itself ‘survive’, like it would do in times of famine.

I’ll see if I can find a source or explanation tomorrow. Off to bed very soon and I need to put the iPad down!
 
I know low carb made me insulin resistant (unpublished research, sample size, me) but it seems to be widely acknowledged. Its the bodys way of preserving glucose for the brain, whilst other bodily sysyems use other mdtobolic pathways
I find i can do a low carb midday meal on workdays and get away with it though, and my ratios are 1 to 12 with 1 to 25 for weekends ( go figure)

Yes, OP, its good to keep peaks under 10 but if you are new its not, perhaps, the most important thing at to mo
 
The other thing I found with a low carb diet was more challenging insulin dosing.
In the absence of, or very low, carbs, our body breaks down protein to glucose. Therefore, we need to bolus for protein. The insulin to protein ratio is different to the insulin to carb ratio. But, for me, it was not just a case of working out the insulin to protein ratio: it was a different ratio for different proteins. So I needed to work out (and remember) different ratios for cheese, eggs, nuts, salmon, prawns, ... It was too much of a faff for me so I return to a "normal" diet.
 
What a difference!
Breakfast 40g carbs, as the hive mind thought I was a little high on the insulin I went with 3 units and will stay at that during this adjustment time. Aimed for 5 mins earlier bolus (was closer to 8 if I'm honest) and this is the result - can't tell you all how happy I am. Let's hope it's the same tomorrow, won't change anything unless it's significantly different over the next few days.
Thank you <3SmartSelect_20240311_115935.jpg
 
DianeD said:
What a difference!
Breakfast 40g carbs, as the hive mind thought I was a little high on the insulin I went with 3 units and will stay at that during this adjustment time. Aimed for 5 mins earlier bolus (was closer to 8 if I'm honest) and this is the result - can't tell you all how happy I am. Let's hope it's the same tomorrow, won't change anything unless it's significantly different over the next few days.
Thank you <3View attachment 29495
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Thats one fine graph!
 
There is absolutely NOTHING pear shaped about either of those! Amazing stuff
1710188709068.gif

Have you seen the International Consensus for Time In Range?
forum.diabetes.org.uk

Time In Range - useful for Libre / CGM wearers

I've been meaning to post this for ages, but kept forgetting! At the ADA this year the international consensus paper on TIR (time in range) was published by a panel of experts with a huge amount of knowledge and expertise in supporting people to use continuous data to help manage their...
forum.diabetes.org.uk forum.diabetes.org.uk

If you aim for exceptionally good diabetes management (according to a panel of expert diabetes specialists) you can have up to 25% of time above 10.

And I’m reminded of Partha Kar’s interpretation/framing of the same guidance


🙂
 
everydayupsanddowns said:
There is absolutely NOTHING pear shaped about either of those! Amazing stuff
View attachment 29502

Have you seen the International Consensus for Time In Range?
forum.diabetes.org.uk

Time In Range - useful for Libre / CGM wearers

I've been meaning to post this for ages, but kept forgetting! At the ADA this year the international consensus paper on TIR (time in range) was published by a panel of experts with a huge amount of knowledge and expertise in supporting people to use continuous data to help manage their...
forum.diabetes.org.uk forum.diabetes.org.uk

If you aim for exceptionally good diabetes management (according to a panel of expert diabetes specialists) you can have up to 25% of time above 10.

And I’m reminded of Partha Kar’s interpretation/framing of the same guidance


🙂
Click to expand...
Thank you

I'm so happy, if I can get it to stay like this, more often than not, I shall be ecstatic, no headache for the first time since diagnosis 🙂
 
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