Hi

[Robin]

Whats the formula ? Or is it something you can get from Libre reader. Mine is just Libre and not Libre 2. Still not latest tech

Just checked my original reader, and it’s the same as the Libre 2.
When you’ve swiped the sensor, and it’s displaying a reading, press the little button at the bottom right.Or if you’re not scanning, just press the button again when it displays the 'Check glucose' screen
Touch 'Review history' on the screen, it will display a list of options.
Touch the down arrow at the bottom of the screen to take you to the second page.
Touch 'Time in target'
It displays the time in range for 7 days, clicking the left hand arrow will give you 14 days, repeat for 30 days, and 90 days.

 

[Mom of Type 1]

Today, we change his Libre sensor to a new one as the old one accidentally were peeled off. The new one has a closer difference to the finger pricking readings, which makes us feels more confidence. Now, I understand why finger pricking is a good backup method. Thank you all for the advice and guidance.

 

[Mom of Type 1]

We noticed that the glucose level tends to only go down a few units during the evening. It is like a lazy insulin whereas we dont see that during the day. Any idea why it is like that ? This kind of mess up the the level in the morning.

 

[rebrascora]

Not sure I understand you.
When are the levels starting to go down and how low do they go? Do you mean he is having night time (nocturnal) hypos?
What is the problem with his morning levels?
Can you post a photo of his Libre graph illustrating the problem?

 

[SimonP]

There are differences in insulin sensitivity across the day, it may be that he therefore requires a different insulin to carbs ratio (i.e. more insulin for a given quantity of carbs) in the evening (or indeed any other time - you have to work out how it changes across the day).

 

[Mom of Type 1]

Not sure I understand you.
When are the levels starting to go down and how low do they go? Do you mean he is having night time (nocturnal) hypos?
What is the problem with his morning levels?
Can you post a photo of his Libre graph illustrating the problem?

It took so long for the levels to go down. He had a heavy dinner though. It took whole night to go back optimal level. We had dinner around 7.30pm the night before 6th Jul, injected novorapid at that time, at 10pm, injected Toujeo. The chart about is from 12midnight onwards till this morning around 7am..

 

[SimonP]

A large meal will take a number of hours to digest, also meals containing fat (which tbh is most main meals) will take longer still to digest (pizza being the ultimate, though not for me, ymmv.)

I tend to split my evening meal bolus to allow me to take enough, but not all up-front (as otherwise I'll go low in the early evening as there's a mis-match between the insulin effect and the food being digested.) Depending on insulin sensitivity at that time of day more insulin may be required than at other times, splitting it is a way of avoiding a hypo.

I'm interested to see that the graph did get back down to an "ideal" range in the morning - was this taking extra insulin? If not, it says to me that there's too much basal and that had he not gone high, he would have gone low. Hard to judge from a single graph mind you! What happens on other nights with smaller meals, etc.?

 

[Mom of Type 1]

A large meal will take a number of hours to digest, also meals containing fat (which tbh is most main meals) will take longer still to digest (pizza being the ultimate, though not for me, ymmv.)

I tend to split my evening meal bolus to allow me to take enough, but not all up-front (as otherwise I'll go low in the early evening as there's a mis-match between the insulin effect and the food being digested.) Depending on insulin sensitivity at that time of day more insulin may be required than at other times, splitting it is a way of avoiding a hypo.

I'm interested to see that the graph did get back down to an "ideal" range in the morning - was this taking extra insulin? If not, it says to me that there's too much basal and that had he not gone high, he would have gone low. Hard to judge from a single graph mind you! What happens on other nights with smaller meals, etc.?

Today, he is all-time in optimal range...now, giving me worry as it is 5mmol at 11.30pm....just injected Toujeo...need to monitor thru the night, whether this will cause hypo...

 

[rebrascora]

In that situation many of us were initially advised that if our level was below 8 at bedtime, to have a snack which would push it up to about 8, so if he is currently on 5mmols then about 10g carbs (a digestive biscuit or half to three quarters of a slice of bread with some peanut butter or cheese to push his levels up a bit more rather than worrying that he might hypo during the night.

 

[Mom of Type 1]

In that situation many of us were initially advised that if our level was below 8 at bedtime, to have a snack which would push it up to about 8, so if he is currently on 5mmols then about 10g carbs (a digestive biscuit or half to three quarters of a slice of bread with some peanut butter or cheese to push his levels up a bit more rather than worrying that he might hypo during the night.

I did not do that. However, interesting thing is that all thru the night, his reading was stable at 5mmol, then suddenly at 7am in the morning, it went up 3 units...and by now 8.45am, it is already 10mmol...is this normal ? so sudden...

 

[rebrascora]

Yes, it is quite normal and is known as Dawn Phenomenon (DP) or its slightly more sociable sibling, Foot on the Floor syndrome(FOTF). This is where the liver starts to release extra glucose into the blood stream in the morning to give us energy for the day ahead. Sometimes it starts before we wake up (DP) or as soon as we roll out of bed and stand up hence (FOTF). I inject 1.5-2 units of my fast acting insulin to cover this surge of glucose as soon as I wake up and before I get out of bed because otherwise my BG will rise by as much as 6mmols in the first hour after getting up. I can do this because there is a very clear regular pattern. I would not recommend your son do this unless you see a regular trend happening day after day.

 

[Mom of Type 1]

Yes, it is quite normal and is known as Dawn Phenomenon (DP) or its slightly more sociable sibling, Foot on the Floor syndrome(FOTF). This is where the liver starts to release extra glucose into the blood stream in the morning to give us energy for the day ahead. Sometimes it starts before we wake up (DP) or as soon as we roll out of bed and stand up hence (FOTF). I inject 1.5-2 units of my fast acting insulin to cover this surge of glucose as soon as I wake up and before I get out of bed because otherwise my BG will rise by as much as 6mmols in the first hour after getting up. I can do this because there is a very clear regular pattern. I would not recommend your son do this unless you see a regular trend happening day after day.

Ok, thanks. Will continue monitor and observe. Everyday is a new learning !

 

[Mom of Type 1]

How do you know whether it is DP or FOTF ? I happened to see this this morning because I check his BG every 2 hours after midnight because his BG was good whole day 5mmol and I was scared it went down during the night. But we cannot be checking everyday. We are not on pump.

 

[SimonP]

Both are related to hormones which are quite naturally released based on time of day/what one is doing. DP is typically a gradual rise from mid-early morning (e.g. 2-3am) and IIRC is due to growth hormone amongst others (though someone please correct me if my fuzzy memory is wrong). FotF happens either as soon as you wake up, or as soon as you get up out of bed (due to adrenaline being released to get you, and the liver, going).

I get the latter, but not noticeably the former.

 

[rebrascora]

How do you know whether it is DP or FOTF ? I happened to see this this morning because I check his BG every 2 hours after midnight because his BG was good whole day 5mmol and I was scared it went down during the night. But we cannot be checking everyday. We are not on pump.

You will start to see a regular pattern on his daily graph, where his levels start to rise in the morning. You should have a daily patterns feature on your Libre. I think it may be just above the Time in Range feature and that can be useful for spotting trends.
It doesn't matter too much whether it is DP or FOTF, but if you get a regular pattern of levels rising in the morning then you either adjust basal if that is possible without causing hypos at other times like earlier during the night or jab a bit of fast acting insulin as soon as he wakes up to deal with it. At this very early stage you are really just looking to get the hang of the basics so I would not worry too much about it, but these are the options for fine tuning when you/he is ready to take things to the next level. I think I was several months down the line with my diagnosis before I had a clear enough picture of what was going on to learn to deal with it effectively but I didn't have Libre, just finger pricks so it was harder to see the patterns and work out my strategy to deal with it. Injecting both my basal and fast acting insulin as soon as I wake up and before I get out of bed was a game changer for me, but your son may be different. I even went hrough a spell of setting an alarm for an hour before I was going to get up to inject my basal insulin and that 1.5-2units but I lost interest in doing that after a few weeks 🙄 and I have found that injecting as soon as I wake up works well enough. With diabetes management you have to balance everything and that includes quality of life over better and better results and particularly now we have the likes of Libre where we can see all the ups and downs throughout the day and night, finding that balance can be harder because it can encourage us to try to iron out every peak or dip which is unrealistic and unnecessary and can lead to obsession and diabetes burnout. The body is remarkably resilient and as long as you are doing your best and ideally achieving 70% Time in Range then you are doing brilliantly.

 

[Mom of Type 1]

When my son did a exercise, his BG went up. So, after exercise, do you take into consideration the BG that went up or use the number before exercise ? I notice that his level went down fast and we wonder did we inject too much insulin...

 

[helli]

When my son did a exercise, his BG went up. So, after exercise, do you take into consideration the BG that went up or use the number before exercise ? I notice that his level went down fast and we wonder did we inject too much insulin...

Exercise is a complex one. That does not mean you need to stop exercise but you need to learn how different types of exercise affect you.
Typically, resistance exercise and stop/start exercise will increase our BG whereas longer constant cardio exercise will decrease BG ... at the time. Both types of exercise can deplete our glucose reserves in our liver so we may need less insulin over the next 24 to 48 hours.
It will take some trial and learning to work out what types of exercise have what affect on your son.

When I am calculating my insulin dose, I take my BG at that time and knowledge of what I have just done or am going to do. For example, if I have just exercised (and I know from experience that this reduces my BG), I will adjust my insulin to carb ratio so I have less insulin. Likewise, if I am going to do some exercise in the next 2 hours or so that I know will increase my BG, I will take more insulin.

Sorry, there is no absolute answer as we are all different.
This is why it is useful to keep a diary of food and exercise as well as BG and insulin dose.

 

[rebrascora]

Exercise will affect his levels for up to 48 hours afterwards so whilst it might raise his levels at the time he is doing it and shortly afterwards depending upon the type of exercise he does, it will almost certainly come down later and he will need less insulin afterwards not more, How much less, depends on the individual and the type of exercise and how long he did it for. It can help to keep notes on exercise and how much his levels drop afterwards to help you make better decisions in the future. My advice would be not to add any correction insulin after exercise if he is high and consider a 20% reduction in his bolus.

What was his level before exercise and how high did he go as a result of it?

 

[Mom of Type 1]

Exercise is a complex one. That does not mean you need to stop exercise but you need to learn how different types of exercise affect you.
Typically, resistance exercise and stop/start exercise will increase our BG whereas longer constant cardio exercise will decrease BG ... at the time. Both types of exercise can deplete our glucose reserves in our liver so we may need less insulin over the next 24 to 48 hours.
It will take some trial and learning to work out what types of exercise have what affect on your son.

When I am calculating my insulin dose, I take my BG at that time and knowledge of what I have just done or am going to do. For example, if I have just exercised (and I know from experience that this reduces my BG), I will adjust my insulin to carb ratio so I have less insulin. Likewise, if I am going to do some exercise in the next 2 hours or so that I know will increase my BG, I will take more insulin.

Sorry, there is no absolute answer as we are all different.
This is why it is useful to keep a diary of food and exercise as well as BG and insulin dose.

Ok..yeah really complex...will continue to analyze the pattern..

 

[Mom of Type 1]

Exercise will affect his levels for up to 48 hours afterwards so whilst it might raise his levels at the time he is doing it and shortly afterwards depending upon the type of exercise he does, it will almost certainly come down later and he will need less insulin afterwards not more, How much less, depends on the individual and the type of exercise and how long he did it for. It can help to keep notes on exercise and how much his levels drop afterwards to help you make better decisions in the future. My advice would be not to add any correction insulin after exercise if he is high and consider a 20% reduction in his bolus.

What was his level before exercise and how high did he go as a result of it?

It was 11 before exercise and it shot up to 16mmol..