Can I ask if you double checked these readings? It sounds like you felt they were unexpected and I would certainly say that 15 was a hyper.
Also if you crashed to 3.2 30 mins later did you not double check with a finger prick and then again 15 mins afterwards to ensure that your hypo treatment had worked, in which case you would know that you were not hypo for 90 mins.
It seems extremely unlikely to me that even the fastest acting insulin would bring you down from 15 to 3 within 30mins of injecting it. I could understand a drop like that if you had injected the bolus insulin 15-30mins before and it was reaching peak activity but not from a dead start if you know what I mean so your numbers just don't seem to add up to me at all which is why I would be interested in knowing the finger prick results.
For me, it makes sense that a Libre reading which indicates that I need to take action, should be double checked, unless I can see a logical reason for that reading happening... ie after exercise. For instance my levels dropped earlier today after I ran up a steep hill to my stable yard to facilitate an unexpected haylage delivery. Half an hour later I was collecting eggs in the hen house and felt the hypo. Libre said 3.1 but it exaggerates 🙄 . I knew I was hypo because the run up the hill had likely caused it and I was feeling it quite strongly..... Ordinarily in that situation I would just have treated it without double checking because it was understandable and to be expected but I was curious to see how good my hypo awareness is so I did actually double check on that occasion and got a 3.9 (happy with that! 😎 ). The thing is that at 3.1 on the Libre I need to take action to treat a hypo, so a double check would be advised. If you are advised to do corrections over 10 then a reading of 11 or above on the Libre would constitute a double check with a finger prick before calculating and administering a correction dose. Personally I correct above 8 because once I get above 10 I am less responsive to insulin and it takes longer to come down and I like to keep my TIR stats in good nick because I treat them like a computer game.... but that is just me.
I agree for Newbies that clear rules are helpful and double checking before taking action is I believe the standard advice. Someone very newly diagnosed will usually not be instructed to do corrections at all and then after a few weeks, possibly correct over 15 and as your levels slowly come down then maybe over 12 and then 10 and now for me 8 is usually my personally imposed limit where I am happy to do corrections. Not everyone would be comfortable with that, so it is very hard to give definitive numbers.
Hello
@rebrascora ,
Several strands to your response, but I'm happy to chat in case you can see a trend that I'm missing. This reply is, in retrospect, ultra lengthy and I won't be offended if you speed read and move on. At least doing this written analysis reassures me that within what I knew in the small hrs my routine was broadly OK.
Yes, my BG behaviour yesterday was sort of unexpected - with the caveat that I get lots of BG behaviour that is unexpected and at this 2 yr point I'm no longer so stressed or bothered about this aspect.
I started yesterday expecting to be active during the day, as I frequently am. So I reduced my breakfast bolus by 65%, which is a reduction I've found by trial and error over the last 2 months. (I'm stepping over whether I need to review my breakfast ratio for now, but I am alert to this possibility. The important thing is I've found a routine that normally works.) But "things" intervened, including heavy rain as I was changing to go gardening. So I was very inactive - for the first time for a while - and not surprisingly my BG rose during the afternoon into 10s by 3pm, 12 by 4.30pm and I gradually reduced this with modest indoor activity. Bolus for dinner + correction at 6.30pm and dinner at 7.30pm; my normal pre-bolus is only 15 mins. I rarely eat until I'm approaching 7 unless the domestic timetable forces my hand, when I'll eat while a bit higher! (Diabetes is in practice already a huge intrusion into our lives, but I'm alive, still getting all clear from the onc'y spec, so we're accepting the price, for now.) Anyway by 8.30 pm my BG was climbing then levelled in the 9s until at 9.15pm it more aggressively rushed to 11.8 by 9.33pm; stayed in the 11's for a further hr then climbed steadily until at 11pm as I went to bed it was on the cusp of 15. I checked my carb count was sound and concluded my body was reacting to the general lack of activity overall (but slightly wondered if my dinner pre-bolus had been faulty - my Echo pen confirmed the dose and timing @ 6.30pm, but had I been 'lazy' with my technique?).
Anyway based on a finger prick just after 11pm I took a correction and went straight to sleep; I sleepily cancelled an Urgent high alarm for above 15 (actually at 16.3) at around 11.30pm; I knew I'd taken the correction, so just needed to wait. Shortly after the 'normal' high alarm told me I had moved back into the 10-15 zone and a different "going down" alarm at some point told me I was falling. Then at 1.47am my Urgent low alarm told me I was at 3.9, finger prick said 4.3; this was my only finger prick in the small hrs - I wasn't hypo, so no need to wait and verify that I wasn't hypo. Libre misleading again? CGM told me after the event I'd been 7.5 at 1.37, ie an apparent drop of 3.6 units in 10 mins; there is no recorded reading for 01.42, which strongly suggests Libre had been overwhelmed by that rapid fall in 10 mins. This is pretty fast but I've fallen faster, so I wasn't unduly phased. At this point in my sleepiness I concluded my earlier high wasn't a solid high, just a momentary thing (of course with no identifiable explanation) the on board insulin was doing its stuff and was grateful that my 11.30pm correction hadn't been more aggressive - which I sometimes do when I'm above 15. I ate a 6gm biscuit to nudge myself away from the lower 4s (probably should have been 2 biscs) and even remembered to take a Creon capsule with a drink. I take Creon on an industrial scale, which is a slight throwback from the 21+ months I spent malabsorbing all food! I went back to sleep and was surprised to see later that Libre and Diabox had me in hypo zone for 130 mins, from 01.47 to 03.58. I don't believe I actually ever was: no night symptoms such as sweats or restlessness and I'm pretty sure I couldn't have caused a compression low - but who knows .....? If I'd been hypo it could only have been very shallow. I found this out at around 4.30pm when I needed my normal stroll to the bathroom and as I got out of bed saw my reading leap from low 3s to upper 4s. Then the dawn phenomena comes into play and dissipates 30 mins later, confusing the picture; frequently happens. Further scrutiny now tells me I was still wobbling around the high 4s and upper 3s until 06.30, so definitely needed 2x biscs and perhaps more. Hindsight is a great thing! Foot on the Floor at 08.09am took me from 4.4 to 6.6 by 08.39, then started dissipating over the next 30 mins before a shower (mild activity), prebolus and breakfast 40 mins later. Been high 10-12 a lot of today, until a moderate walk to a shop brought me back into the 9s.
I have an android phone so I have the Diabox app to give me CGM along with an array of alarms with sounds that are distinctive and tell me roughly what is going on; eg high pitch siren for the upper high alarm and lower pitched fire truck siren for the Urgent low alarm and rising string of notes when in rapid rise and falling string of notes for falling fast. So much of the time I hear an alert, merely glance at my phone (or watch by day) and see a reading and a trend. This has allowed me to intercept lots of hypos and while Libre records several Low Glucose Events most of those never occurred - just Libre reading low and providing false data. This is a nuisance, but manageable; I find it slightly more difficult when Libre is naturally reading high - can go towards hypo without due warning. Normally Diabox, which uses its own algorithm, is calibrated to reflect actual BG; but this needs a decent period of steady state to do the calibration and a second steady period at least 2 hrs later to confirm the earlier calibration. Diabox is, of course, dependent on Libre providing continuous output to convert into readings. Technology is wonderful when it works well; and when it doesn't ...*#*#*..!
So the night drop wasn't so rapid overall: 11.30pm @16.3, Urgent alarm 01.47am @ 3.9 (actual 4.3, but was this simply Libre lag?); albeit with an apparent crash from 7.5 to 3.9 in 10 mins. When watched, Diabox provides quantified rise and fall numbers as well as trend arrows; its theoretically capable of displaying 1.6 mmol/L/min and I've seen it show 0.7mmol/L/min
I do still genuinely, but infrequently, go hypo and I recognise the symptoms, but I've not had a deep "horrible hypo" for at least 3+ months. So I'm happy that I have reasonable hypo awareness. I finger prick quite a lot at the moment, partly to verify when I'm not hypo despite Libre saying otherwise, partly to calibrate Diabox and always before I apply a correction; if I'm high I don't trust Libre or Diabox (which was why I originally started this thread, to be clear about the official boundaries [4-10]!).
When I was discharged from Hospital in Feb 2020, the senior DSN gave me a standard formula for bolusing which included simple rules for correcting highs, so I was mentally equipped to do corrections from the outset. Because she personally dealt with all the HPB patients on their transfer from intravenous insulin to MDI, she was perhaps conscious that most of us were T3c and so likely to have more erratic (brittle) diabetes. So from my experience I wouldn't conclude that Newbies aren't ready to do corrections.
This year, I've been trialling using lots of activity to contain high periods, after a successful couple of months last year in almost stopping all hypos by diligently responding to falling alerts and alarms. Had some success with high control, but it's too demanding to be a long term solution.
That's enough for now, don't worry if this an overload!
