Blood glucose levels during average day

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Evergreen

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Relationship to Diabetes
Type 1.5 LADA
Hello everyone! Hope you are all well 🙂

I am a little nervous about asking this question as I’m worried it’ll confirm my suspicions that I’m doing something not quite right!

I was wondering if people (particularly people with LADA or T1) could post a screenshot of an average day on their Libre or CGM?

I seem to be able to keep mine only kind of stable when I eat low carb. As soon as I eat some carbs (and inject rapid-acting insulin) I still have quite a bit of a spike. I’ve spoken with my nurse about this who was a little dismissive as the levels go to what they were before a couple hours after eating. I don’t think this is quite right though? Isn’t insulin supposed to flatten the spike?

I have tried to experiment with ratios and if I do more I tend to go down very quickly. Ratios also can change massively day to day (think one day 1:10 and the next day 1:30, without noticeable changes in food/timing etc).

Hope seeing other people’s curves and their approach might help me make some changes to mine 🙂
 
My experience is that it is impossible to eliminate post-prandial spikes. The best you can hope for is to keep those peaks and troughs as shallow as possible. Ratios can change day to day because of illness, prior-day exercise and/or alcohol intake, to mention just a few possibilities. I try to keep the 90-day average graph as green and narrow as possible and try not to sweat those days when things go a little pear-shaped. Current AGP attached (Dexcom Clarity - I use the G7 sensor).
 

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Thank you, that’s helpful to see!

I can see the 90 day overall and the individual days at the bottom with the little spikes. It looks really good and something I am aiming towards!

The spikes I get after eating go up between 12-15, sometimes higher. I don’t know how to avoid these as whenever I up my bolus I just hurtle towards hypo….

I have thought of adjusting basal, but when I look at my trend overnight it’s normally very stable (unless after having a glass of wine but that’s rare)
 
Evergreen said:
The spikes I get after eating go up between 12-15, sometimes higher. I don’t know how to avoid these as whenever I up my bolus I just hurtle towards hypo….
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If your BG comes down to the level you want (or lower), typically, this is due to bolus timing rather than the amount of insulin. The insulin starts working after your body digests the food. Do you pre-bolus? You could try bolusing earlier in relation to your meal.
If you use NovoRapid, there are now some insulins that work faster for some people such as Fiasp.
 
Thank you! That’s helpful! I try to keep to the taking insulin 10-15 mins before eating but could experiment with this a little more to see what happens! Different foods seem to have such a different effect, minefield!
 
@helli has beaten me to it. Reducing the spikes is all about timing of the insulin rather than increasing the dose. The insulin likely needs more of a head start, because the glucose from your food is hitting your blood stream before the insulin. This timing will vary with the time of day (most of us need longer prebolus time at breakfast than at lunch or evening meal) and can also vary with the type of food. So foods which are slow to digest like fatty foods or lots of protein or fibre (think pizza or dahl or a creamy sauce with pasta or fish and ships), will not need so much prebolus time as a couple of slices of toast or bangers and mash etc. This timing is different for everyone and you need to carefully experiment to find the right timing for the time of day and the insulin you use and the food you eat.
As an example, I used to need 75mins prebolus time at breakfast with Novo(not so)Rapid 🙄 with a breakfast of yoghurt and berries, but just 20-30 mins for meals at other times of day. I now use Fiasp and usually I need about 45 mins prebolus time for the same breakfast and 15-20 mins for most other meals. This is an extreme and most other people need less time between injecting and eating but hopefully it demonstrates how variable this timing can be.

Start by increasing the prebolus time you currently use by a few minutes and just work on one meals a day....Breakfast is easiest because most of us have a similar breakfast most days of the week, so keep the breakfast the same and jusy work on increasing the time between injecting and eating a little bit each day, until your graph shows those peaks getting lower and find a level and timing that you are happy with. Then once you have fine tuned your breakfast timing, work on lunch etc. This is really just fine tuning your diabetes management and plenty of people managed fine for years/lifetime not even knowing that their levels spiked so high before Libre and other CGM allowed them to see it, so don't feel it is essential to do this, particularly if you are newly diagnosed, so give yourself time to get comfortable with the basics, before you move on to more advanced diabetics. If you feel you would like to flatten out some of your peaks, then that is the way to tackle it but always be mindful that perfection is not possible and devoting too much time to flattening out the graph can lead to burnout, so always consider your mental health when you view these issues. That said I felt better both physically and emotionally when my BG levels were not spiking up to 15 every morning and then crashing back down to 5 2 hours later.
 
It does concern me that you say your ratios change from day to day and by so much o_O and I wonder if your basal dose(s) is(are) correct and holding you steady. The other option would be that exercise/activity is affecting your meal ratios and we would normally either reduce basal for exercise (depending on the basal insulin you use) of reduce the bolus (before and after) exercise. Longer acting basal insulins like Tresiba/Toujeo cannot be altered so easily so you would need to adjust bolus for exercise whereas shorter basal insulins like Levemir/Lantus can be reduced for exercise.
insulin in fits and starts
Of course it may just be that you are in your honeymoon period and your own pancreas is spitting out a bit of insulin in fits and starts and making it appear that your ratio has changed. It will all settle down eventually. Some people find their honeymoon period rounds off the edges of their diabetes management and others find it makes it more erratic.
 
If you want to see an average graph of mine.... below is one I have chosen because I strayed from my low carb way of eating in the evening for a Chinese banquet including soup and prawn crackers, mixed hors d'ouvres, duck pancakes and main courses.... It took lots AND LOTS of insulin, but quite proud of how well I managed it...

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I deliberately took my BG levels down to the bottom of my range before the meal to allow myself maximum room for the meal spike. This involved a correction a couple of hours before heading out for the meal, because I knew that I would not be able to prebolus much in advance for the meal when eating out.
 
rebrascora said:
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and can also vary with the type of food. So foods which are slow to digest like fatty foods or lots of protein or fibre (think pizza or dahl or a creamy sauce with pasta or fish and ships), will not need so much prebolus time as a couple of slices of toast or bangers and mash etc. This timing is different for everyone and you need to carefully experiment to find the right timing for the time of day and the insulin you use and the food you eat.
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Or you may find you need to split your dose and take part at the beginning and the rest sometime later to avoid going hypo or needing fast acting carbs a couple of hours after the meal, only to find the rest of the carbs then catch up and send you high later on. It's not an exact science in my experience! 🙂
 
Have a look at mine for today, if you want some amusement! I made some flapjack mid morning, because my (adult) kids are around at the weekend, and half a piece detached itself when I was cutting it up. So I ate it. And then injected afterwards. And got a spike! We can’t always be perfect, and I couldn’t have predicted beforehand that I was going to break a piece, let alone that I'd be tempted to eat it, and no, I wasn’t strong minded enough to inject, wait half an hour, and then eat it, as I'd have been wanting to get on with my morning by that time.
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rebrascora said:
It does concern me that you say your ratios change from day to day and by so much o_O and I wonder if your basal dose(s) is(are) correct and holding you steady. The other option would be that exercise/activity is affecting your meal ratios and we would normally either reduce basal for exercise (depending on the basal insulin you use) of reduce the bolus (before and after) exercise. Longer acting basal insulins like Tresiba/Toujeo cannot be altered so easily so you would need to adjust bolus for exercise whereas shorter basal insulins like Levemir/Lantus can be reduced for exercise.
insulin in fits and starts
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I'd also say this isn't all that unusual, if I have a Saturday morning where I literally have nothing I need to do (no shopping, my children are happy playing & don't need to be dropped anywhere, no DIY or car maintenance to do, etc.) but I can't go out for a ride, I will probably end up reading the paper or a book or browsing the internet and will then go high as soon as I get up and stay high unless I take quite a lot of bolus insulin (much more than on a normal or even WFH morning, and even then I rarely come down in time for breakfast, it's normally lunchtime by that point).

If I then have to go and do something (walk round the block, drive to the shops, etc) my blood sugar will drop through the floor pretty much immediately (not helped by lots of bolus on board by that point). This does appear to be exercise related, but in much smaller quantities than I usually deal with, and not really something I'd look to deal with using basal insulin.

Turbo trainer seems to be the way forward, or going for a walk, or always have things to do! 🙂
 
And as I've only just worked out where my phone stores screenshots, here's my day thus far:
Screenshot_2023-05-04-17-38-25-212_com.eveningoutpost.dexdrip.jpg

I'd say the "spikiness" is quite standard and I'm happy it's stayed within range, I'd not be too bothered if I'd strayed out of range temporarily after eating. It's not what I would call a very well planned day (in terms of insulin) - you can see an overnight high, which is the result of a 3h30 bike commute yesterday and my not being overly sure how to dose overnight, but erring on the side of not going low. Today I've only injected (bolus) twice, so my basal is obviously too high as I've had to eat quite a lot. I'm a bit surprised by the combination of cycling yesterday, high overnight then tending to be low today, though it has been quite a busy day at work with a drive in, loads of back to back meetings across campus, then a rushed drive to parents' day and run after finding a parking space. Interestingly my stress response for this is to go low, while for something like the expectation of a long ride or job interview it would be to go high, though is very much in the realm of memory and personal reporting rather cold hard facts.

I should also add that I would ideally aim for a lower average value, but it's difficult when there are things that require you to always be "on the ball" and any time needed to sort out hypos is eating into/taking you away from meetings, or just downright dangerous if driving.
 
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Evergreen said:
I seem to be able to keep mine only kind of stable when I eat low carb. As soon as I eat some carbs (and inject rapid-acting insulin) I still have quite a bit of a spike.
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Same here. It also depends on what you combine it with and the order in which you eat it.
My approach is to keep insulin sensitivity maximal through daily exercise and prepare fresh food every day.
 
Hi there, I’m a LADA. Here’s my graph. It’s kinda pointy. Some days it’s flatter. I’d say I have about 120g carbs per day.
 

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By the way, that just yesterdays. Spikes to 12 are common with me also if I have something a little more carby. I could do really well (graph wise) on 30g carbs per day but I was about to pass away so had to re start insulin and every day I’m learning and every day is totally different. What works one day doesn’t the next. It’s tough, but I’m a lot more relaxed than I used to be. I just tell myself I haven’t figured it all out yet… but I will. And so will you.
 
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This is todays, but it’s not necessarily an accurate one as I eat a low carb lunch when at work, but I did eat porridge for breakfast and will have potatoes with tea. I am so insulin resistant when at work my pre-bolus was ridiculous and I would just spike then shoot back down after - however I have found if I eat something very protein esque, like a protein yogurt, this effect is much lessened! (One day I was even able to eat a donut without spiking at work because I’d had protein before). Even eating a salad instead of a sandwich helped this to some extent. So by no means am I suggesting starting the protein shakes but I have found adding protein to any meal this helps me, even if that’s just peanut butter on toast or a bit of extra veg. My other graph below is from Saturday where I ate loads of carbs at every meal (I don’t keep count) and as you can see it’s very much reflected in the picture - but my spikes are within a range. Hope this helps to reassure to some extent! 0B7641DA-7726-4899-9C28-F7C8A60D2E78.png
 
Wow so many replies!!

Thank you everyone! The ‘spikiness’ has reassured me. I think I can do better in terms of timing the insulin but agree with the advice to take it slow and experiment day by day. I’m a bit of a perfectionist so having diabetes is a challenge to let this go a bit more I suppose!

The ratios differing as much as they do isn’t always the case, but I think it’s probably the honeymoon period as well as me still producing a fair amount of insulin. Just not in similar levels every day and seemingly unrelated to exercise/illness/time of month etc. However all these things definitely also have a noticeable effect.

We’re going on holiday today and I’m a little anxious about how I’ll manage my levels with unknown foods, probably a bit of alcohol and lots of exercise, but here’s to learning!
 
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