Hypos and libre2

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Lisamw

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Type 1
Hi all
I am looking for a bit of advice. I am fairly recently diagnosed and still getting a bit panicky when I go into the red with a low reading. I am using the libre2 and as a result I think I am ending up over treating resulting in a spike. For example, last night I must have judged tea wrong and had a reading of 3.4 after 2-3 hours. I had some jelly babies but 10 minutes later was down at 3.1 so had some more. However I think the libre2 is about 15 minutes delayed so I am wondering whether I should just hold my nerve at the 2nd reading or wait a bit longer because I ended up with a spike up to 12. Any help or advice would be appreciated.
 
Do you have a fingerprick meter? Any hypos should be checked with a fingerprick and you should use the fingerprick meter again to confirm your bg has increased not the libre. This is the advice for everyone but if you use insulin and drive then it is even more important and a condition of your licence for any hypos around driving.
 
Yes, Libre will almost always show your levels have dropped lower at the 15 mins post hypo treatment due to the delay between blood glucose and interstitial fluid glucose and you should always check with a finger prick before considering taking a second hypo treatment otherwise Libre will cause you to overtreat hypos pretty much every time.

I find that my blood to interstitial fluid glucose exchange seems to be slower over night too, so during the day, Libre will show my levels come back up within half an hour, but during the night it takes longer.
 
When using a CGM (including Libre), it is really important to understand the limitations of the technology. Unfortunately, DSNs rarely explain these but they have been mentioned many times on this forum. From memory,
- uncalibratable CGMs such as Libre are factory calibrated to be most accurate at "normal" levels. Therefore, highs and lows should be checked with finger pricks before correcting.
- CGMs read interstitial fluid and use an algorithm to convert this toa blood sugar reading. Interstitial fluid records blood sugar levels about 10 to 15 minutes behind finger prick readings. Libre accounts for this by extrapolating the current trend. Most of the time, this is fine. However, if the direction of the trend changes (e.g treating a hypo with fast acting carbs), in the last 15 minutes, the Libre algorithm does not know so will be incorrect. Again, always check with finger pricks before treating.
- I'd you apply pressure to a sensor it may report and incorrect low. This is most common at night when we lie on our sensor in our sleep. Again finger prick checks are important.
- some of us find our body reacts to an unusual alien object inserted into our arm which can affect the Libre reading for the first day or two. To allow for this, I insert my Libre a day or two before activating.
- due the the algorithm used, Libre does not like it when our levels change quickly. This is when it will report the "Try again in 10 minutes" message. A sudden variation in levels could be an indication of a failing sensor. As a result this message may (but not always) pre empt a sensor failure.
- yes, sensors fail or occasionally be very inaccurate at "normal levels". There is no point comparing with finger pricks when levels are high, low or changing rapidly. If this happens, always report it to Abbott. Most of the time, they will replace it. There is no reason why you or the tax payer (NHS) should pay for faulty equipment.
- some of us find our bodies do not match the factory calibration so use third party unofficial apps such as xDrip. These allow calibration and pick up the Bluetooth signal so it is not necessary to scan. However, there is limited support and they can be finicky to set up if you are not technically minded.

I think that's it but I am sure I will be reminded if I forgot something.
 
Hi @Lisamw ,

One thing you are finding out is that although being low, even hypo, is horrible (all sorts of slightly frightening & lousy feelings) you survive! Being low is not good for your body in the long term, but it's just as bad for you mentally and physically to get onto the BG roller coaster of low, then rebound to hyper and then over correct and back to low; once on the roller coaster it is hard to get off it!

So, somehow you need to stop yourself from overtreating a low or mild hypo, indicated by your Libre BUT confirmed by a finger prick by treating with 15gms of high glucose (eg 3 or 4 jelly babies) then wait a full 15 minutes, retest and only treat again if needed. This is much easier said than done!

During my early hypos I craved food, any food and really struggled with the 15 minute wait. I now know that any extra food doesn't immediately help. If it is not extra jelly babies, any ordinary carbs such as a biscuit "dilutes" or blunts the effect of the high glucose treatment and so slows down the recovery. The DSN on my recent DAFNE course confirmed this (for the benefit of one of us who was very newly diagnosed T1). If that extra is more JBs too soon, then this high glucose stacks up and starts you onto the roller coaster - but because of Libre lag, you are unaware of this.

Yes, hold your nerve, breathe deeply and smoothly to try and calm yourself (stress invariably causes a release of glucose by the liver triggered by adrenaline - worsening the roller coaster effect and not instantly seen on Libre) then finger prick after at least 15 mins to establish if your treatment is working. If necessary treat again with another 15gms high glucose, remain calm, and wait another 15 minutes. Repeat if needed, but usually twice is sufficient.

Once recovery is happening and you are in the 4s, consolidate your recovery with a medium carb biscuit, preferably not chocolate so the fat content is not slowing digestion of that biscuit; those few carbs should help the recovery momentum to continue; whereas high glucose will digest and dissipate too quickly. You are now trying to prevent that 2nd hypo from coming along, but with YOUR controlled response.

I set my Libre alert / alarm at 5.6 and nowhere near a low 4. I want to know when I'm starting to drop, then take a small snack to arrest any potential hypo before it gets there. I don't finger prick with that alert; if the trend arrow says diagonally down, then I treat slightly. If vertically down then a bigger snack, say up to 12 gms carbs. By monitoring and experimenting you will find what works for you.

With a relatively high "low alert" at 5.6, Libre provides you with the tool and opportunity to prevent most hypos and keep you away from the red zone. There is nothing wrong with staying above 6 or 7 all day and night and in my opinion better to be even higher at this early stage than ever getting near the low red zone.

Good luck.
 
Proud to be erratic said:
There is nothing wrong with staying above 6 or 7 all day and night
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What is this based upon? It would certainly result in a higher than ideal hba1c.
We are all different but I find my optimum for energy and concentration levels is in the 5s and lower 6s. Once I get to the 7s, I feel mentally and physically sluggish.
 
helli said:
We are all different but I find my optimum for energy and concentration levels is in the 5s and lower 6s. Once I get to the 7s, I feel mentally and physically sluggish.
Click to expand...

Very surprised by that must admit, tbh honest don't feel any different from being in 5s than say 9, would have to get well into double figures to feel sluggish. Guess we are all different as you say.
 
It depends what I am doing.... Above 8 my body starts to feel it when I am physically active as my arms and legs start to feel heavier, but I don't notice it if I am sedentary. During the night, I have my best, deepest, most restful sleep when my levels are upper 3s to 6. Above 8 I start to get restless and once I hit 10, I usually wake up and jab a correction. I am still using Libre 1 so no alarms to wake me, so I know this from listening to my body and how I feel in the morning.... and obviously what my Libre graph shows me.
 
helli said:
What is this based upon? It would certainly result in a higher than ideal hba1c.
We are all different but I find my optimum for energy and concentration levels is in the 5s and lower 6s. Once I get to the 7s, I feel mentally and physically sluggish.
Click to expand...
For someone newly diagnosed like the person started this thread, staying in the 6s or 7s all day would be fantastic. It’s important not to bring blood sugars down too quickly.
 
Lucyr said:
For someone newly diagnosed like the person started this thread, staying in the 6s or 7s all day would be fantastic. It’s important not to bring blood sugars down too quickly.
Click to expand...
I don't disagree but ultimately, I would not target mid 6 or 7s.
 
helli said:
What is this based upon? It would certainly result in a higher than ideal hba1c.
We are all different but I find my optimum for energy and concentration levels is in the 5s and lower 6s. Once I get to the 7s, I feel mentally and physically sluggish.
Click to expand...
Two things in this suggestion:
Firstly stated in an email from my first DSN from Bucks in my early days and repeated by the DSN from Oxford on my recent DAFNE course.
Secondly, there is a rationale for the relatively recent endorsement of "out of range" outcomes from CGM data. Being low is not at all good, short or long term, hence suggested 4% max below 4.0. Being above 10 is also not good, but less so overall; hence the suggested 25% max above 10. I deduce high is more acceptable than low for overall long term health outcomes.

I appreciate that you are aware of even the 7s; I'm not and actually barely notice the 12s. But you are highly experienced and have excellent BG awareness, as well as great IT to supplement your tech. I spent a year on MDI without Libre, had Diabox for a short while after Libre 2 arrived before the IT defeated my phone (!!) and hugely appreciated the brief experience of real time CGM rather than flash scans that I've had to revert to. Also, I'm still very aware of my first year of seemingly uncontrolled BG with its roller coasters and just frustration of all of that; I didn't understand much (I was recovering from surgery then dealing with chemo) and had not found this forum, with its excellent guidance.

I think my view is valid, but the OP is free to ignore it and I won't take offence. My goal was to help the OP gain some stability and if that means being a bit higher than perfection in these early days - so be it.

I still don't have ideal management; and don't expect to get near that without much better tech, which I'm not eligible for on the NHS apparently. Even today I've been harassed by low alarms and what feels like an entrenched low state for over 2 hours, preventing me from driving to our Christmas destination - but for the previous 2 days I've been in mid teens continuously, corrections have done nothing (as if injecting water) and 85% high out of range. So I'm determined to not go back there! My D is a *...* , but I'm alive and accept that it's all a compromise.
 
helli said:
I don't disagree but ultimately, I would not target mid 6 or 7s.
Click to expand...
How exactly is this supposed to encourage a new person struggling to get to grips with diabetes and who is panicky about hypos? 6 or 7 would be incredible blood sugars to sit at for someone new to this and targeting that sort of level helps get used to normal blood sugars whilst reducing the risk of hypos
 
When you are newly diagnosed any number in your target range is good! Plenty of time to run when you have figured out the whole walking malarky! ( not that numbers are bad or good, just data fir your decidion making)
Re hypo treatments, I started on jelly babys, but i must admit i prefer dextrose tablets. I feel they act quicker. Also, you aren't going to eat them for fun, whilst its temption to snaffle a jelly baby you don't really need. You can get them from large boots, the lift ones are nice, the orange ones are easier to break than some of the other flavours which is good if you just what 2 carbs.
I must admit i always found 15 g carbs way too much personally, but stick with the guidelines at first, for safety's sake
 
Tdm said:
I must admit i always found 15 g carbs way too much personally, but stick with the guidelines at first, for safety's sake
Click to expand...
Yes, I am the same and certainly couldn't get away with 15g fast acting carbs plus some slower ones like a biscuit on top. Mostly a hypo treatment for me now is just 1 or 2 jelly babies and interestingly I am never tempted to eat them at other times as I have come to view them as tablets/medicine, solely there for hypo treatment. Perhaps it helps that I keep them in portions of 2 rather than in the packet, so that they don't look like a bag of sweets to be dipped into for pleasure, but portioned medication. I experimented with other sweets a couple of times when I couldn't get JBs but for some reason I couldn't be so disciplined with those, so it seems to be a mentality that I have developed with JBs rather than anything else. I certainly enjoy them, so it isn't a question of them being nasty medicine..... except the green ones.... Definition of a bad hypo is one that has to be treated with green JBs because there are no nice ones left! 🙄

I agree though that it is important to stick to the 15g fast acting carbs for every hypo until you get experienced.
 
Lucyr said:
How exactly is this supposed to encourage a new person struggling to get to grips with diabetes and who is panicky about hypos?
Click to expand...
My initial comment was not directed at a new person. It was in reply to another member.
 
Proud to be erratic said:
Hi @Lisamw ,

One thing you are finding out is that although being low, even hypo, is horrible (all sorts of slightly frightening & lousy feelings) you survive! Being low is not good for your body in the long term, but it's just as bad for you mentally and physically to get onto the BG roller coaster of low, then rebound to hyper and then over correct and back to low; once on the roller coaster it is hard to get off it!

So, somehow you need to stop yourself from overtreating a low or mild hypo, indicated by your Libre BUT confirmed by a finger prick by treating with 15gms of high glucose (eg 3 or 4 jelly babies) then wait a full 15 minutes, retest and only treat again if needed. This is much easier said than done!

During my early hypos I craved food, any food and really struggled with the 15 minute wait. I now know that any extra food doesn't immediately help. If it is not extra jelly babies, any ordinary carbs such as a biscuit "dilutes" or blunts the effect of the high glucose treatment and so slows down the recovery. The DSN on my recent DAFNE course confirmed this (for the benefit of one of us who was very newly diagnosed T1). If that extra is more JBs too soon, then this high glucose stacks up and starts you onto the roller coaster - but because of Libre lag, you are unaware of this.

Yes, hold your nerve, breathe deeply and smoothly to try and calm yourself (stress invariably causes a release of glucose by the liver triggered by adrenaline - worsening the roller coaster effect and not instantly seen on Libre) then finger prick after at least 15 mins to establish if your treatment is working. If necessary treat again with another 15gms high glucose, remain calm, and wait another 15 minutes. Repeat if needed, but usually twice is sufficient.

Once recovery is happening and you are in the 4s, consolidate your recovery with a medium carb biscuit, preferably not chocolate so the fat content is not slowing digestion of that biscuit; those few carbs should help the recovery momentum to continue; whereas high glucose will digest and dissipate too quickly. You are now trying to prevent that 2nd hypo from coming along, but with YOUR controlled response.

I set my Libre alert / alarm at 5.6 and nowhere near a low 4. I want to know when I'm starting to drop, then take a small snack to arrest any potential hypo before it gets there. I don't finger prick with that alert; if the trend arrow says diagonally down, then I treat slightly. If vertically down then a bigger snack, say up to 12 gms carbs. By monitoring and experimenting you will find what works for you.

With a relatively high "low alert" at 5.6, Libre provides you with the tool and opportunity to prevent most hypos and keep you away from the red zone. There is nothing wrong with staying above 6 or 7 all day and night and in my opinion better to be even higher at this early stage than ever getting near the low red zone.

Good luck.
Click to expand...
Thank you - really helpful advice.
 
Lucyr said:
How exactly is this supposed to encourage a new person struggling to get to grips with diabetes and who is panicky about hypos? 6 or 7 would be incredible blood sugars to sit at for someone new to this and targeting that sort of level helps get used to normal blood sugars whilst reducing the risk of hypos
Click to expand...
 
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