Hello
@Pam123.
In a different thread you remarked:
4.4 for me alarm went of while eating my dinner 3.9 so ended up drinking a small glass of Coke didn't fancy jelly babies half way through a salmon salad havn't had Coke for 6 months didn't Seam to work but not sure how long I should take about 30 mins rose to 5 so silly me had a small slice of chocolate cake and it shot up slowerly to 11.6 at 10pm now its 7.6 no idea why this has happened
I'm assuming the following and hope they are about right:
You are still on Lantus now taking 32 units having steadily increased from your original 12 units;
You have Libre 2 CGM and I've seen that you check Libre readings with a finger prick test when your CGM readings are low or high. [Well done by the way in getting to grips with this D hassle!]
You are still taking thyroxine for your very longstanding thyroid problem.
You still have some mobility problems, so the idea of a 15+ minute walk after a meal is inappropriate for you.
I have some observations that I think might help you in the future. I have no medical qualifications so my comments have absolutely no medical standing, they are just things that flashed through my mind as I read your recent comment above, (in my italics).
Firstly full Coke is rated at 10.6 gms of carbs per 100ml, so that 200ml was an extra 21 gms of carbs, which seems to me quite a lot for someone who is T2. That T2 diagnosis almost by definition means your body has a high level of natural resistance to insulin, which makes it difficult for you to process glucose in your blood anyway; so adding another large gulp of 21 gms won't be helping your D management.
If while eating your dinner and you get an alarm for 3.9, there would normally be no need for you to react at all. While you do have Lantus in place as your background insulin (which could possibly make you vulnerable to a future hypo) with your dinner already started a future possible better decision is to just keep eating and get a few mouthfuls of higher carb foods eaten, such as potatoes. If the whole salmon salad meal was very low carb anyway - then the Coke would be a possible choice, but I think better to be a smaller amount, say 100ml.
However once some food is already in your digestive system the efficiency of a high GI food (such as coke) is inevitably diluted by what is already being digested. Yet the extra carbs and thus extra glucose will still need to be managed out of your BG; the high GI coke won't seem like being a high GI food to your metabolism because it is now diluted. The strong advice for those of us on both basal and bolus is to NOT start a meal if already very close to the hypo zone, but to take our normal hypo treatment [15gms high GI carb, wait 15 mins, test for signs of response and treat again if not yet responding]. Only start that meal once response is clearly happening - which these days (thanks to CGM) the trend arrows quickly show response is happening (or not yet). So once already eating keep eating and help by choosing higher GI carbs from off your plate. A couple of savioury crackers would also work instead of Coke.
Strictly hypo is actually 3.5mmol/L and the figure of 4 is
routinely used to provide a small safety margin. Even at 3.5 most people might only feel mildish hypo symptoms. My Dexcom G7 CGM has an unchangeable fixed Urgent Low alarm of 3.1, unchangeable to stop me from trying to go lower (!) and to make me really take note and do something about my low (which is fair enough I suppose).
However 3.1, 3.5, or 4.4 is, I suggest, a digression here in my thoughts because I think
your alarm should be at 5.0 or even 5.6 (the maximum for Libre 2) and that you should
not even consider it as an Alarm but an "
Alert" because in practice at 4.4 that is already too low to guarantee any response will always keep you above 4 anyway. And why live by alarms when Alerts are a gentler and less stressful way of life?
Given your limited mobility as well, unless you always have snacks at your finger tips at all times of the day and night to allow you to respond to a low alert, ie in the lower 4s, then you just need that alert a distinct bit earlier. Then your response won't always need to be search for the dextrose, Coke or Jelly Babies - but first a timely look at the trend on your CGM. Then assess and if the change is very gentle with a horizontal arrow you have choices. If the next meal is imminent - do nothing; just eat that next meal. Or perhaps a single boiled sweet or a toffee will be enough to just stop that gentle change for 30+ mins (great excuse for the toffee!). If there is a more obvious fall going on then one plain biscuit (or 1/2 a fancy Cookie) at c.6-7 gms carbs might well be enough; continue to monitor and have a second small biscuit (or the other half cookie). The bottom line here is stay well away from the 4s, better in the 5-6s and make optimum use of your CGM to monitor and learn about what is great for you to get small steady responses to. Certainly not a 21 carb gm glass of Coke, I suggest.
The International Conference that looked at Time in Range [from 4-10 mmol/L] for people using CGM recommended less than 4% time below 4, whereas up to 25% above 10 was acceptable. The harsh reality for our age group is that time below 4 worsens anyone's vulnerability to dementia and alzheimers and we already have that threat ahead of us just because of our age. So I think (again I'm not medically qualified) we should do our best to stay in a safer zone away from the 4s completely.
My last thought was that because you have now successfully made inroads into your D management (again really well done) and increased from your original 12 units to 32 units of Lantus .... perhaps you have gone 1 or 2 units too far. Consider this: is it possible that not only have you done well with steadily yet safely increasing your Lantus but have you also steadily made changes in your eating habits and been quietly reducing your carb intake? This wouldn't be surprising. You were diagnosed as T2 after a dreadful period of illness last year, you now have T2 ingrained into your mind and reminded daily with the Lantus injections, so are you just routinely choosing lower carb options?
I think you could consider a small Lantus reduction or a more relaxed menu selection - but if I may suggest DO NOT change both things at the same time. If your meal choices are now in some sort of harmony with your husband's needs, then leave those alone and slightly scale down your Lantus. That way the odd biscuit or sweet remains as a perfectly good way (and treat) for nudging your BG up when necessary - provided your alarms are now
Alerts at up to 5.6.
Anyway some things to at least consider as a follow on from when you first joined this forum. Best wishes.
