How do you react to Libre Arrows?

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Purls of Wisdom

Purls of Wisdom

Well-Known Member
Relationship to Diabetes
Type 1
rebrascora said:
60 mins is too long for a first experiment in my opinion and COULD BE DANGEROUS .

If you have only tried 20 before, maybe try 30mins in the morning and then 35mins the next day and keep adding 5 mins until you find the right timing for you.
You may well go hypo if you leave it 60 mins straight off. Most people would probably hypo in that time. It is very much an individual thing, so please experiment cautiously rather than jump in with both feet! It took me a couple of weeks to find out what worked for me.... granted, I was initially just finger pricking and didn't have Libre, so I had to be much more cautious and I did A LOT of finger pricking but I would hate for you to end up hypo because you assumed you would be safe on 60 mins, just because I am.
Your BG reading in the morning will also have a bearing on how long the insulin will need. If you wake up in the 4s you will almost certainly need less prebolus time than if you wake up in the 7s or 8s.
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What would you suggest to someone who woke up to 11.2mmol/L and a vertical arrow? Thanks. X
 
Purls of Wisdom said:
What would you suggest to someone who woke up to 11.2mmol/L and a vertical arrow? Thanks. X
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I think it would help if this had a thread of it's own to discuss this as it is a bit of a tangent now from the original post which is effectively about how to prevent constipation on a low carb diet 😳 so this is a bit of a migration from the topic now.
I wonder if @everydayupsanddowns could create a new thread to move it to?

@Purls of Wisdom Are we talking an upward vertical arrow (as oppose to a downward arrow) and can you post a photo of your Libre graph for some context? I would want to be sure it wasn't a rebound from a compression low caused by lying on the Libre sensor before I gave you an idea of what I might do in that situation. Also can you remind me which basal insulin you use and when you inject it?
 
rebrascora said:
I think it would help if this had a thread of it's own to discuss this as it is a bit of a tangent now from the original post which is effectively about how to prevent constipation on a low carb diet 😳 so this is a bit of a migration from the topic now.
I wonder if @everydayupsanddowns could create a new thread to move it to?

@Purls of Wisdom Are we talking an upward vertical arrow (as oppose to a downward arrow) and can you post a photo of your Libre graph for some context? I would want to be sure it wasn't a rebound from a compression low caused by lying on the Libre sensor before I gave you an idea of what I might do in that situation. Also can you remind me which basal insulin you use and when you inject it?
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Screenshot_20220926-181022.jpg
 
OK, so the 11.2 with an upward arrow was at 2.17am and looks to be an erroneous prediction by Libre because the Libre graph doesn't go through that orange dot and the same again with the orange dot on 11.8 at 7.41am, so both these readings look to be about 2mmols higher than your actual BG. Before taking any action, it would be prudent to do a finger prick check to see what your actual BG is because clearly Libre has got it slightly wrong with these readings.

That said, looking at that graph your levels are fairly persistently rising throughout the night since you were just over 6 at midnight and ended up at about 10 at 7am, so provided that you didn't eat something just before bed then it would suggest that your evening Levemir dose may not be quite enough. Do you have similar overnight rises on your other graphs the last few days as that would confirm for me that my evening Levemir dose needed increasing. If it was just a one-off overnight rise, then I would not adjust my basal. You should talk to your DSN about any changes to basal insulin unless you have been taught how to adjust it and your nurse is happy for you to do so.
If I woke up in the night with my levels high like that, I would double check it with a finger prick and then calculate how much fast acting insulin I needed to bring it down into range.... say a BG of 6-7.... inject that insulin and go back to sleep.
In fact, I did exactly that last night. Woke up at 4.40am after very restless sleep with a reading of 10.9 and a graph showing I had been 10-12 all night. I calculated how much fast acting insulin I would need to bring me down into range, I injected that correction dose of insulin and went back to sleep and woke up when the alarm went off to a very nice 5.6. I will be increasing my evening Levemir tonight by 1 unit and hopefully that will prevent it going high again tonight. At least this is what I will be doing unless I get out for a long walk or run tonight but if it keeps raining and I don't get that exercise then I will increase the Levemir.

So just to recap..... if you wake up with a high or low reading you should firstly do a finger prick test to confirm the actual reading because Libre is not always accurate.

If it is low then you eat 15g sugary carbs and test again in 15 mins until the hypo is treated.... using finger prick not Libre.

If the reading is high, then you have to think about when you last injected fast acting insulin. If it was 4 or more hours before, then you are safe to do a correction dose and you use the finger prick reading to calculate the correction based on your correction factor..... which might be 1 unit of insulin drops your levels by 3mmols or some other amount. 3 is usually the suggested starting point.
You then look at your actual reading which for me was 10.9 (near enough 11 for ease of calculation) and I want to be down to about 6, which is a nice mid range level, so I need to reduce my BG by 5mmols to get down from 11 to 6. If 1 unit drops me 3mmols then 2 units will drop me 6mmols. I happen to know that my levels are more resistant to insulin when they are above 10 so 2 units will be safe and at worst could bring me down to 5 which is still a perfectly acceptable waking reading, so that is how I calculate the amount of insulin I need to correct that high level and then I inject it and go back to sleep.

I can tell you that I slept much more soundly after I injected that correction and my levels started to come down. I hate that hot restless feeling of high levels! I should also say that I went over on my ankle yesterday and hit the deck so my high levels last night may well have been down to the damage and inflammation to soft tissue caused by the fall and I will have to take that into consideration when I dial up my Levemir dose tonight.
 
rebrascora said:
OK, so the 11.2 with an upward arrow was at 2.17am and looks to be an erroneous prediction by Libre because the Libre graph doesn't go through that orange dot and the same again with the orange dot on 11.8 at 7.41am, so both these readings look to be about 2mmols higher than your actual BG. Before taking any action, it would be prudent to do a finger prick check to see what your actual BG is because clearly Libre has got it slightly wrong with these readings.
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Point understood and duly noted.
rebrascora said:
That said, looking at that graph your levels are fairly persistently rising throughout the night since you were just over 6 at midnight and ended up at about 10 at 7am, so provided that you didn't eat something just before bed then it would suggest that your evening Levemir dose may not be quite enough
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The DSN mentioned something similar but in regards to morning Levemir. When I took 14u at bedtime, I used to dip around 3:00am for a couple of hours and did not know about it.
rebrascora said:
. Do you have similar overnight rises on your other graphs the last few days as that would confirm for me that my evening Levemir dose needed increasing. If it was just a one-off overnight rise, then I would not adjust my basal.
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If anyone sees my irratic graphs, you will understand why I get stressed about it.
rebrascora said:
You should talk to your DSN about any changes to basal insulin
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She did mention and then withdrew it straight away.
rebrascora said:
unless you have been taught how to adjust it and your nurse is happy for you to do so.
If I woke up in the night with my levels high like that, I would double check it with a finger prick and then calculate how much fast acting insulin I needed to bring it down into range.... say a BG of 6-7.... inject that insulin and go back to sleep.
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all I get suggested is, let us concentrate at one time (breakfast) only.
rebrascora said:
.
In fact, I did exactly that last night. Woke up at 4.40am after very restless sleep with a reading of 10.9 and a graph showing I had been 10-12 all night. I calculated how much fast acting insulin I would need to bring me down into range, I injected that correction dose of insulin and went back to sleep and woke up when the alarm went off to a very nice 5.6. I will be increasing my evening Levemir tonight by 1 unit and hopefully that will prevent it going high again tonight. At least this is what I will be doing unless I get out for a long walk or run tonight but if it keeps raining and I don't get that exercise then I will increase the Levemir.

So just to recap..... if you wake up with a high or low reading you should firstly do a finger prick test to confirm the actual reading because Libre is not always accurate.

If it is low then you eat 15g sugary carbs and test again in 15 mins until the hypo is treated.... using finger prick not Libre.
Click to expand...
I've learnt to treat a hypo successfully, if nothing else.
rebrascora said:
If the reading is high, then you have to think about when you last injected fast acting insulin. If it was 4 or more hours before, then you are safe to do a correction dose and you use the finger prick reading to calculate the correction based on your correction factor..... which might be 1 unit of insulin drops your levels by 3mmols or some other amount. 3 is usually the suggested starting point.
You then look at your actual reading which for me was 10.9 (near enough 11 for ease of calculation) and I want to be down to about 6, which is a nice mid range level, so I need to reduce my BG by 5mmols to get down from 11 to 6. If 1 unit drops me 3mmols then 2 units will drop me 6mmols. I happen to know that my levels are more resistant to insulin when they are above 10 so 2 units will be safe and at worst could bring me down to 5 which is still a perfectly acceptable waking reading, so that is how I calculate the amount of insulin I need to correct that high level and then I inject it and go back to sleep.
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How and where did you get to learn about all this information? It sounds like rocket science to me, completely unknown and scary territory.
My desired time in range is 56% with average BG 10mmol/L. I know it is far from perfect. I assume once I have achieved that then I will be advised to squash it down further into the real boundaries. Fat chance of that happening since I am struggling big time to achieve those not so good limits.
rebrascora said:
I can tell you that I slept much more soundly after I injected that correction and my levels started to come down. I hate that hot restless feeling of high levels! I should also say that I went over on my ankle yesterday and hit the deck so my high levels last night may well have been down to the damage and inflammation to soft tissue caused by the fall and I will have to take that into consideration when I dial up my Levemir dose tonight.
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I'm sorry to hear about your injury. Hope it is not a bad one. Get better soon, you have lot many anxious people who are looking to tap into your knowledge and understanding.

Take care!
 
@Purls of Wisdom
Do you understand the concept of doing a correction? ie. Using your fast acting insulin to bring your levels down when they are too high as I have described above?

It is kind of you to be concerned but I am fine apart from a graze and some bruising and stiffness as a result of my fall and the embarrassment of course which hurts the most 🙄 . I mentioned it really because it is something else which can impact BG levels (things to be aware of) and I need to factor it into my consideration of my diabetes management. It explains why my levels were persistently high last night.

As regards where I learned all this, it was mostly from the good people on this forum sharing their knowledge and experience and then experimenting on myself to see how my body worked. The DAFNE course also helped to provide a framework for identifying problems and how to solve them but I follow those principles very loosely if at all now and my diabetes management is more intuition and experience of what has previously worked rather than empirical calculations. Knowledge has given me confidence to not be frightened of making mistakes but always keeping one eye firmly on keeping myself safe.
 
rebrascora said:
@Purls of Wisdom
Do you understand the concept of doing a correction? ie. Using your fast acting insulin to bring your levels down when they are too high as I have described above?

It is kind of you to be concerned but I am fine apart from a graze and some bruising and stiffness as a result of my fall and the embarrassment of course which hurts the most 🙄 . I mentioned it really because it is something else which can impact BG levels (things to be aware of) and I need to factor it into my consideration of my diabetes management. It explains why my levels were persistently high last night.

As regards where I learned all this, it was mostly from the good people on this forum sharing their knowledge and experience and then experimenting on myself to see how my body worked. The DAFNE course also helped to provide a framework for identifying problems and how to solve them but I follow those principles very loosely if at all now and my diabetes management is more intuition and experience of what has previously worked rather than empirical calculations. Knowledge has given me confidence to not be frightened of making mistakes but always keeping one eye firmly on keeping myself safe.
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You have put it so rightly. I feel I am so engrossed with numbers that I fail to see the bigger picture. I need to take a step or two back and watch the scene unfold. I know I am doing everything right as far as I am concerned and stop fretting.

Thank you for explaining things so well.

Take care!
 
Amity Island said:
What a great comment! That should have a thread of its own. It's the conclusion i've come to myself as a libre 2 user over past few weeks. I've been taking action and found on all occasions it was the wrong course of action, as on a later scan, the graph was different to what it had said just a few moments ago. I'll wait a bit now and rescan before taking any action.
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Yeh! It is easy to get into a state of mind where you are tempted to respond to Libre straight away and then end up chasing the dragon's tail when a bit of patience shows the bigger picture which can look very different.
The reader doesn't plot dots on your graph like the phone app does so I never see those ones that the line doesn't go through on my graph, but occasionally it will give a BG level and indicate it is rising fast and then the next reading 10 mins later will be lower than that previous reading with an horizontal arrow, so clearly the previous reading was an erroneously inflated prediction. Doesn't happen very often, but occasionally I get caught out when I am too impatient. 🙄
 
Amity Island said:
Hi @rebrascora did you find the same with Libre 1? I didn't.
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I am still using Libre 1. It is very occasional that I notice it happen and I have to be scanning regularly to spot it, but I think it may occur a lot more frequently with Libre 2 from some of the comments I have read on the forum or perhaps the unconnected dot on the phone app which is more commonly used with Libre 2 than Libre 1, where people initially just used the reader, may make it more noticeable with Libre 2 and therefore it looks like it happens more frequently..... or the algorithm is different in the phone app compared to the reader and it actually is more prone to erroneous extrapolation. I don't think I have ever got the "try again in 10 mins" error message with Libre 1 using the reader but that seems to happen more frequently with Libre 2 for people so maybe it is an algorithm issue. I am not looking forward to having to change to Libre 2 and finding out!
 
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