Just been diagnosed with Type 2 Diabetes and struggling a bit

[Kingsleyh]

Here’s a (random from Google but looked authoritative even if American) link to help

Diagnosed With Diabetes? Seeing Your Eye Doctor Is Essential

If you’ve been diagnosed with diabetes, it’s essential that regular eye exams are part of your healthcare routine. According to a report from the Centers

www.optometrists.org

thanks for this 🙂

 

[silver minion]

I see that's very helpful - the nurse told me to have an eye test and during that eye test the optician told me I needed to buy glasses - and since I couldn't see for my job I thought they would take like a couple of days to get them and then would be ok. The optician said that he didn't think my prescription would change also - I guess that was bad advice because it's totally changed back to how it was and I feel like I bought the glasses for no reason.

I had my eyes tested last year after being diagnosed a few months earlier. I was overdue an eye test anyway and struggling to read small print with my existing condition.
The first thing the optometrist said was they wouldn't normally prescribe new glasses until my BG settled down.
Still not fully settled down yet but I needed new glasses to drive so I got them.

 

[rebrascora]

I'm also not very happy with the Libre 3 app! I can't zoom in on the graphs to see better what has happened and I can't set alarms between time periods, and I can't set percentage drop alarms, and I can't also see my reading on my phone when I use it as a night stand - which would be really nice. Also it doesn't rotate when I turn my phone which would make the graph easier to read. They seem to use some kind of smoothing on the graphs as well.

The smoothing of the graph may well be because the algorithm that the Libre uses to make up the lag between changes in blood glucose and interstitial fluid glucose causes it to over egg highs and lows. Basically the Libre extrapolates the last few readings of interstitial fluid to predict what your BG will be because interstitial fluid lags behind Blood Glucose by about 15mins.
The algorithm works well when levels are changing slowly and steadily but if levels are say dropping fast but then level out, it takes a while for Libre to catch on that they are no longer dropping and it will usually predict them continuing to drop which certainly can cause panic if they are showing you hypo and continuing to plummet 15 mins after you have taken hypo treatment, when a finger prick test will usually show that you have come back up. Once the Libre algorithm eventually catches on that levels have changed direction, it redraws the graph and the line doesn't go through the low readings it showed you. Once you get used to this through finger prick testing, you can usually just learn to interpret the Libre data and assess whether it is likely being a drama queen and give it time to sort itself out without causing you to panic and over treat a low. It does the same when levels are rising fast and often show the peak of a rise as being higher than it actually is. Hopefully that makes sense. Of course the time when you would ideally like it to be most reliable is when you are potentially hypo, but hey ho, nothing in life is perfect and the Libre is otherwise an amazing bit of kit which has really revolutionised our diabetes management for those of us on insulin.... especially those who remember collecting a urine sample, boing it up with a reagent and assessing the colour it went against a colour chart to figure out what their BG was about 3 hours previous!! Even those of us who started on finger pricking can find a huge benefit to the regular data it provides once to learn to assess when it is calling "wolf" for real and when it is just being over dramatic.

 

[Leadinglights]

What they probably meant was that you should get an appointment for retinal eye screening which is not the same as a sight test that the optician would do. They should not be prescribing new glasses in people who are first diagnosed. Some people found a cheap pair reading glasses helped and when their eyes had settled then have the sight test.
My eyes changed when I reduced my carb intake and blood glucose fell but until I read here that it could happen I wondered what was going on. Fortunately I resisted going to the optician as I wear varifocals which cost mega bucks.

 

[Kingsleyh]

The smoothing of the graph may well be because the algorithm that the Libre uses to make up the lag between changes in blood glucose and interstitial fluid glucose causes it to over egg highs and lows. Basically the Libre extrapolates the last few readings of interstitial fluid to predict what your BG will be because interstitial fluid lags behind Blood Glucose by about 15mins.
The algorithm works well when levels are changing slowly and steadily but if levels are say dropping fast but then level out, it takes a while for Libre to catch on that they are no longer dropping and it will usually predict them continuing to drop which certainly can cause panic if they are showing you hypo and continuing to plummet 15 mins after you have taken hypo treatment, when a finger prick test will usually show that you have come back up. Once the Libre algorithm eventually catches on that levels have changed direction, it redraws the graph and the line doesn't go through the low readings it showed you. Once you get used to this through finger prick testing, you can usually just learn to interpret the Libre data and assess whether it is likely being a drama queen and give it time to sort itself out without causing you to panic and over treat a low. It does the same when levels are rising fast and often show the peak of a rise as being higher than it actually is. Hopefully that makes sense. Of course the time when you would ideally like it to be most reliable is when you are potentially hypo, but hey ho, nothing in life is perfect and the Libre is otherwise an amazing bit of kit which has really revolutionised our diabetes management for those of us on insulin.... especially those who remember collecting a urine sample, boing it up with a reagent and assessing the colour it went against a colour chart to figure out what their BG was about 3 hours previous!! Even those of us who started on finger pricking can find a huge benefit to the regular data it provides once to learn to assess when it is calling "wolf" for real and when it is just being over dramatic.

Ah this is really helpful thanks so much. Libre could probably improve that a bit - I don't know how often they update the app but having a few more features would be really nice.

 

[Kingsleyh]

What they probably meant was that you should get an appointment for retinal eye screening which is not the same as a sight test that the optician would do. They should not be prescribing new glasses in people who are first diagnosed. Some people found a cheap pair reading glasses helped and when their eyes had settled then have the sight test.
My eyes changed when I reduced my carb intake and blood glucose fell but until I read here that it could happen I wondered what was going on. Fortunately I resisted going to the optician as I wear varifocals which cost mega bucks.

When I went to the opticians they did some test that took a photo of the back of my eye with a really bright flash as well as the normal one. But I don't know if thats the same as a retinal screening.

 

[Leadinglights]

When I went to the opticians they did some test that took a photo of the back of my eye with a really bright flash as well as the normal one. But I don't know if thats the same as a retinal screening.

I know the NHS out sources retinal screening to places like Specsavers in some areas but what you had doesn't sound like the retinal screening where they put drops in your eyes to dilate the pupils and then take pictures from various angles of the retina. Results are the analysed by a specialist ophthalmologist.

 

[sparkalee]

Hi, 3 weeks ago I ended up in hospital with a burst abcess in my leg which required a surgery to clean out and I also found out that I have Type 2 diabetes. They did the 3 month test and it was 131 and my sugar was really high.

I was discharged with a novomix 30 pen and metaformin and told to take 33 clicks of insulin and 2 metaformin (500mg each) in the morning and 22 clicks and 2 more metaformin in the evening. This was going ok for the first couple of weeks but I started getting stressed about pricking my fingers all the time to know my blood sugar, so I bought a libre 3 CGM and this helped massively to see what was going on.

Try to refrain from keep checking the readings from the sensor on your phone, I used to do that all the time, it came a bit of an obsession. Some lows are normal, I once went to 3 but the alarm on the app woke me. It is usually caused by insufficient carbs, much the same as too many carbs send it high. Mine is always high in the afternoon.

 

[Leadinglights]

Try to refrain from keep checking the readings from the sensor on your phone, I used to do that all the time, it came a bit of an obsession. Some lows are normal, I once went to 3 but the alarm on the app woke me. It is usually caused by insufficient carbs, much the same as too many carbs send it high. Mine is always high in the afternoon.

The Libre can be quite useful but can cause people to over react to something which is actually the normal fluctuations in blood glucose throughout the day and night. It perhaps is something to try after getting to grips with a structured regime of finger prick testing which is much cheaper anyway.

 

[helli]

I didn't know it could give me false readings if the sensor gets pressure applied to it - which I'm wondering now if that has contributed to any of the night time drops

I think we get used to spotting "compression low candidates" on Libre graphs. Typically, you will find the graph suddenly drops (when we turn over onto the sensor) and bounces back (when we turn over off the sensor).

I'm also not very happy with the Libre 3 app! I can't zoom in on the graphs to see better what has happened and I can't set alarms between time periods, and I can't set percentage drop alarms, and I can't also see my reading on my phone when I use it as a night stand - which would be really nice. Also it doesn't rotate when I turn my phone which would make the graph easier to read. They seem to use some kind of smoothing on the graphs as well.

There are third party apps that might be worth looking at if you are a bit techy. They are written by "enthusiasts" who are not great at documenting but are good at adding extra features. I have used Glimp and xDrip+ but there are others which I can't remember at the moment.

And if you want to zoom into the graphs, you may find the LibreView website useful. If you registered for your Libre, you should have access to your data online (via Libreview.com) which does some analysis (shows averages at different times of the day, etc.) and your graphs on a larger screen.

 

[Kingsleyh]

Try to refrain from keep checking the readings from the sensor on your phone, I used to do that all the time, it came a bit of an obsession. Some lows are normal, I once went to 3 but the alarm on the app woke me. It is usually caused by insufficient carbs, much the same as too many carbs send it high. Mine is always high in the afternoon.

thanks thats good advice - I'm hoping to get my 3 month test down to better levels - so I've been worried that my levels are too high now. I am kind of bouncing between omg it's dropping too low and I need to drink something to omg it's too high and it's not gonna help my 3 month test!

I had reduced my insulin to try to cope better and try to keep my sugar stabilised - which yesterday for the first time I managed to keep it between 8 and 9 in almost a line (well more like a tiny rainbow shape) But I want it the line to be between 7 and 8 instead next so I will talk to the nurse about increasing my insulin back up in the morning a little to see if that helps now that I'm eating pretty much the same thing at the same time everyday.

 

[Kingsleyh]

I think we get used to spotting "compression low candidates" on Libre graphs. Typically, you will find the graph suddenly drops (when we turn over onto the sensor) and bounces back (when we turn over off the sensor).


There are third party apps that might be worth looking at if you are a bit techy. They are written by "enthusiasts" who are not great at documenting but are good at adding extra features. I have used Glimp and xDrip+ but there are others which I can't remember at the moment.

And if you want to zoom into the graphs, you may find the LibreView website useful. If you registered for your Libre, you should have access to your data online (via Libreview.com) which does some analysis (shows averages at different times of the day, etc.) and your graphs on a larger screen.

Thats great thanks. I will take a look at some of the alternatives. It looks like the libre 3 can only be paired with one app at a time which is a bit of a pain.

 

[rebrascora]

BG levels naturally fluctuate up and down in response to many different factors, so trying to keep between 8 and 9 all the time or even 70% of the time on the Libre is unrealistic. Our aim is to keep between 3.9 and 10.0mmols/l 70% of the time with insulin and that is considered good management. Even non diabetics go above 10 and below 3.9 occasionally, so don't try to be superhuman and get straight lines on your graph because it just doesn't work like that.

 

[Kingsleyh]

BG levels naturally fluctuate up and down in response to many different factors, so trying to keep between 8 and 9 all the time or even 70% of the time on the Libre is unrealistic. Our aim is to keep between 3.9 and 10.0mmols/l 70% of the time with insulin and that is considered good management. Even non diabetics go above 10 and below 3.9 occasionally, so don't try to be superhuman and get straight lines on your graph because it just doesn't work like that.

oh this is amazing advice thanks - I feel like I'm doing terrible with my sugar management - but at least my average over the last 14 days is within that zone you mentioned.

 

[rebrascora]

Those are really great results, so you are doing brilliantly.
When I was reading your posts about dropping fast, I wonder if your own insulin production is working alongside the injected insulin to bring you down when you are high and then you are panicking when it is dropping fast when actually it is just trying to bring you down to normal levels and you are then pushing it back up. Libre tends to exaggerate these drops in my experience and often shows you continuing to drop after you have taken a hypo treatment, when in reality your Blood Glucose (BG) has usually come back up, but the algorithm Libre uses to try to make up the lag between BG and interstitial fluid glucose which is what the sensor measures shows you still going down. I find with Libre I can be 4.3 with a vertical downward arrow and 2 jelly babies well chewed (they break down and absorb quicker through the mouth if you chew them well, rather than a couple of chews and swallowing them) can usually turn me around before I hit "the red" although LIbre will show me going much lower and take at least half an hour to catch on and then when I look at my graph it doesn't show any red (hypo) at all or not nearly as low as the readings it showed me at the time, because it realises that the algorithm got it wrong. Once you learn to trust your hypo treatment and finger prick to check recovery and ignore Libre in these circumstances and be disciplined about only eating or drinking as much glucose as you really need, it all becomes less panicky and scary. The panic also triggers adrenaline release which makes you feel worse, so for me finding confidence in my chosen hypo treatment and being organised and disciplined in how I treat them or how little I need to head them off before they happen has been a game changer in managing my diabetes with insulin.

 

[Kingsleyh]

Those are really great results, so you are doing brilliantly.
When I was reading your posts about dropping fast, I wonder if your own insulin production is working alongside the injected insulin to bring you down when you are high and then you are panicking when it is dropping fast when actually it is just trying to bring you down to normal levels and you are then pushing it back up. Libre tends to exaggerate these drops in my experience and often shows you continuing to drop after you have taken a hypo treatment, when in reality your Blood Glucose (BG) has usually come back up, but the algorithm Libre uses to try to make up the lag between BG and interstitial fluid glucose which is what the sensor measures shows you still going down. I find with Libre I can be 4.3 with a vertical downward arrow and 2 jelly babies well chewed (they break down and absorb quicker through the mouth if you chew them well, rather than a couple of chews and swallowing them) can usually turn me around before I hit "the red" although LIbre will show me going much lower and take at least half an hour to catch on and then when I look at my graph it doesn't show any red (hypo) at all or not nearly as low as the readings it showed me at the time, because it realises that the algorithm got it wrong. Once you learn to trust your hypo treatment and finger prick to check recovery and ignore Libre in these circumstances and be disciplined about only eating or drinking as much glucose as you really need, it all becomes less panicky and scary. The panic also triggers adrenaline release which makes you feel worse, so for me finding confidence in my chosen hypo treatment and being organised and disciplined in how I treat them or how little I need to head them off before they happen has been a game changer in managing my diabetes with insulin.

This is excellent advice and very insightful. last night my libre was showing 4.2 with a down arrow and I got worried so I did a finger prick test and it was 6.1 which helped me to stop worrying a lot. The finger prick doesn't indicate if a drop is happening but at least it stopped me from freaking out as much and drinking too much sugar!

 

[JimmyBlue]

Hi @Kingsleyh and welcome to the forums. With regards to the CGM and its reporting. I use the Libre2+ occasionally and sometimes get falls in my BG that take me below 4.0, normally after intensive exercise. Initially I worried about this but now I just monitor the reporting for a about 10-15 mins and the BG level always rises and moves back to 4 or above without issues. I also get the odd compression low which I ignore.
My experience has been that the first six to seven months after diagnosis as you start making the various dietary and lifestyles changes can result in widely varying BG levels and sometimes these can be unexplainable (10 after a meal one day and then nor more than 8 after the same meal a few days later). It is only now having been diagnosed last October, that I am starting to see more consistency in both my daily BG levels and also in terms of the food I have eaten. I think giving yourself time to make the changes without reading too much in to the variations in the BG levels might help you a little, especially bearing in mind that getting worried will trigger stress hormones which can impact your BG.
With regards to your diet, as others on here advised me many months ago, less than 130g/day works for most but not necessarily everyone and trying to balance that out across meal has helped me. Try to avoid my mistake which was to fail to properly monitor your carb intake as that can result in sudden and somewhat worrying weight loss. It also caused me to have some additional tests I didn't need and having to monitor my ketone levels.

 

[Kingsleyh]

Hi @Kingsleyh and welcome to the forums. With regards to the CGM and its reporting. I use the Libre2+ occasionally and sometimes get falls in my BG that take me below 4.0, normally after intensive exercise. Initially I worried about this but now I just monitor the reporting for a about 10-15 mins and the BG level always rises and moves back to 4 or above without issues. I also get the odd compression low which I ignore.
My experience has been that the first six to seven months after diagnosis as you start making the various dietary and lifestyles changes can result in widely varying BG levels and sometimes these can be unexplainable (10 after a meal one day and then nor more than 8 after the same meal a few days later). It is only now having been diagnosed last October, that I am starting to see more consistency in both my daily BG levels and also in terms of the food I have eaten. I think giving yourself time to make the changes without reading too much in to the variations in the BG levels might help you a little, especially bearing in mind that getting worried will trigger stress hormones which can impact your BG.
With regards to your diet, as others on here advised me many months ago, less than 130g/day works for most but not necessarily everyone and trying to balance that out across meal has helped me. Try to avoid my mistake which was to fail to properly monitor your carb intake as that can result in sudden and somewhat worrying weight loss. It also caused me to have some additional tests I didn't need and having to monitor my ketone levels.

Ah very interesting! well I need to loose weight for sure! But I see your point with keep track of carbs. I was a bit worried because I'm taking both insulin and metaformin and I though I was supposed to keep my sugar under 6 at all times and I'm nowhere near that - I'm always between 7 and 9.

 

[rebrascora]

Ah very interesting! well I need to loose weight for sure! But I see your point with keep track of carbs. I was a bit worried because I'm taking both insulin and metaformin and I though I was supposed to keep my sugar under 6 at all times and I'm nowhere near that - I'm always between 7 and 9.

No one keeps their BG below 6 at all times or even tries to. That would be dangerous. The old rules before Libre were between 4-7 BEFORE meals and ideally no more than 8.5 2 HOURS AFTER meals, but with Libre and other CGMs the target for people using insulin are 70% time in range (3.9-10) with less than 4% below range

 

[Kingsleyh]

No one keeps their BG below 6 at all times or even tries to. That would be dangerous. The old rules before Libre were between 4-7 BEFORE meals and ideally no more than 8.5 2 HOURS AFTER meals, but with Libre and other CGMs the target for people using insulin are 70% time in range (3.9-10) with less than 4% below range

Thanks goodness