Hi there

[Amanda Jane]

I've never been on a forum of any kind before so please excuse my inexperience. I was diagnosed as a Type 1 ten years ago at the age of thirty nine and I still can't get to grips with it. So I'm looking for tips on how I can get the readings on my freestyle libre app to be a nice straight line and not resemble a heart monitor ☹️ And if anyone has advice on dealing with diabetes during the menopause that would be great too

 

[Bruce Stephens]

So I'm looking for tips on how I can get the readings on my freestyle libre app to be a nice straight line and not resemble a heart monitor

The DSNs here always emphasised that the only people who can get straight lines are the dead. Some variation is normal and unavoidable. To try and reduce the variation, work on reducing the lows first (because lows are unpleasant in themselves and they often precede highs).

But how bad are things, really? What's your time in range?

(Oh, and welcome to the forum 🙂)

 

[Amanda Jane]

The DSNs here always emphasised that the only people who can get straight lines are the dead. Some variation is normal and unavoidable. To try and reduce the variation, work on reducing the lows first (because lows are unpleasant in themselves and they often precede highs).

But how bad are things, really? What's your time in range?

(Oh, and welcome to the forum 🙂)

Hi Bruce,thank you for your reply . Only about 50% in range (set at between 5 and 10). It's CP/insulin ratios and varying ratios through the day that I really struggle with.

 

[rebrascora]

Hi and welcome.

HRT was the answer to your second question for me. That small patch of plastic has revolutionized my life in lots of ways, after battling for 5 years with pretty bad menopausal symptoms. Just a wonder treatment as far as I am concerned.

As regards Libre, it maybe that your expectation is too high as even non-diabetic people get spikes rather than straight lines. If you are getting particularly high spikes but coming back down into range then it is likely a timing issue with your bolus insulin. Just to give you some idea of how that works.... Most people are more insulin resistant on a morning and so their bolus insulin takes longer to get going than normal. Added to that, most breakfast options (cereals and toast) are quite carb rich so the carbs hit the blood stream long before the insulin and spike levels high until the insulin eventually overcomes the resistance and brings levels back down. If you inject the insulin earlier (I inject before I set foot out of bed) and give it longer to get going, it enables it to start overcoming the insulin resistance and work on the carbs when they hit the blood stream. The timing of this is very individual but Libre enables you to see it happening. I used to need 75 mins prebolus time with NovoRapid ( 🙄 ) which is why I changed to Fiasp but still need 45mins advance injection time to prevent spikes. Lunchtime and evening meal are usually nearer 15-30 mins. It is important to note that many people would hypo long before 45 mins even at breakfast, so you need to cautiously increase the timing by a few mins each day until you find the right timing for you and keep a close eye on your Libre to see when levels start to decrease and the insulin is kicking in. Breakfast is the easiest meal to start with because most of us have a similar breakfast each morning, so there is less to think about. Also a good idea to experiment on a non working day when you have more time to experiment and therefore less likely to make a mistake and end up hypo. You can then do the same experiement with lunch and evening meals although foods will release glucose at different rates so you need to be aware that higher fat foods like pizza and pasta with a creamy sauce fish and chips etc willrelease carbs more slowly and not need much or any prebolus time and may benefit from a split dose of bolus ie some up front just before you eat and some an hour or so later.

That may all sound quite complicated but once you get the hang of it it starts to make sense and you will see patterns. There is lots to learn with diabetes and always something new. The great thing about the forum is that we can all share what we learn with each other and that means it is probably a more practical resource than any consultant or DSN can offer as they really mostly know the theory. As an example, my consultant was absolutely horrified that I injected my bolus insulin so far in advance for breakfast, but he couldn't argue with the results and from sharing info on this forum there are several of us who need 45mins prebolus time. A consultant or nurse would never recommend someone inject that far in advance.... but it is necessary for some of us to iron out some of those sky high peaks and then descents, the latter of which used to make me feel pretty rubbish mid morning as levels came crashing back down. I rarely go above 8 after breakfast now.

Anyway, make yourself at home on the forum and ask whatever questions you have or feel free to have a moan about the frustrations of it all as that is also a valid function of the forum.... to have a safe place to let off steam when you need to. Look forward to hearing more from you and hopefully that you have had success in reducing some of those peaks to more rolling hills.

 

[Bruce Stephens]

Only about 50% in range (set at between 5 and 10). It's CP/insulin ratios and varying ratios through the day that I really struggle with.

Which isn't great, but it's not horrible. (I have days like that. My longer term stats are much better, but I'm male.)

Any interesting patterns in the daily patterns view? For example is night time OK? (If not, looking at the basal dose makes sense. If you can't find a basal dose that works for the whole night maybe that's a sign that you need a pump, as some people do.)

 

[Amanda Jane]

No idea what this is telling me, but I find I'm high first thing in the morning and it keeps rising til lunchtime then I goes down dramatically. I've been trying a 1.5:1 ratio for breakfast and 0.5:1 for lunch as advised by the dsn but it's not working very well. I'm keen to try Rebrascora's idea of the timings. What I do have to do, which I know is my biggest fault is be patient and make small changes, but I do get easily frustrated and I worry about the dsn's reaction if my hba1c is high so I take more insulin than I should to get the levels down and then bounce between hypos and highs ☹️

 

[Bruce Stephens]

No idea what this is telling me, but I find I'm high first thing in the morning and it keeps rising til lunchtime then I goes down dramatically.

My (non-expert) reading is that you're falling a little overnight, but only slowly so it's probably not the first thing to look at. As you say, it looks like you're rising from about 6am to about 12am and then falling quite quickly until 9pm. (This is all on average. Individual days will each look different, of course.)

So I'd guess you need a bit more insulin for breakfast and a bit less for lunch and dinner. (How much, none of us can say. Common advice is to change these things by no more than 10% at a time.)

As @rebrascora says timing can make an enormous difference, so certainly try pre-bolusing as well. But the directions of the (average) lines look like the amounts of insulin are a bit wrong too.

You're completely right that changing too many things at once is an easy way not to really learn anything, so try and resist that.

 

[SB2015]

Welcome to the forum @Amanda Jane

Great that you have found us and that you are looking to get more settled with your levels.
I am another supporter of pre-bolusing for meals. I find that this gives the insulin a chance to get going and meet the glucose from my carbs head on, so reducing the spikes I was getting.

We can never get perfectly flat lines but it is good to look at the patterns that appear using data from a n7 bed of days. From what you have said it sounds like you work with your DSN when making changes to carb ratios And as others have said it is important to change one things at a time.

Which insulins are you currently using. Some find it useful to get their basal insulin sorted first, and if using Levemir you can split your basal to a morning and evening dose, enabling you to alter one without impacting the other. This some increased flexibility and then a good base on which to work on your carb ratios. I had the same ones throughout the day initially before I cam on here and realised that many have different ones for different times of the day. I now find I need more insulin in the morning bolus that I do at other times.

Are you using half unit pens? These also help you to make finer adjustments. You could also talk to your team about whether a pump would be appropriate.

let us know how you get on and keep the questions coming. Nothing is considered silly on here, so just ask.