Confusing numbers

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Charl

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Relationship to Diabetes
Type 1
Yesterday...reading was 9.4 before breakfast.
Took 7 units of novorapid
Had breakfast, 3 hours later reading was 5.5

Today...reading was 14.4 before breakfast.
Took 11.5 units, 7 for the breakfast and 4.5 correction,
Had same breakfast as yesterday,timing etc,
3 hours later reading is 13.8
Did nothing more,less today,any advice appreciated. Cheers
 
Once your levels are in double figures you become more insulin resistant and the higher they are the more resistant they are to coming down and the longer it takes. I will need a bigger correction factor for levels over 10 and whereas 1 unit will drop my levels 2.5-3 mmols when I am below 10 it will only drop me 2 mmols above 10 and into the teens it will take more still.
Added to that if I eat when my levels are above 8 then they will just stay high, so in that situation I would have injected the correction and bolus before I got out of bed and then waited until my levels came down to about 6 before eating breakfast. That might take 2-2.5 hours with a reading of 14, so if I can't wait that long for breakfast, I would just inject the correction at the higher rate to overcome the insulin resistance at that level and skip breakfast or eat a few nuts and hope that by lunchtime it was looking more in range.
I have a general rule that I don't eat any carbs when my levels are above 8 because it will take so much longer and more insulin to bring them down if I do. So, I inject my insulin plus any correction and then potter on doing whatever I need to do whilst keeping a close eye on my Libre and generally when I get down to 6 or mid 5s, I eat. Obviously this isn't possible when you are out for a meal, but most of the time it is doable. If I am going out for a meal, I plan my levels an hour or more before I set off, so if I am on 8 or 9 when I am getting ready and there is no significant insulin on board to bring me down, I will jab a 1.5 unit correction before I jump in the shower, so that my the time I get to the venue for my meal and look at the menu and order my food, most of that insulin will have worked to bring me down into the 6s. (I use Fiasp which works over about 3 hours for me so if I was using NR I would probably have to plan that correction a couple of hours before setting off.)
Proactively keeping your levels below 10 as much of the time as possible really helps to reduce the waiting and makes it all a lot smoother.

Do you know why you woke up so high? What did you have for your evening meal? Was it pasta or pizza or something similar which is slow release?
 
Around 10pm libre was showing 6, I was expecting to get woken again so had some bread and butter to get me through the night, musthave been the bread.
 
Charl said:
Around 10pm libre was showing 6, I was expecting to get woken again so had some bread and butter to get me through the night, musthave been the bread.
Click to expand...
At 10pm, was the trend upward or downward on the graph ... not the arrow but was the graph showing your levels were climbing or going down?
What had you had for tea and when was that?
How much bread and butter did you have?
Is this after a reduction in your basal insulin?
Can you post a screenshot of your Libre graph for last night and this morning so that I can see what is happening?
 
Can you answer the other questions in my post?
ie What you had for tea and when?...Looks like about 6pm from the graph and the trend was downward at 10pm but it is
important to know what you ate. ie, was it something slow release?
And how much bread and butter is very important and if you had changed your basal dose as discussed in another thread and by how much and when?
 
Chile with jacket potato ,yoghurt and pumpkin seeds at about 17.45
19.45 snack of a wheat biscuit
22.15 slice of bread and butter, only reduced basal this morning.Thanks
 
It could be the kidney beans from the chilli releasing later but it would need a lot of chilli beans to produce that increase although obviously the bread will have contributed significantly.
How confident of your carb count for the jacket potato and chilli are you?
Did you bolus for the wheat biscuit and how many carbs was it? Do you mean a Weetabix type biscuit or a digestive biscuit?
What sort of bread was it? How many grams in the slice?

If you didn't bolus for the wheat biscuit and the bread then that is likely the cause of the rise along with perhaps some late glucose release from the kidney beans.

Generally they suggest that 10g carbs will raise your levels 3mmols, so if your slice of bread was 20g carbs, then that will raise your levels 6 mmols. So the bread would take your levels from 6mmols at 10.15pm up to 12. If the biscuit wasn't bolused for then that is going to be another 10-20g carbs, so that is another 3-6mmols.... which might take you up as high as 18mmols, but then if your basal insulin dose is a bit high as discussed as a possibility in another thread), that will reduce it and could potentially bring you down to the 14 that you woke up on. If you bolused for the biscuit then that that would throw that very rough calculation off slightly, so will be interesting to know if the biscuit was bolused for?

I have to be extremely careful with carbs because it is so very easy to push levels up much higher than I want them and it is really frustrating and time consuming trying to get them back down again. In your situation if my levels were 6 at bedtime and my bolus insulin was all spent ie not injected in the last 4 hours, I would have had 10g carbs (something like a digestive biscuit), which should push my levels up to about 9 and be very happy going to bed at that. I think your problem may be that you are frightened of going low overnight and therefore you are having more carbs than you need. It takes time to learn to be as gently with the carb corrections as you need to be with the insulin. I often have just one jelly baby (5g carbs) to nudge my levels up if I am in the low 4s and that is enough to take me up to mid to upper 5s and without bolus insulin there should be nothing to bring it down again unless my basal is too high.

It is far pleasanter in my opinion, having the odd jelly baby (or prune or dried fig) now and then to lift my levels up a bit if they are running a little low, as being stuck in double figures and having to inject correction after correction and wait hours to bring my levels down.

Your daytime graph looks like you may be having snacks between meals judging by the number of spikes and that may be confusing you, so if you are snacking between meals, it might be worth stopping for now and just having set meals for a week or so and see if you can start to make more sense of things whilst keeping it basic. If you are hungry then a few nuts or some cheese or a boiled egg shouldn't produce any significant spike in between meals.
 
The only food bolused for was the chile,potato and the yoghurt, the bolus for the weetabix type biscuit should I have included that in with my evening meal or took that separate considering my evening meal insulin was taken a couple of hours earlier, regarding the bread it was taken because I expect to be woken through the night, breakfast is usually eaten around 7 am then I'm usually hungry by 9.30am so have 2 x ryvita with peanut butter till the next meal at 12 am. Hope you can understand that.
 
OK well the unbolused wheat biscuit and then the bread on top caused your overnight high. Do you understand my calculation as to why it caused you to go that high.... ie that is nearly 40g of unbolused carbs, so if 10g raises your levels 3mmols then 40g carbs will raise them 12mmols (ie 3x4), so if it wasn't for the fact that you have a bit of some surplus basal insulin overnight (dose being a bit too high) which drops your levels a bit, you would probably have woken up on 18. Without the wheat biscuit you would likely have woken up with levels about 10. Once your change in basal insulin dose kicks in you will need less top up carbs at bedtime because your basal should not drop you, BUT you will need to bolus for whatever carbs are in the snacks you have during the day because there will probably no longer be surplus basal insulin to deal with them, although it will take a few days for your basal change to show it's full impact.

Since the wheat biscuit was more than an hour after your meal, I would probably bolus for it separately but you have to bear in mind that a bit of that bolus insulin may well still be active when you go to bed because it will still be working on the carbs, even if it is just the tail end of it. If the snack is just 10-15 g carbs then after 3-4 hours there will be only a tiny bit left, if it was 5 or 6 units perhaps for a late dessert, then there might still be a whole unit left 3-4 hours later and it would be more of a concern. If you have calculated correctly then it should not make any difference but you would not do any correction with insulin when you inject for that snack even if your levels are high and similarly when you go to bed.

I tend to judge whether to have a snack by my levels. If my levels are high, I wouldn't have a snack because there is plenty of glucose in my system or I would have a very low carb snack like a boiled egg or cheese if I was genuinely hungry. A lot of the time snacking is habit rather than real hunger though. If my levels were low, then I would judge the size of the snack based on my levels. If I am in the 4s then a dried fig or a couple of prunes will top me up without sending me too high. If I was in the 5s or 6s I would bolus for the snack.
 
Was not aware that it would have been ok to have extra bolus for the wheat biscuit whilst my evening meal bolus would still be active, learn something new every day. Thanks
 
It is the same if you go out for a meal. You don't know what or if you are going to have for dessert after your main meal, so you bolus for your main course and then after you have eaten that, decide if you want a dessert and what to have and then bolus for it separately. Same if you had lunch and then 2 hours later, went out to a garden centre or something and decided to have a cup of tea and a scone as a treat. You would bolus for the scone/cake whatever you chose, but not do any correction if your levels were high because the lunchtime insulin would still be working.
 
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