Cold Symptoms

[mscharlottek]

Thanks all for your really helpful tips. I've got alot to look into. I've been on a few different background insulins and think I got confused with the names! I definitely have alot of symptoms of lpr. What did they do for this? Unfortunately I'm currently not working due to always feeling awful. Feel like a total waste of space so hoping we can get to the bottom of the issues. I was anemic but the gp said at last blood test that they were back to normal and to stop vit d tablets aswell. Maybe the levels have dropped again. Sorry if I've missed any questions x

 

[mscharlottek]

These are my graphs. Are anyone else's like this? When I went for my last check up they said oh they aren't that bad. But to me they are horrendous...

 

[EmmaL76]

Bless you, you’re struggling I can tell. I’ve been exactly where you and some days I’m still there. Also haven’t worked in a while. With the LPR it could mean you need PPIs but they never really worked for me. It’s a difficult one to treat and a lot of doctors don’t know too much about it. Sleeping on an incline like a wedge pillow can be helpful. Your graphs may not be a disaster but you will almost certainly be feeling those swings in blood sugar no doubt attributing to your fatigue. The tighter range you can get those in ( and unfortunately that takes time) the better you should start to feel. As for the anemia I’d ask which test the doctor ran, see hemoglobin can be ok but ferritin (iron stores) can be low and ferritin has such a large range of normal something like 15-150. You could be 16 ? That would make you feel pretty crappy xx

 

[rebrascora]

OK, looking at the graphs, firstly it would be really helpful if you can notate on the app when you eat (either meals or hypo treatment) and when you inject insulin, as that helps to make more sense of what is going on with the graphs.

It isn't surprising that you are feeling rough with spikes and troughs like that so working on flattening them out should help you to feel better physically and mentally. I too suffer with mental health problems and the more stable I can manage my BG levels the better I am mentally, but I know that when I am going through a bad spell it is hard to focus enough to get back into a good spell, so I am not saying it is easy but I do think we can help you to improve on this.

First graph...

My first question would be.... what did you have for tea and when? Looks like you might have had some "pIzza effect" slow release.... or possibly not enough basal. Was that dip about 1am which brought you down to 10mmols caused by you injecting a correction or could it have been a compression low caused by lying on your sensor in your sleep? If you had notated an insulin dose in the notes this makes it easy to tell. If it is a compression low, then it looks like your levels rose steadily overnight which might suggest looking for a recurring pattern to see if a basal insulin increase is warranted. We don't make changes like that off one day's graph, but it is something I would be looking out for and considering, particularly if you hadn't had a pizza/creamy pasta/fatty or high protein meal the night before.

Next comment is the massive fast drop from 18-3mmols at 7am. I am assuming that was a large correction plus breakfast bolus? Obviously just a bit too much since you hit the red. A large correction (even overly large) is not a problem if you keep a close eye on it and this is the beauty of Libre and ideally head it off before you hit the red line.... which is where your low alarm comes in.
Where do you have your low alarm set?
Mine is 4.2 because I know that even if I am dropping quite fast a couple of well chewed jelly babies (glucose absorbs quicker in the mouth than in the stomach so worth chewing well before you swallow) will stop my levels dropping into the red but I have pretty quick absorption of glucose. You might need your low alarm set at 5 to give you time to turn it around before you go below 4.
In that situation myself I would have been scanning every 10-15 mins once my levels started to drop and if I hit 6 and they were still dropping fast I might eat 1 jelly baby to slow the drop and continue to scan every 5 mins to see how it panned out and then if I got to 4.2 and still dropping I would have another JB.

I see my insulin and carbs sort of as an accelerator and brake, so I use JB here and there to slow down the speed my levels are dropping after a large correction... particularly as I get towards the bottom of my range and before I crash through the red line at the bottom.

Not sure if the spike back up to 12 is your breakfast/brunch kicking in, which is a reasonable spike in the circumstances and levels come back down but then it looks like there may have been some fighting to keep it from dropping too low with those 2 small spikes afterwards (suggesting ratio may possibly be wrong.... but again, not something to decide off one event) before levels rose again which I am guessing may have been lunch. It looks like you come nicely down into range after that, so the only thing to prevent such a high spike would be to prebolus a bit earlier, but if you were fighting to keep levels out of the red before lunch I can see how that would not be a good idea until you get levels more stable. reducing the height of your meal spikes is less important than preventing the hypos and getting your basal dose optimized, so some basal testing should help figure a few things out.

My gut feeling from that graph is that basal is not right and meal time ratios may also not be right and consequently you are fighting 2 different things and nothing is making sense as a result and you are just reacting to problems. Some basal testing.... skipping a meal here and there should start to shed a bit of light on the matter.

If you can start to notate your Libre app with info like insulin injections and carbs and exercise, it will help to interpret it better. Not saying that needs to be forever, but just whilst you are having problems.

 

[rebrascora]

This was the day before the graph above...

First question would be was that dip during the night due to a correction at bedtime. I am guessing it was and probably a large correction since you were high teens. Other than obviously being a bit too much (again... consider where you have low alarm set to prevent a dip into the red) the thing would be to prevent being so high at bedtime, so perhaps taking that correction earlier in the evening before your levels got that high. I know that might mean that you are stacking but if you can see that the active insulin left on board is unlikely to bring you even close to in range, then I find it can be helpful to stick a small correction in earlier, rather than needing a big one at bedtime.

Levels then went sky high and I am guessing that may have been breakfast spike with not enough prebolus time or possibly over treatment of the hypo and then breakfast spike added on. I like to get my levels stable and in range before I eat whenever possible and I will delay eating until I get my levels settled and then prebolus, This means that sometimes, like yesterday, I need to wait a couple of hours before I eat breakfast, but for me, the increased stability is worth the inconvenience of waiting. If you are hungry, you could have a low carb breakfast like an omelette which should also help to stabilize levels.

After that, the rest of your graph is not too bad but obviously ;evels are rising towards bedtime which is setting you up for the problems on the overnight graph discussed which as mentioned may have been pizza effect or perhaps snacking before bed.

I don't think you can tell anything at all from this graph about basal insulin because it looks like there is too much bolus correction going on to see anything much clearly. If you weren't on Tresiba then I might consider that basal insulin might be running out at night as levels have risen both evenings but Tresiba has such a long profile it doesn't run out because one dose overlaps the next by about 12 hours.

Good to hear that you are off work at the moment because this will take some time and effort to sort out, but hopefully once we can help you do that, you will be able to do your job better and enjoy your life more. These erratic levels must be really affecting your ability to concentrate as well as making you feel shattered.

 

[Amity Island]

These are my graphs. Are anyone else's like this? When I went for my last check up they said oh they aren't that bad. But to me they are horrendous...

Hi,

To me the graphs look like you are over correcting the drops and bouncing back up again.

What and how much do you use to treat the hypo's?

 

[Spathiphyllum]

OK, looking at the graphs, firstly it would be really helpful if you can notate on the app when you eat (either meals or hypo treatment) and when you inject insulin, as that helps to make more sense of what is going on with the graphs. ...

If you can start to notate your Libre app with info like insulin injections and carbs and exercise, it will help to interpret it better. Not saying that needs to be forever, but just whilst you are having problems.

Barbara is absolutely right. If you use the "Logbook" in Libre to record when you consume carbs and how much, and when you inject insulin and how much, you will find it really really helpful. Even more helpful if, when you consume carbs, you also make a little note in the logbook of what kind of food you ate (or drank)-- "pizza and salad" or "toast and coffee with milk" or "juice" or whatever.

Then you'll have the information you need to look back and get an idea of what's going wrong-- and what's going right-- and then you'll be able to improve things and you'll feel much, much better.

I'm speaking from experience-- if I hadn't been using my logbook since I got my Libre, I would be all over the place! All the best.

 

[Proud to be erratic]

I realise this discussion has moved on a bit since you posted yesterday @mscharlottek, but about Tresiba and basal testing:

Tresiba is the longest acting basal (as far as I know) with a profile of 40-42 hours duration; other basals are up to 24 hrs or shorter. This means that today's single Tresiba dose is topping up yesterday's dose. It also means a basal change can take 3 days to have an effect. Normally no basal is a perfect fit for a full 24 hours and so people do basal tests either to find the optimum time for a single dose or with split basal doses to find the best fit across any one 24 hours - done knowing that a basal adjustment should be effective in the next few hours.

But with Tresiba having such a long duration and the carry over, it is only possible to optimise that single basal for part of a day - usually for nights. It doesn't make any difference when that basal is taken. In particular the next dose can be several hours away from the previous dose time. [A bonus point of this is that Tresiba is very good for people who regularly fly longhaul. The time zone variations are readily managed- but this ia a digression!]

For me I have got my Tresiba optimised to give me steady nights, particularly without hypos or dips close to hypos all nights. This does mean I'm not expecting my basal to provide optimum or even good cover by day. But on the plus side I know this and expect to manage my waking hours with a mixture of bolus and/or exercise or activity for corrections, along with extra carbs to counter BG falls. This allows me to scrutinise my bolus ratios, if I'm getting repeated irregularity for certain foods or after certain mealtimes.

I have no pancreas whatsoever, so my BG can be inexplicably erratic and it is described as brittle; my BG falls can be very fast. This does mean I have to be a bit obsessive about monitoring. But it also means once I've had 4 or more days steady nights after a basal change, I no longer wrestle with the question: should I alter my bolus or basal? No point in considering changing the basal, so just look to bolus or exercise and activity for correction to highs.

Anyway I don't need to do specific basal testing because, in conjunction with the results visible from my Libre, I can see whether I have my basal dosing correct for night cover. I do need to adjust my basal periodically, perhaps 2 to 4 times per year. Changes in the weather, or an unexpected longish stay in hospital are 2 reasons for basal changes in the last 9 months. But I do think it's important to get the basal correct first and then attend to the bolus (along with the many other variables, like timing, ratios, weather, stress, other medications, etc, etc).

You have a lot going on medically and it is quite probable that your BG is being affected by various degrees of medical stress, along with everything else. But that is my non-medical guess and in no way authorative. I like the night time stability that Tresiba has given me, after a fair amount of fine-tuning and I particularly appreciated that stability during my 4 hospital stays in 2022. Interestingly, but alaming though, it became clear that pre-op protocols required me to alter my basal - demonstrating how poorly the authors of those protocols misunderstood how Tresiba works. For one of those hospital visits for a procedure with an overnight stay I was nearly turned away because I hadn't altered my Tresiba dosing as directed on the pre-op paperwork. It took a while to get the ward sister to accept that I knew what was needed and by complete chance I had the name and mobile phone no of the pre-op assessor who had agreed that the pre-op declaration was wrong - for Tresiba!

Good luck with all that is going on for you.