BG drops after meals

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Susan64 said:
I was on humulin 3 before. You are probably correct, the libre is fantastic in some ways but probably does make me panic more than i should. i will get used to it eventually.
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I assume you are still checking with a finger prick if going low and then 15mins after your hypo treatment before having more.
The advert for the Libre implies that there is no need to finger prick which I think is very misleading.
 
So, you have had a complete change of insulin for both basal and bolus. That will take some getting your head and body around and I would give it at least a month to start feeling like you are getting to grips with it.
I am guessing Humulin 3 is a mix of Humalog and Humulin I It might have been easier if they had given you those insulins as your bolus and basal rather than a compete change. Some nurses have no idea how changing just one type of insulin can disrupt your diabetes management let alone 2. Was it a DSN at the hospital who changed you or a nurse with some diabetes training at your GP practice?
 
Susan64 said:
I normally inject in either stomach or thighs but i don't record it so maybe that's something i should do.
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The stomach is one of the fast areas. The thigh is usually middling, and the bum is slowest. It would be worth seeing if there’s any correlation. I never inject in my stomach now as I absorb the insulin too fast.
 
Leadinglights said:
I assume you are still checking with a finger prick if going low and then 15mins after your hypo treatment before having more.
The advert for the Libre implies that there is no need to finger prick which I think is very misleading.
Click to expand...
Yes i still use finger prick checks but as for the 15 mins after treatment, it was falling so fast i wasn't sure i had that amount of time.
 
rebrascora said:
So, you have had a complete change of insulin for both basal and bolus. That will take some getting your head and body around and I would give it at least a month to start feeling like you are getting to grips with it.
I am guessing Humulin 3 is a mix of Humalog and Humulin I It might have been easier if they had given you those insulins as your bolus and basal rather than a compete change. Some nurses have no idea how changing just one type of insulin can disrupt your diabetes management let alone 2. Was it a DSN at the hospital who changed you or a nurse with some diabetes training at your GP practice?
Click to expand...
hi, it was the DSN at the local hospital. As you say it's a complete change so will take a while to adjust.
 
Welcome to the forum @Susan64

Sorry to hear about the wobbly time you’ve had starting on MDI (basal bolus). I really hope you can stick with it. It siunds like it’s doing OK for you earlier in the day, but playing up in the evening :(

In your shoes I would try taking the dose when the food was in front on me. I need to prebolus for breakfast and lunch - but have to be careful with evening meals, as a few minutes prebolus the evening can drop me very quickly too!
 
Susan64 said:
Yes i still use finger prick checks but as for the 15 mins after treatment, it was falling so fast i wasn't sure i had that amount of time.
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That statement should be that Libre showed you dropping so quickly and that is the problem because Libre continues to show you dropping even when the JBs have kicked in. I creates more panic and you have to learn to be quite disciplined about double checking and treating lows because Libre will panic you into over treating. It is due to the nature of how it works because it extrapolates your previous readings in order to predict your current one. That is because the sensor reads interstitial fluid rather than blood and that lags about 15 mins behind blood, so the algorithm in the system aims to predict what your Blood Glucose will be at the point of testing from the previous readings where you were dropping rapidly. If you have eaten glucose in the mean time, your interstitial fluid will not register that glucose until approx. 15 mins after it hits your blood and it takes 10-15 mins to hit your blood stream from eating the Jelly Babies, so the Libre will continue to show you dropping rapidly when your blood has started coming up. It usually takes 30 mins total to figure out that things have changed and it got it wrong and then it will usually redraw your graph so that it shows you didn't drop as low as it originally said you did. It is one of the times when Libre is not to be trusted. If you didn't have Libre you wouldn't see it dropping so fast and worry about it. It is a great bit of kit but you have to be wise to it's quirks and limitations and know when to double check it.

There is a list of it's limitations here on the forum which I will link below which is worth reading if you haven't already. The naughtiest quirk is compression lows when you lie on the sensor in your sleep and the compression of the tissue under the sensor that the filament samples causes it to give false low readings, so if you are woken by your low alarm at night, the first thing to consider is.... were you lying on that side when you woke up and if so, could it be a compression low.
Anyway this is the link....
forum.diabetes.org.uk

CGM limitations and precautions

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk forum.diabetes.org.uk
 
rebrascora said:
That statement should be that Libre showed you dropping so quickly and that is the problem because Libre continues to show you dropping even when the JBs have kicked in. I creates more panic and you have to learn to be quite disciplined about double checking and treating lows because Libre will panic you into over treating. It is due to the nature of how it works because it extrapolates your previous readings in order to predict your current one. That is because the sensor reads interstitial fluid rather than blood and that lags about 15 mins behind blood, so the algorithm in the system aims to predict what your Blood Glucose will be at the point of testing from the previous readings where you were dropping rapidly. If you have eaten glucose in the mean time, your interstitial fluid will not register that glucose until approx. 15 mins after it hits your blood and it takes 10-15 mins to hit your blood stream from eating the Jelly Babies, so the Libre will continue to show you dropping rapidly when your blood has started coming up. It usually takes 30 mins total to figure out that things have changed and it got it wrong and then it will usually redraw your graph so that it shows you didn't drop as low as it originally said you did. It is one of the times when Libre is not to be trusted. If you didn't have Libre you wouldn't see it dropping so fast and worry about it. It is a great bit of kit but you have to be wise to it's quirks and limitations and know when to double check it.

There is a list of it's limitations here on the forum which I will link below which is worth reading if you haven't already. The naughtiest quirk is compression lows when you lie on the sensor in your sleep and the compression of the tissue under the sensor that the filament samples causes it to give false low readings, so if you are woken by your low alarm at night, the first thing to consider is.... were you lying on that side when you woke up and if so, could it be a compression low.
Anyway this is the link....
forum.diabetes.org.uk

CGM limitations and precautions

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors. My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of...
forum.diabetes.org.uk forum.diabetes.org.uk
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Thank you for that information. I have seen it redraw graphs and never new the reason, very helpful. 🙂
 
Welcome to the forum @Susan64

Sorry you have had such a wobbly start to your basal/bolus regime. If you can stick with it you will find it a lot more flexible than using mixed insulin, but any change in our management is difficult to get used to.
You are also getting used to the Libre which has benefits but takes time to get used to the time lag in the data.

You mention that your levels are starting at about 10 before a meal and dropping to 5 which makes you panic. If you have been used to having higher levels it will take time for your body to get used to the improved control, and have confidence that your lower levels are safe.

This is a big change for you so give yourself time to adapt to it if you can.
You have already had lots of ideas to try and I hope that they help.

It is good that you have an appointment soon, and if you are sharing your Libre data with your clinic, and keeping notes of what is happening they will be able to help you to learn how to make adjustments to your basal and bolus insulin.

Let us know how you get on, and keep the questions coming.
 
So, woke up today to a 7.5 reading 🙂. Toast and 4 units for breakfast, was at 10.5 at 12:00. Chicken and egg salad for lunch, only 10g of carbs so 1 unit rapid and now i'm at 21.5 mmol .Not sure why that's happened so this evening will be interesting.:(😡:confused:
 
If your basal (Lantus) is too low that might be part of the reason. You might also find that you now need to make some allowance for protein in your meals if you eat it without many carbs. That can cause a later rise. Do fingerprick to check the high. The Libre usually reads higher than you actually are once you get into higher numbers, eg it might say 17 when you’re 13.5.
 
Inka said:
If your basal (Lantus) is too low that might be part of the reason. You might also find that you now need to make some allowance for protein in your meals if you eat it without many carbs. That can cause a later rise. Do fingerprick to check the high. The Libre usually reads higher than you actually are once you get into higher numbers, eg it might say 17 when you’re 13.5.
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Thanks, the Lantus was upped yesterday to 12 units and i was in the target zone until breakfast this morning.How do i work out the protein allowance? I have done several fingerpricks today to verify everything .
 
For protein I just go by my previous experience of the meal. I have a pump spits slightly different for me, but on injections I’d test at 3hrs and inject if necessary. There are formulae to work out protein, but I find they don’t work for me. I tend to avoid no/low carb meals because everything is simpler when you don’t have to think about protein. So, for example, if I had protein plus a salad, I’d accompany it with bread or even dessert carbs and then I can ignore the protein.
 
Regarding Lantus, unless your basal needs are the same for 24hrs a day, it’s not so good. Many people find they need more or less basal for the day than the night. That’s partly why Levemir or similar is recommended - you take a morning injection with the right amount to cover the daytime and an evening injection with the right amount to cover the night. Sometimes the two doses can vary significantly. You can also use one of the isophane insulins twice a day, which has the same flexibility @Susan64
 
Inka said:
For protein I just go by my previous experience of the meal. I have a pump spits slightly different for me, but on injections I’d test at 3hrs and inject if necessary. There are formulae to work out protein, but I find they don’t work for me. I tend to avoid no/low carb meals because everything is simpler when you don’t have to think
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To be honest i would prefer carbs with all meals but thought the protein would slow the carbs down so thought it easier to avoid them but i was wrong. A lesson learned.
Inka said:
Regarding Lantus, unless your basal needs are the same for 24hrs a day, it’s not so good. Many people find they need more or less basal for the day than the night. That’s partly why Levemir or similar is recommended - you take a morning injection with the right amount to cover the daytime and an evening injection with the right amount to cover the night. Sometimes the two doses can vary significantly. You can also use one of the isophane insulins twice a day, which has the same flexibility @Susan64
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I will bring this up with the nurse when i speak with her in 2 weeks. I take it at 8pm so i guess by lunchtime onwards it's lost some effectiveness anyway.
Thank you for your help, much appreciated.
 
@Susan64 I could be slightly wrong here, but I understand it is fats which slow down the digestive process and therefore for myself, insulin dependent, with a lot of fats in my meal I can endup with insulin arriving early (before the digested carbs) and dissipating (sometimes taking me unnecessarily low so then needing extra high GI carbs to chase the insulin!) before eventually releasing the fat laden digested carbs and elevating my BG - which then needs more insulin to chase the carbs!

This is sometimes referred to as the pizza effect.

I think the problem for T2s is that extra fats can cause unwanted weight gain which usually doesn't help the natural insulin management in someone who is already experiencing high resistance to their own natural insulin. It's not easy!
 
Proud to be erratic said:
@Susan64 I could be slightly wrong here, but I understand it is fats which slow down the digestive process and therefore for myself, insulin dependent, with a lot of fats in my meal I can endup with insulin arriving early (before the digested carbs) and dissipating (sometimes taking me unnecessarily low so then needing extra high GI carbs to chase the insulin!) before eventually releasing the fat laden digested carbs and elevating my BG - which then needs more insulin to chase the carbs!

This is sometimes referred to as the pizza effect.

I think the problem for T2s is that extra fats can cause unwanted weight gain which usually doesn't help the natural insulin management in someone who is already experiencing high resistance to their own natural insulin. It's not easy!
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That pretty much sums up a large portion of my 1st week on this regime, fingers crossed for the 2nd week .
 
Out of curiosity where your mixed insulin doses the same morning and evening or was one larger than the other?
 
So you could replicate that difference with the Levemir twice daily, or an isophane twice daily 🙂 It might also help explain some of your blood sugar results now.
 
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