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[rebrascora]

Keeping these records when your levels are misbehaving is really helpful to your health care professionals to support you in finding a solution... and to us here on the forum too, to help point you in the right direction. It isn't something you need to do everyday for the rest of your life, but certainly, when you are having problems it is essential.
You should be able to make notes on the LibreLink app of this info.

 

[Inka]

I agree with @rebrascora Splitting your basal should help a lot. Your Levemir could well be running out by mid-morning. Get advice about your split as it’s very possible it might not be a 50/50 split and you don’t want to have a hypo.

 

[void]

Type 1s can eat a normal diet and usually aren’t insulin resistant.

This, I think needs to be contextualised.

What i *think* you mean to say here is that t1s don't usually have metabolic syndrome. Which is true. But you'd be incorrect/imprecise if you meant exactly what you wrote. Because insulin resistance is dynamic in everyone, diabetic or not. It changes according to circadian rhythm and activity and age and is present in everyone on waking.

Personally, I (usually!!!) avoid carbohydrate mostly for the first couple hrs after waking, because it keeps things simple. Exceptions are a couple of cappucinos to wake up and these two combined are 6g carb. It usually spikes a little but hardly ever into double figures. Rarer exceptions like once a month I get croissants, and enjoy them. Even though the carb was covered by insulin it went from 5.8 to 13.5. But a few hrs later it's in the normal range.

But I'd never routinely have carbs in the morning apart from the milk in those two cappucinos.

 

[rebrascora]

Rarer exceptions like once a month I get croissants, and enjoy them. Even though the carb was covered by insulin it went from 5.8 to 13.5. But a few hrs later it's in the normal range.

I also like to keep my carbs lowish on a morning too but if you prebolus far enough in advance you can usually prevent the spike and keep it below 8. 45mins at breakfast time is about right for me with Fiasp but it was 75mins with NR which was a pain in the backside, hence the change to Fiasp.

I agree with you about insulin resistance. It is a sliding scale with insulin sensitivity at the other end and lots of factors impact it and where we are on that scale.

 

[Inka]

This, I think needs to be contextualised.

What i *think* you mean to say here is that t1s don't usually have metabolic syndrome. Which is true. But you'd be incorrect/imprecise if you meant exactly what you wrote. Because insulin resistance is dynamic in everyone, diabetic or not. It changes according to circadian rhythm and activity and age and is present in everyone on waking.

Personally, I (usually!!!) avoid carbohydrate mostly for the first couple hrs after waking, because it keeps things simple. Exceptions are a couple of cappucinos to wake up and these two combined are 6g carb. It usually spikes a little but hardly ever into double figures. Rarer exceptions like once a month I get croissants, and enjoy them. Even though the carb was covered by insulin it went from 5.8 to 13.5. But a few hrs later it's in the normal range.

But I'd never routinely have carbs in the morning apart from the milk in those two cappucinos.

You’re Type 1.5 - more likely to have a greater element of insulin resistance than a Type 1. Most Type 1s can eat perfectly normal breakfasts. I had a large bowl of cereal today - blood sugar before was 5.6, 2hrs after 6.8.

Obviously, some Type 1s can develop insulin resistance - hence double diabetes. That’s why I wrote “usually” in my sentence.

 

[Jimmy2202]

Have you also had some lunch during that time and did you inject some bolus insulin for it or a correction? It would really help if you noted on your LibreLink log when you inject insulin and eat food so that we have more information to see what is going on?

As you can see my only meal was this afternoon about 1pm which was a 20g sandwich and I injected 2 units novarapid 15 mins before but I still spiked to like 19 mmol

I didn’t eat anything for breakfast only a cup of coffee with milk at 7am

 

[rebrascora]

OK. So looking at that graph, your levels are noticeably dropping overnight and if you hadn't been above target at bedtime then you might have ended up hypo this morning so that suggests your evening Levemir dose is too high for overnight because it has dropped you from about 13 at midnight to about 8 at 6am. That is a drop of 5 whole mmols and I believe I have seen a similar drop on other graphs you have posted, so overnight basal is too high.... which supports splitting your Levemir dose.

The spike at lunchtime is probably due to you not giving the NovoRapid a long enough prebolus time and perhaps your evening Levemir dose wearing off. 15 mins might be fine if your levels were 4-6 when you injected your insulin for lunch, but if your levels are higher it takes longer for the insulin to work and it looks like you were about 8 when you injected, so it often takes longer to work when higher. Your digestive system is obviously like mine and breaks down carbs much faster than it absorbs insulin. I am guessing you also stop your physical work to have lunch so that maybe when the Levemir is running out and making that peak higher than it should be.

What did you have in your sandwich? Did you have anything with it like soup or crisps or a piece of fruit or just the sandwich? 20g carbs seems low for a sandwich? Did you use special low carb bread?
Generally 10g carbs would raise your BG by 3 mmols so 20g carbs would raise it by about 6, but you have gone from about 8 to 18 which suggests there were more carbs than just 20 but it may be that there were other factors at play if that is an accurate carb count, like the Levemir running out.

 

[rebrascora]

The important thing is that the spike comes back down so the combination of the NovoRapid and presumably the physical activity after lunch brought it back down into range, so it may just be a timing issue unless you dropped too low in the afternoon?

 

[rebrascora]

The spike in the evening at 6pm also looks like you need to give your bolus injection longer in advance of eating to prevent that massive spike and it doesn't come back down into range which is likely because your Levemir has run out but could also be because you miscalculated carbs and under dosed the NR for your evening meal.

 

[void]

As you can see my only meal was this afternoon about 1pm which was a 20g sandwich and I injected 2 units novarapid 15 mins before but I still spiked to like 19 mmol

I didn’t eat anything for breakfast only a cup of coffee with milk at 7am

Hi Jimmy,
Have you tried verifying the numbers from the libre against fingerprick tests? (or rather, take a fp test then scan 3mins later). Same or nearly the same value?

As you're a relatively new diabetic (less than 2 years), and you might be in "honeymoon" period I'd suggest speaking with your diabetic team before making changes

 

[Jimmy2202]

The spike in the evening at 6pm also looks like you need to give your bolus injection longer in advance of eating to prevent that massive spike and it doesn't come back down into range which is likely because your Levemir has run out but could also be because you miscalculated carbs and under dosed the NR for your evening meal.

Same
Thing has now happened for my evening meal. Was only a 40g carb meal

It’s literlly every time I eat food it does it.

Really getting frustrated with this - it’s changed like a flick of a switch - I used to nail this game every day easily really.

All of a sudden it’s gone pear shaped

 

[Jimmy2202]

Hi Jimmy,
Have you tried verifying the numbers from the libre against fingerprick tests? (or rather, take a fp test then scan 3mins later). Same or nearly the same value?

As you're a relatively new diabetic (less than 2 years), and you might be in "honeymoon" period I'd suggest speaking with your diabetic team before making changes

Hi yes I do check with finger prick every now and again if I don’t think I believe the Libre reading.

Quite frankly I’d rather suss it out myself than speak to the medics - I have spent far too many hours days in hospitals - a bit of research and I’ll get there.

 

[Jimmy2202]

The spike in the evening at 6pm also looks like you need to give your bolus injection longer in advance of eating to prevent that massive spike and it doesn't come back down into range which is likely because your Levemir has run out but could also be because you miscalculated carbs and under dosed the NR for your evening meal.

I mean I have always usually waited 15 - 20 mins and it’s been fine

 

[Jimmy2202]

The important thing is that the spike comes back down so the combination of the NovoRapid and presumably the physical activity after lunch brought it back down into range, so it may just be a timing issue unless you dropped too low in the afternoon?

Yes work always brings me back down quick enough.

Christmas screwed me right over and so do weekends when I’ve got my little boy cos when I’m not working it all goes wrong in the day.

I live my life wishing I was at work which is not right

 

[rebrascora]

Again, it looks like you didn't prebolus far enough in advance.

Unfortunately our bodies change and what worked last week or last month, or for the last 6 months, may not now and you have to find a new strategy to deal with it. This is the way with diabetes, the goal posts keep moving and the rules change just when you think you have it all sussed and it is ticking along reasonably nicely. This is especially true as the honeymoon period starts to come to an end and you get more significant changes. It is incredibly frustrating so do cut yourself some slack. You are not doing anything wrong as such, it's just playing hardball with you.

I would experiment with giving your insulin another 5 mins head start each day until that spike starts to come down and remember that different times of day may need different timings. I personally need 45 mins at breakfast but just 20 mins at other times of day, unless my levels are high and then I inject my insulin and keep a close eye on my Libre and scan regularly and only start eating when my levels come down to 5. Yes, it might mean I sit looking at my meal for 30 mins and it needs to get zapped in the the microwave but otherwise I will go high and stay high and I hate that more than waiting to eat my meal. Once you figure out the new timing you will know how far in advance of preparing the meal, you need to inject. So for instance some people inject when they put the spuds on to boil if they need a 20 min prebolus time. On a morning I inject before I get out of bed, then get washed and dressed, have a coffee and prepare my breakfast, catch up with the news and then eat, which takes up the 45mins that I need. Once you get into a routine it becomes easier..... until the goal posts change again. 🙄

 

[rebrascora]

Yes, having a big difference between work days and days off will make things extra difficult and ideally a pump would be the thing to help you. I understand you not wanting to spend more time at appointments but ultimately if you can get the support to get it sorted, it will make life a lot easier.... and less frustrating!

 

[Jimmy2202]

Again, it looks like you didn't prebolus far enough in advance.

Unfortunately our bodies change and what worked last week or last month, or for the last 6 months, may not now and you have to find a new strategy to deal with it. This is the way with diabetes, the goal posts keep moving and the rules change just when you think you have it all sussed and it is ticking along reasonably nicely. This is especially true as the honeymoon period starts to come to an end and you get more significant changes. It is incredibly frustrating so do cut yourself some slack. You are not doing anything wrong as such, it's just playing hardball with you.

I would experiment with giving your insulin another 5 mins head start each day until that spike starts to come down and remember that different times of day may need different timings. I personally need 45 mins at breakfast but just 20 mins at other times of day, unless my levels are high and then I inject my insulin and keep a close eye on my Libre and scan regularly and only start eating when my levels come down to 5. Yes, it might mean I sit looking at my meal for 30 mins and it needs to get zapped in the the microwave but otherwise I will go high and stay high and I hate that more than waiting to eat my meal. Once you figure out the new timing you will know how far in advance of preparing the meal, you need to inject. So for instance some people inject when they put the spuds on to boil if they need a 20 min prebolus time. On a morning I inject before I get out of bed, then get washed and dressed, have a coffee and prepare my breakfast, catch up with the news and then eat, which takes up the 45mins that I need. Once you get into a routine it becomes easier..... until the goal posts change again. 🙄

Thankyou.

Reading this has just slapped in around the face and woke me up a bit.

Half my trouble is I out every day at work so I’m to impatient to wait to eat my food cos it’s usually warm from where ever I buy it from lol

I need to make my own packed lunch so that I can eat it and wait the right amount of time from injecting and also so that I know the true carb content.

It just seems scary to me having a insulin carb ratio of like 1:8 or even a bit less… not used to it

 

[rebrascora]

I think if you had your Levemir doses better balanced, you probably wouldn't need 1:8 and I also thing that you are probably underestimating your carbs if that was a bought sandwich today, because I cannot imagine a bought sandwich being made with low carb bread, so more likely 35g carbs in a 2 slice sandwich and maybe a bit more if it was a bun. so your ratio was probably very different to what you calculated, but you obviously worked the excess off in the afternoon which is fair enough. If you had just timed the insulin a bit earlier it might have looked a whole lot better.

If the worst comes to the worst and you drop a little bit too low before you start eating, you can always have a single Jelly Baby to stop the drop.... say you get to 5.3 with a vertical downward arrow, chew it really well and then have your meal and that should level it out. This happens to me occasionally and it is amazing how quickly a single jelly baby can slow things down. I used to fear my insulin. Now I see my insulin and food like an accelerator and brake. Using them appropriately will get me to where I want to be. Now I know how effective a JB can be at slowing it down I am more confident to use the insulin earlier before a meal and then watch my Libre and wait until I see the insulin starting to drop my levels and then eat. It becomes more of a game or a challenge to see if I can get the timing spot on rather than a chore or frustration and don't forget those big spikes affect your physical and mental wellbeing, so a bit of preplanning before the meal can make all the difference to how you feel. I don't get it right all the time like everyone else and sometimes you can't really wait and just have to accept that you will spike, but often you can just delay it a bit longer or inject a bit more in advance. Things like, if we go to the takeaway which is 5 mins down the road, I inject when I order. If it the worst happens and it isn't ready when I expect it to be, I can eat a JB to slow the drop and that will give me another 10-15 mins for the food to be ready and 5g carbs isn't going to make a huge difference to my levels. I might end up 1 or at worst 2mmols higher than I would like when the insulin has finished working but if I don't spike above 10 and end up at 8 instead of 6, it is better than spiking up to 18 and then coming back down to 5.

Hope that makes sense. For me Libre allows us to make these small adjustments if necessary, whereas before, when we only had finger pricks, the advice was not to inject until you had the food in front of you, but now that we can monitor our levels easily, we can just slow it down if it is starting to drop and the food isn't quite ready and 1 JB isn't going to spoil your appetite if you get to the situation that you need to use it. That is the way I see it and how my confidence has developed with prebolusing.

 

[Jimmy2202]

Regarding the sandwich it was a sausage bacon and egg sandwich at 40g and I only ate 1 half of it.

Was blinking starving all day but I’m sick of the highs

 

[Jimmy2202]

I think if you had your Levemir doses better balanced, you probably wouldn't need 1:8 and I also thing that you are probably underestimating your carbs if that was a bought sandwich today, because I cannot imagine a bought sandwich being made with low carb bread, so more likely 35g carbs in a 2 slice sandwich and maybe a bit more if it was a bun. so your ratio was probably very different to what you calculated, but you obviously worked the excess off in the afternoon which is fair enough. If you had just timed the insulin a bit earlier it might have looked a whole lot better.

If the worst comes to the worst and you drop a little bit too low before you start eating, you can always have a single Jelly Baby to stop the drop.... say you get to 5.3 with a vertical downward arrow, chew it really well and then have your meal and that should level it out. This happens to me occasionally and it is amazing how quickly a single jelly baby can slow things down. I used to fear my insulin. Now I see my insulin and food like an accelerator and brake. Using them appropriately will get me to where I want to be. Now I know how effective a JB can be at slowing it down I am more confident to use the insulin earlier before a meal and then watch my Libre and wait until I see the insulin starting to drop my levels and then eat. It becomes more of a game or a challenge to see if I can get the timing spot on rather than a chore or frustration and don't forget those big spikes affect your physical and mental wellbeing, so a bit of preplanning before the meal can make all the difference to how you feel. I don't get it right all the time like everyone else and sometimes you can't really wait and just have to accept that you will spike, but often you can just delay it a bit longer or inject a bit more in advance. Things like, if we go to the takeaway which is 5 mins down the road, I inject when I order. If it the worst happens and it isn't ready when I expect it to be, I can eat a JB to slow the drop and that will give me another 10-15 mins for the food to be ready and 5g carbs isn't going to make a huge difference to my levels. I might end up 1 or at worst 2mmols higher than I would like when the insulin has finished working but if I don't spike above 10 and end up at 8 instead of 6, it is better than spiking up to 18 and then coming back down to 5.

Hope that makes sense. For me Libre allows us to make these small adjustments if necessary, whereas before, when we only had finger pricks, the advice was not to inject until you had the food in front of you, but now that we can monitor our levels easily, we can just slow it down if it is starting to drop and the food isn't quite ready and 1 JB isn't going to spoil your appetite if you get to the situation that you need to use it. That is the way I see it and how my confidence has developed with prebolusing.

I admire your knowledge. You sound like you’ve nailed it 🙂 fair play.