Libre 2 Application

[Inka]

On first glance, that looks like not enough basal because you continued to rise but it depends when you ate, and what you ate (eg a higher fat meal could cause a later rise).

 

[Purls of Wisdom]

Very informative 🙂 What time did you have dinner?

Around 7:30pm.

 

[Purls of Wisdom]

On first glance, that looks like not enough basal because you continued to rise but it depends when you ate, and what you ate (eg a higher fat meal could cause a later rise).

4 units of Novorapid and certainly not over 40g of carbs. Homemade lentils, courgettes curry with small chapatti and a Satsuma.

 

[Inka]

Around 7:30pm.

I wonder whether part of the issue is that your Lantus is running out by the evening (I think you take it at night?) Perhaps you might also need more. A basal test would give you more information about this.

Your spike at 9pm isn’t too bad, it’s the continued rise that’s the issue as by midnight your blood sugar should have come down to a normal range.

 

[Inka]

4 units of Novorapid and certainly not over 40g of carbs. Homemade lentils, courgettes curry with small chapatti and a Satsuma.

Was the chapatti home-made or shop-bought? Just trying to work out the carbs.

 

[Purls of Wisdom]

Was the chapatti home-made or shop-bought? Just trying to work out the carbs.

Always home made with 100% whole meal flour.

 

[Purls of Wisdom]

I wonder whether part of the issue is that your Lantus is running out by the evening (I think you take it at night?) Perhaps you might also need more. A basal test would give you more information about this.

Your spike at 9pm isn’t too bad, it’s the continued rise that’s the issue as by midnight your blood sugar should have come down to a normal range.

I used to be on 12units. Reduced to 10units a week or so ago by DSN.
Mid night numbers were 17.9.
It is definitely lower than 22.2 but normal?

 

[Inka]

Always home made with 100% whole meal flour.

Definitely the tastiest! At the risk of driving you mad with Maths, did you work out the carbs per chapatti?

I still think your basal is part of the issue, but it’s possible your mealtime (bolus) insulin is too. A basal test is tedious but informative. Do you think the reduction from 10 to 8 units of Lantus is part of the issue?

No, 17.9 isn’t normal. It’s too high.

 

[Purls of Wisdom]

Definitely the tastiest! At the risk of driving you mad with Maths, did you work out the carbs per chapatti?

I still think your basal is part of the issue, but it’s possible your mealtime (bolus) insulin is too. A basal test is tedious but informative. Do you think the reduction from 10 to 8 units of Lantus is part of the issue?

No, 17.9 isn’t normal. It’s too high.

Lantus is reduced to 10 from 12. Novorapid remains same.
The chapatti was small but I did not weigh the dough, within the limits I'm sure.

 

[rebrascora]

The lentils might have been part of the problem too.
I made ham and lentil soup yesterday which I absolutely love, but lentils continue to give and give and give with me and I lost track of the number of corrections I needed to keep me out of double figures. Some of us are more efficient than others at digesting lentils.

 

[Inka]

Lantus is reduced to 10 from 12. Novorapid remains same.
The chapatti was small but I did not weigh the dough, within the limits I'm sure.

I just use the weight of the flour and then divide it by the number of items I make to work out the carbs.

Perhaps the reduction in Lantus is contributing? If it is the Lantus, you could look at changing the dose and/or moving the time of your injection, and/or splitting it into two injections, one morning, one night. There are also other basal insulins you could try.

 

[Proud to be erratic]

@Purls of Wisdom An important question - how many carbs were in your evening meal? If your blood sugar before your meal was normal, you ate too many carbs for your fixed insulin dose.

As you had ketones the other day too, you need to look at your insulin amounts. If you’re not confident in reducing those, then reduce your carbs gradually.

@Proud to be erratic You shouldn’t use Lantus as a correction.

Yes, @Inka thank you for the correction. I should know better than to make such a reply at 4am, couldn't sleep and saw an opportunity to keep myself occupied. 😡
You used the word reduction, just above, but perhaps you meant change; in this circumstance it's about whether an increase in food bolus was needed or a subsequent additional bolus as a correction was needed, ideally before getting to 22.
@Purls of Wisdom my comments about correction ratios are nonsense, ie we know nothing further about correction ratios for you because I mindlessly transposed your basal Lantus into being a bolus! Sorry to confuse this attempt at analysing what and why.

That’s what the Novorapid is for. I suspect the Lantus was mentioned simply because it was due. 111 wouldn’t suggest correcting to someone with no knowledge, nor without knowing their individual details.

@Inka I've never had a need to call 111; if they aren't empowered to offer correction advice (and I take your point about insufficient knowledge of the individual) then is there any point in reaching out to 111? If Purls has no DSN night time emergency number (I do have one, but never had to use it) then presumably its a 'just wait until morning' or a trip to A&E?

 

[Inka]

You’re right @Proud to be erratic My first ‘reducing’ was meant to be ‘adjusting’. I’ve amended my post now.

111 can be useful. I’ve phoned them before when I’ve been ill. I got a call-back from a doctor. If Purls had/knew her correction ratio, then perhaps 111 would have asked about it, but it’s too risky to suggest corrections to people without a correction ratio, and I suspect they’d rarely suggest them anyway due to the risk of hypoglycaemia, however slight.

 

[Proud to be erratic]

The lentils might have been part of the problem too.
I made ham and lentil soup yesterday which I absolutely love, but lentils continue to give and give and give with me and I lost track of the number of corrections I needed to keep me out of double figures. Some of us are more efficient than others at digesting lentils.

I also don't have much luck with my lentil carb counting and consequent bolus. Probably made worse by the generous garlic content, with that relatively high carb content; I don't necessarily get an even share of the garlic in each portion and we sometimes make a batch of 10 portions. As you say digestion efficiency is also varied (which for me = erratic).

 

[Purls of Wisdom]

The lentils might have been part of the problem too.
I made ham and lentil soup yesterday which I absolutely love, but lentils continue to give and give and give with me and I lost track of the number of corrections I needed to keep me out of double figures. Some of us are more efficient than others at digesting lentils.

To be fair and honest, it was a leftover mixed lentils dish, we ate it in order to finish it. I don't think it was more than a couple of tablespoons. That leaves Zucchini and small WM chapattis plus a Satsuma.

I ve heard of the term adjusting insulin but the words correction dose has not been mentioned to or in front of me.

 

[Purls of Wisdom]

You’re right @Proud to be erratic My first ‘reducing’ was meant to be ‘adjusting’. I’ve amended my post now.

111 can be useful. I’ve phoned them before when I’ve been ill. I got a call-back from a doctor. If Purls had/knew her correction ratio, then perhaps 111 would have asked about it, but it’s too risky to suggest corrections to people without a correction ratio, and I suspect they’d rarely suggest them anyway due to the risk of hypoglycaemia, however slight.

I have found calling 111 very pacifying.

 

[Leadinglights]

I have found calling 111 very pacifying.

You are lucky if you get a prompt reply, my other half had an issue (not diabetes related) and hung on for 50mins before they replied and them waited another 5 hours for a doctor to call back and tell him to go to A & E.

 

[Proud to be erratic]

I ve heard of the term adjusting insulin but the words correction dose has not been mentioned to or in front of me.

The fixed dose bolus you currently take is just one possible dose - providing insulin to cover the carbs in the food you are about to eat.

Another possible bolus dose is a correction dose, used when one's BG level is higher than whatever target you have been set, (or the target you choose as you increasingly take over the responsibility for your diabetes). I was initially set a target of 8, then 7, recently 6 has been suggested. So, if my BG is significantly above 6, eg 9, I will intentionally take a correction dose that is intended to reduce my BG from 9 to 6, ie by 3 units. I have a correction ratio that has been tested and found to be appropriate for me.

Taking that correction, adds a small potential complication to what otherwise seems a simple enough concept: extra insulin on board, thus possible insulin stacking leading to increased and potentially deep hypos.

At first I rigorously only took a correction as an addition to my food dose, so my food might need 6 units and my correction 2, thus my bolus was total 8 units. In the early days, after learning about carb counting and abandoning fixed defined bolus doses, I was frequently needing a correction as well as a food component in my total bolus. This helped my erratic BG to steady and gradually the need for corrections reduced. Once I got Libre 2 my BG control further improved and I needed less and less corrective doses of bolus. But I never got to zero corrections, nor do I expect to !! More about 3 times weekly rather than twice daily. Until quite recently, I've always only taken a correction at the same time as I've taken a food bolus and kept all my meals at least 4 hours, usually more, apart; thereby preventing the possibility of stacking and creating the possibility of going hypo. That was, for me, a simple and safe way to proceed and possible because I'm fully retired.

More recently, if I've been higher than I wish to be as I go to bed, I've taken a correction dose; sometimes as little as 1 unit, just to 'nudge' my BG down during the night. I can do this because (until last Saturday's surgery) my Tresiba basal has been slowly and gently adjusted to match my 24 hour needs, optimised to give me very steady nights and greatly reducing nighttime alarm intrusions. So a small 'nudge' was working for me.

Because of my recent surgery, medical stress (from tissue trauma and pain) has caused a steady release of the hormone cortisol which triggers the liver to release extra glucose (that I don't actually need, but my body as a whole thinks I do need). So my BG has been predominantly above 10, a certain amount above 15 and my time in range (4-10) has been very small. To counter this I've been taking increased basal doses; and bolus corrections at an increased or hardened ratio to my normal at an increased frquency approximately every 4 hours. These correction bolus doses are as well as food bolus doses as necessary. Although this has meant a correction at around 4am, in practice I've needed a bathroom visit anyway, so the bolus dose at 4am is barely any intrusion at all; if I hadn't been woken by my bladder I wouldn't have taken those early morning corrections.

This seemingly draconian approach is working; today I've achieved 37% time in target in the last 24 hrs, a big improvement on yesterday, albeit still far from what I would like. Also my very slow (inflexible) Tresiba basal insulin should start to deliver the benefits of my Tresiba increases started on Sunday and my bolus corrections should (fingers crossed) become less frequent and/or at more normal rates.

Yesterday I took 8 bolus doses, 5 solely as corrections, 2 for food only and just one combined for food and correction. Today I've managed to reduce this to 7, by getting 2 as combined food and correction doses. When the medical stress reduces, I'm going to have to 'unwind' the process - right now I don't have any sense of whether that will be a period of days or weeks to start 'unwinding' and I'm guessing it will be a process of gradual reductions. I will lean on my Libre heavily for managing this 'unwind' as indeed I am leaning on it currently. Doing this without Libre would be pretty awkward.

Adjusting insulin is different. Before this recent surgery I was pretty fit and very active, so I would calculate my required bolus for food and possibly a correction, then I would adjust the total requirement to reflect either known activity or anticipated activity. Those adjustments were a % reduction of bolus, derived by trial and error; how much reduction and how frequently is a long post for another time! I sometimes adjust my bolus for changing weather. Currently I'm making no adjustment for activity - far too immobile right now and banned from lifting much more than a cup! But I am adjusting my bolus to counter medical stress by increasing what I've calculated - and nominally making a 20% net increase. The 20% figure originated from my former DSN when I was receiving chemo and taking steroids; my current DSN has supported my current strategy but seems content to let me micro-manage as needed. My diabetes, my management effort.

 

[helli]

@Proud to be erratic you only mention the correction as a positive number (extra insulin to take of you are above target).
It can also be a negative number. Let's say your target is 6 and when you come to calculate your bolus for food, your current level is 4 (maybe you have been exercising). If your basal levels were stable and you only calculated your food bolus considering the insulin to carb ratio, you would end up back to lower than your target. Therefore, you need to subtract equivalent to 2mmol/l of correction dose from your insulin to carb ratio dose.

 

[Inka]

To be fair and honest, it was a leftover mixed lentils dish, we ate it in order to finish it. I don't think it was more than a couple of tablespoons. That leaves Zucchini and small WM chapattis plus a Satsuma.

I ve heard of the term adjusting insulin but the words correction dose has not been mentioned to or in front of me.

A correction dose is extra insulin to correct a high blood sugar.
A correction factor is a personal ratio given to you which tells you how much one unit of fast-acting insulin should drop your blood sugar. Knowing this allows you to calculate an appropriate correction dose.