Newbie

[Proud to be erratic]

Hi,thank you for your reply.
I’m still very up and down. Had my bloods (lfts) done before Xmas,came back borderline,had them re- done,came back abnormal. Doctor rang me,wants to re-do them again on Monday,if they come back as high again then he is getting in touch with my consultant for advice. Doctor thinks it could be a short stay in hospital,put on a drip to repair my liver.Hopefully it doesn’t come to that.

Hi Judy,

Really sorry you are very up and down. I am also still pretty erratic sometimes; indeed only yesterday I realised that I haven't had a single day 100% in range since October. But my overall time in range is gradually improving; still very slow work in progress. Sometimes I know what the cause is and sometimes I simply don't have a clue. Below is me over the last 24 hrs. The tiny 7.8 in the top left is Diabox giving my BG at that moment (by chance = my libre reading, not always so close).

And this is what I see on Diabox, 5 mins later BG=8.2 and climbing slightly. Each dot is a reading from every 5 mins and this screen is displaying the last 12 hrs (my choice, could have been 1, 3, 6, 12 or 24 hrs). The mild rise didn't actually happen, I know to not react to possible mild change.


If I scroll further down that D'box screen, below, I can remind myself that I have my non-urgent high alarm set for 10 (Urgent high alarm is normally 15 and I would usually take a correction bolus at that point). The routine low alarm is set for 6.2, which I just monitor happy to be below that when change is gentle (the 26% reflects time below 6.2, not below 4, but if I want that I just set the upper low alarm at 4 and the % will change - today nil so far) and the Urgent low alarm is routinely at 4.2 and I'm scrambling for JBs if the Urgent low siren goes!


The Std deviation, GVI & PGS are interesting (bottom of screenshot above) fairly reflecting my Glucose Variability Index (GVI) is poor; to be expected with no pancreas and consequent brittle diabetes. My challenge to myself this year is to improve that GVI.

Before my pancreatectomy I had a stent fitted to bypass the bile duct blockage from the tumour. The relief to my deep jaundice was almost instant - quite amazing. But during the procedure they nicked my liver, unfortunately. I started to feel off and getting worse daily, but didn't realise my liver had been damaged. Just before Xmas I spoke on the phone to my nominated cancer nurse and she fobbed me off; I accepted that, slightly unhappily. On 2 Jan 20 I had to have a CT scan prior to my forthcoming surgery, and felt very ill. I insisted there was something wrong, spoke to & immediately got seen by the senior cancer spec nurse who was able to see my scan results from 45 mins prior and immediately spotted the liver infection on the scan. A blood test identified the specific culprit and 24 hrs later I was on appropriate antibiotics. By this time I was seriously ill, but the abx did their stuff and recovery was pretty swift. So I totally empathise with having a liver problem and if those circumstances recurred I would not allow someone to fob me off again - and insist on being taken seriously.

Regarding your current difficulties: during the night I am anything from 7 to 4. But each night can be quite different. Firstly I recently reduced my basal Tresiba from 11 to 10 and the outcome from that shows particularly well on Diabox. Previously I was making sure I was close to 9 before going to sleep, knowing that my basal would drag me down during the night; after allowing 3 days for the Tresiba change to take effect my night variability is a lot better (as I hoped). Secondly if I'm close to 10 or above I'll take a correction bosul dose before going to sleep; I always finger-prick before that correction, and then exercise judgement on how much correction trying to get to 6 through the night. I rarely hear the upper alarm during the night, but have the volume setting so that the Urgent low alarm always wakes me; so even if I'm overcorrected I get woken up. Sometimes Libre shows I've had a low glucose event during the night, but I'm pretty sure that I haven't. It's just the inherent inaccuracy of the sensor and sometimes the sensor failing.

Your night hypos are bad, too close to problematic for comfort. If your basal is too high overall, then during the night it will drag you too low; presumably you take Tresiba 1x daily - is that morning or evening? You might be worsening things by applying correction if your basal is wrong. I'm not qualified to give medical advice, but as a principle it must be better to sleep safely, albeit a little high than to go hypo while asleep. Internal damage from being too high isn't ideal, but in short bursts I think it's OK, particularly if below, say, 13 or even 15.

I can't remotely explain why you wake up in the 12-15 range after a night hypo and only 2x JBs (c.10gm CHO). Does your Librelink screen shot show an identifiable trend, eg the time and duration of hypo, and the response from JBs? Do you keep a log of what your evening meal was for those occasions? Does that log include absolutely everything? I am mindful that you aren't yet carb counting (and when you start it takes a while to get things about right, so there will be hiccups initially); so the reality is that your pre-bosul isn't matched to your carb intake and the time between bosul and food digestion isn't matched to the GI of what you've eaten. So a rich low GI meal might not start digesting for 3 hrs ... and then your insulin might time lapse after 4 hrs or longer, depending on your natural insulin resistance. It's pretty complicated already and there are still 35+ factors that can play tricks with your BG. But, possibly the real culprit here is medical induced stress - is your liver playing up during the night?

There is something called the Dawn Phenomena (DP) or Foot on the Floor response, which elevates BG on first wakening? I, naively, wrote on this forum before I'd got Libre that I didn't get the dawn phenomena; I was wrong! I now can clearly see this response on my BG most early mornings. I thought no pancreas and thus no glucagon hormone meant my liver couldn't receive any instruction to open the glucose store, but it does. This doesn't happen to everyone, but is fairly common and apparently is a product of evolution and our innate response to go mammoth hunting before breakfast! If you want to know more about this just search for Dawn Phenomena in this forum (top right corner of the page). However this for me is 2 mmoL/L and it often dissipates before I take my first bolus. The questions that intrigue me about the Dawn Phenomenon are: which hormone is triggering this (and how/why)? Why does it sometimes dissipate but not always? Why does it happen sometimes, but not always? Why can I sometimes get 2 hits, when I wake in the small hours and need the bathroom, then later when I wake to get up? One day I'll try to nail down more about this, but what I've read so far has not helped; but it's not so important - it exists for me, sometimes. It could be a small part of the explanation for you.

I strongly suggest you ask your DSN to look at your LibreView and advise you accordingly. I'm presuming you had to establish LibreView and provide the hospital diabetes team with access to your data - as a condition of being fitted with Libre. There are a number of factors in this bit of the jigsaw, for each time this has occurred? If you don't already keep a detailed log I suggest start now - either on a phone or computer OR just on paper. Record as much as you can: exactly what you are eating and drinking, particularly in the evenings; prebolus detail and meal start time. What time you go to bed (routinely take a Libre scan) how long roughly before you fall asleep (scan again) (I can spend an hour reading before sleeping); any night excursions (bathroom or hypos) (scan again), when, what response, etc. You and your DSN are trying to find a pattern or common denominator for your hypos - my DSN made useful adjustments to my DM management from fortnightly scrutiny of photos of my manually completed logbooks, sent by email during lockdown. Record finger pricks, but for hypos scan as your first response and treat, then finger prick.

Finally consider raising your night time alarm to 4.5 at least, if necessary even higher. You need to get ahead of the hypos and better to be woken (disturbed) to fend off the potential hypo. Broken sleep is far from ideal, but in my opinion far better than hypo while sleeping.

Again, this is far too long ... but stick with it, stay strong and contact your DSN ASP.

 

[trophywench]

As a complete aside it pleases me to see people happily quoting phrases that myself and others I've known for donkey's years actually started using. eg FOTF syndrome first aired I think by EDUAD on his Blog. I started the 'hunting the woolly mammoth' one - we already knew about Dawn Phenomenon and that it was a primeval bodily response which humans still retain - so when explaining it to someone one day I just though well, primeval man was either a hunter or a gatherer so he needed the energy to go and get food, didn't he? so I decided it was more amusing to picture him going and hunting the woolly mammoth to kill and eat than go rooting for leaves, nuts and berries etc.

FWIW not having Type 3c myself - I think what @Proud to be erratic has said above re it being a basal (ie Tresiba) dosage issue and it being preferable to have BG a little high overnight instead of hypo, is **** on.

 

[Proud to be erratic]

Judy @The robin ,

I've just been woken by my Diabox Urgent alarm telling me I'm hypo and at 3.2. But I'm not! I was already half awake and didn't feel hypo, so I finger-pricked before treating and confirmed what my body was telling me: that I was actually fine and BG=6.9. I'd had a compression low, where I must have put pressure on my sensor in my sleep and generated a false low reading, which both Libre and Diabox responded to. Within a few mins from being woken, Diabox had corrected my BG. My Diabox detailed logs show 2 low readings and 2 low dots on the screen graph, but Libre has ignored them.

My actual BG was 10 at midnight (Libre said 10.9), so I took a correction of 2 units to get from 10 to 6 (my night target) at a correction ratio of 1:2, before going to sleep. The Libre graph shows that happening between midnight and 02.30ish. Then a dip around 04.30, but not into hypo territory and ignoring the scan of 3.2\ at 04.33.


I didn't ask you if your night hypos were prompted by Libre and if you actually felt hypo, or if you confirmed these with a finger-prick. Could they be compression lows?

Your LibreLink screen graph or daily graph reports should tell you more; if the hypo was a compression low, then it might not even show on the graph, since the Libre algorithm will discard 1 or 2 out of place readings. Do your night hypos show as low glucose events, ie lasting for more than 15mins?

I now revise my suggestion: from a Libre night alarm, if you don't feel hypo, don't treat before finger-prick testing, in case it's a false low. If you had a compression low and were actually mid or upper range, then your 10gm carbs plus Dawn Phenomena could perhaps be pushing you into your 12-15 readings.

@trophywench , pleased to help consolidate the mammoth hunting theory. All the best theories need peer evidence to ultimately prove them! I originally found "Foot on the Floor" as a symbol in the MySugar app, which I used until I got Libre in Feb 21; I still prefer that app to LibreLink, but of course I have to use the Freestyle tools as part of my NHS obligation, in return for getting Libre on prescription.

 

[The robin]

Judy @The robin ,

I've just been woken by my Diabox Urgent alarm telling me I'm hypo and at 3.2. But I'm not! I was already half awake and didn't feel hypo, so I finger-pricked before treating and confirmed what my body was telling me: that I was actually fine and BG=6.9. I'd had a compression low, where I must have put pressure on my sensor in my sleep and generated a false low reading, which both Libre and Diabox responded to. Within a few mins from being woken, Diabox had corrected my BG. My Diabox detailed logs show 2 low readings and 2 low dots on the screen graph, but Libre has ignored them.
View attachment 19814
My actual BG was 10 at midnight (Libre said 10.9), so I took a correction of 2 units to get from 10 to 6 (my night target) at a correction ratio of 1:2, before going to sleep. The Libre graph shows that happening between midnight and 02.30ish. Then a dip around 04.30, but not into hypo territory and ignoring the scan of 3.2\ at 04.33.
View attachment 19815

I didn't ask you if your night hypos were prompted by Libre and if you actually felt hypo, or if you confirmed these with a finger-prick. Could they be compression lows?

Your LibreLink screen graph or daily graph reports should tell you more; if the hypo was a compression low, then it might not even show on the graph, since the Libre algorithm will discard 1 or 2 out of place readings. Do your night hypos show as low glucose events, ie lasting for more than 15mins?

I now revise my suggestion: from a Libre night alarm, if you don't feel hypo, don't treat before finger-prick testing, in case it's a false low. If you had a compression low and were actually mid or upper range, then your 10gm carbs plus Dawn Phenomena could perhaps be pushing you into your 12-15 readings.

@trophywench , pleased to help consolidate the mammoth hunting theory. All the best theories need peer evidence to ultimately prove them! I originally found "Foot on the Floor" as a symbol in the MySugar app, which I used until I got Libre in Feb 21; I still prefer that app to LibreLink, but of course I have to use the Freestyle tools as part of my NHS obligation, in return for getting Libre on prescription.

Hi again,
Thankyou for all this in depth detail, I’m finding it really interesting and helpful to compare.
Im still trying to get my head round all the language everyone uses…..baby steps.
I will attach my readings from today,unfortunately mine are very different on a daily basis at the minute. I do read all the various charts on my libre but sometimes it just baffles me,again it’s a matter of getting used to it. Today we went for a 5 mile walk and I’ve learnt that any exercise that my levels will plummet. My DSN advised me to reduce my bosul by 50% which I did.
My insulin doses are very different to yours:
Tresiba, basal ( always in the morning)18 units.
Nova ,bolus, 4 units at breakfast,5 units at lunch and 4 at tea time.
I have my libre alarms set at 5 and 15, my hypos have always been hypo ( symptoms). I always do a finger prick when this happens.
I intend to scrutinise my sensor behaviour during the night a lot more. I have been thinking of starting a log and I intend to,so it will hopefully make me more aware of how my levels are reacting to different foods. Yes, my liver pains,discomfort is playing up during the night
Regarding the Dawn Phenomena and not knowing anything about it I had realised that my levels behave pretty well from waking up to lunch time.
My DSN has access to all my libre view data and keeps assuring me that I’m doing well. But I sometimes wonder how much they ACTUALLY read it.

 

[Proud to be erratic]

Hi again Judy,

Lots to digest here and a fair amount is difficult (impossible really) to comment on, because I don't have sufficient detail and more significantly I don't have the experience or qualification.

BUT, starting at the end: your day at a glance is comparable to some of my early ones and only a bit more extreme than my current ones. My main achievement in the last 11 months has been in intercepting hypos and that has only been achieved thanks to CGM with a higher "low" alarm. Your mid-morning fall from 14 to 4 in 4 hrs is not surprising. Was that while you were walking? It seems that you didn't actually go hypo, or if you did it was only briefly and not a low glucose event of 15 mins. So, a pat on the back from here: you navigated an active day and fended off going hypo. 🙂

From the screen, again, you seemed to have a modest rise between 06.00 and 08.30, but no Libre entry visible, so no snack? Could be the Dawn Phenomena or Foot on the Floor syndrome ... ? A rise of about 2 mmol/L is what I experience.

Then a big climb around 9am up to 14, which would be your breakfast arriving before your bolus got in place. Not ideal, but without knowing more about your breakfast and it's carbs as well as your likely insulin to carb ratio, its difficult to comment. 4 units of insulin could cover perhaps as little as 30 gms CHO or as much as 50 and that difference is solely down to your personal ratio. When you start carb counting you might be told to assume 1:10, ie 4 units covers 40gm CHO. But your DSN might look at your data and suggest 1:8. So if your actual breakfast meal is 48 gm CHO, at 1:8 you'd need 6 units.

Sadly there's a few more sums to do before that theoretical dose of 6. Should a correction be applied, since you are taking the breakfast bosul at 8+? I would try to target a level of 6, or 7. So a small correction for me. Then there is getting the timing between prebolus and eating a little better. Oh yes ..... are you planning to be active after breakfast, if so how active and for how long? Most days I'm intending to be active, but often am not (for various reasons) and what I finally do can be a long way from my intent. For me my bowel activity dominates my start of day. All in all your bosul, food and outcome isn't ideal, but it's FINE considering you are not carb counting. It would be a bit of a miracle if you were close to 100% in range at this stage.

I suggest looking at your daily graphs in LibreLink reports for the last 7 days, not in fine scrutiny, but to see if there is a sort of pattern about when you peak and when you fall. An Endo pointed out that I seemed to fall mid afternoon most days and to keep that in mind by taking a 3pm snack daily. He was correct.

The 6pm fall and then rise was presumably your pre- bolus then your dinner arriving; but you seem to have omitted to log that. If you had no external input of insulin or carbs around that time, then I have no idea! But you seem to have intercepted another hypo? Great.

Turning to insulin and exercise or activity: even the mildest of activity will affect your BG. No pancreas means you can't rely on your body to self-regulate, like everyone else around you does. If its mild or medium activity [aerobic] you can generally expect a steady fall in BG. No problem really, just snack AND stay hydrated as you exercise; yes, I know its not really that simple: first you've got to remember to do it, thus have the snacks and drink organised and close to hand, also how big a snack and high or low GI? Trial and error brings experience and improved management! You learn what works for you. But from 5-20 CHO rather than 25 upwards works for me; a little - often.

For high or intense [anaerobic] activity, such as sprinting or even fast walking your BG may well rise; this might seem counterintuitive. Your body thinks you are in or about to be in "flight or fight" mode and releases extra glucose from the liver in readiness. Once this glucose has been released it needs (in theory) extra insulin to take it out of the blood and into your cells and muscles; however, in practice the exercise reduces your body's natural resistance to insulin, so the insulin you have on board goes further. This might not be medically exact, but in layman's terms that's what is happening. So no extra bolus needed for that surge release under anaerobic conditions.

I expect, after a particularly active day, my susceptibility to frequent BG crashes because of that activity and this will last 2 or even 3 days. I'm interested to know if you find this after today's 5 mile walk.

Regarding pre-activity bolus: my new Endo told me to start at a 50% reduction and be prepared to go stronger, ie more than 50% reduction. I cautiously started at 65-70% and that wasn't enough, so tried 50% the next time, which was better. I'm currently applying 50% every morning, in anticipation of getting active reasonably soon after breakfast - which sometimes (often) doesn't happen, hence my recent trend of being above 10 at late midday.

That's enough for now, I'll answer or comment on a couple of other things tomorrow. But I'm very interested to know if your recent night hypos and yo-yo bounce recovery were confirmed by finger pricks or you really feeling hypo - rather than possible compression lows.

My "non-medical thought" is that your basal is too strong and your bolus too weak BUT that is just my thought. I'll explain why tomorrow. I agree with your DSN that you ARE doing well; yes it's definitely more erratic than you want, but the last 24 hrs average was in range at 9.7 and yes you'd like to spend more time in range, but you will get there.

Stay strong, stay positive, don't let this stress you; learn something from today and try to apply that one something tomorrow (you mentioned baby steps ......) and take a pat on the back: you fended off 2 hypos in the last 24 hrs. The evidence is in black and white (with green shading!). No one has said this is easy.
😉

 

[The robin]

Hi again Judy,

Lots to digest here and a fair amount is difficult (impossible really) to comment on, because I don't have sufficient detail and more significantly I don't have the experience or qualification.

BUT, starting at the end: your day at a glance is comparable to some of my early ones and only a bit more extreme than my current ones. My main achievement in the last 11 months has been in intercepting hypos and that has only been achieved thanks to CGM with a higher "low" alarm. Your mid-morning fall from 14 to 4 in 4 hrs is not surprising. Was that while you were walking? It seems that you didn't actually go hypo, or if you did it was only briefly and not a low glucose event of 15 mins. So, a pat on the back from here: you navigated an active day and fended off going hypo. 🙂

From the screen, again, you seemed to have a modest rise between 06.00 and 08.30, but no Libre entry visible, so no snack? Could be the Dawn Phenomena or Foot on the Floor syndrome ... ? A rise of about 2 mmol/L is what I experience.

Then a big climb around 9am up to 14, which would be your breakfast arriving before your bolus got in place. Not ideal, but without knowing more about your breakfast and it's carbs as well as your likely insulin to carb ratio, its difficult to comment. 4 units of insulin could cover perhaps as little as 30 gms CHO or as much as 50 and that difference is solely down to your personal ratio. When you start carb counting you might be told to assume 1:10, ie 4 units covers 40gm CHO. But your DSN might look at your data and suggest 1:8. So if your actual breakfast meal is 48 gm CHO, at 1:8 you'd need 6 units.

Sadly there's a few more sums to do before that theoretical dose of 6. Should a correction be applied, since you are taking the breakfast bosul at 8+? I would try to target a level of 6, or 7. So a small correction for me. Then there is getting the timing between prebolus and eating a little better. Oh yes ..... are you planning to be active after breakfast, if so how active and for how long? Most days I'm intending to be active, but often am not (for various reasons) and what I finally do can be a long way from my intent. For me my bowel activity dominates my start of day. All in all your bosul, food and outcome isn't ideal, but it's FINE considering you are not carb counting. It would be a bit of a miracle if you were close to 100% in range at this stage.

I suggest looking at your daily graphs in LibreLink reports for the last 7 days, not in fine scrutiny, but to see if there is a sort of pattern about when you peak and when you fall. An Endo pointed out that I seemed to fall mid afternoon most days and to keep that in mind by taking a 3pm snack daily. He was correct.

The 6pm fall and then rise was presumably your pre- bolus then your dinner arriving; but you seem to have omitted to log that. If you had no external input of insulin or carbs around that time, then I have no idea! But you seem to have intercepted another hypo? Great.

Turning to insulin and exercise or activity: even the mildest of activity will affect your BG. No pancreas means you can't rely on your body to self-regulate, like everyone else around you does. If its mild or medium activity [aerobic] you can generally expect a steady fall in BG. No problem really, just snack AND stay hydrated as you exercise; yes, I know its not really that simple: first you've got to remember to do it, thus have the snacks and drink organised and close to hand, also how big a snack and high or low GI? Trial and error brings experience and improved management! You learn what works for you. But from 5-20 CHO rather than 25 upwards works for me; a little - often.

For high or intense [anaerobic] activity, such as sprinting or even fast walking your BG may well rise; this might seem counterintuitive. Your body thinks you are in or about to be in "flight or fight" mode and releases extra glucose from the liver in readiness. Once this glucose has been released it needs (in theory) extra insulin to take it out of the blood and into your cells and muscles; however, in practice the exercise reduces your body's natural resistance to insulin, so the insulin you have on board goes further. This might not be medically exact, but in layman's terms that's what is happening. So no extra bolus needed for that surge release under anaerobic conditions.

I expect, after a particularly active day, my susceptibility to frequent BG crashes because of that activity and this will last 2 or even 3 days. I'm interested to know if you find this after today's 5 mile walk.

Regarding pre-activity bolus: my new Endo told me to start at a 50% reduction and be prepared to go stronger, ie more than 50% reduction. I cautiously started at 65-70% and that wasn't enough, so tried 50% the next time, which was better. I'm currently applying 50% every morning, in anticipation of getting active reasonably soon after breakfast - which sometimes (often) doesn't happen, hence my recent trend of being above 10 at late midday.

That's enough for now, I'll answer or comment on a couple of other things tomorrow. But I'm very interested to know if your recent night hypos and yo-yo bounce recovery were confirmed by finger pricks or you really feeling hypo - rather than possible compression lows.

My "non-medical thought" is that your basal is too strong and your bolus too weak BUT that is just my thought. I'll explain why tomorrow. I agree with your DSN that you ARE doing well; yes it's definitely more erratic than you want, but the last 24 hrs average was in range at 9.7 and yes you'd like to spend more time in range, but you will get there.

Stay strong, stay positive, don't let this stress you; learn something from today and try to apply that one something tomorrow (you mentioned baby steps ......) and take a pat on the back: you fended off 2 hypos in the last 24 hrs. The evidence is in black and white (with green shading!). No one has said this is easy.
😉

Hi again,thank you once more for taking all this time to help me understand my condition and deal with it more efficiently.
Yes,my mid-morning dip was whilst walking. I expected a dip in my levels,so constantly monitored throughout the walk. I reduced my bolus by 50% and it seemed to work.
I take my bolus and basal together ( my nurse said this was fine)at 8am,breakfast of granola/fresh fruit and yogurt at approximately 8.30. I haven’t logged any food intake on the libre as not carb counting yet but do log jelly babies/dextrose when heading for a hypo. I do eat very healthy,eat very little junk food and prepare meals from scratch 90% of the time.
I tend to be pretty active in the mornings,keeping busy,cleaning,shopping etc and I don’t tend to have any massive drops/rises. Early afternoons is when I seem to hit a brick wall and sleep for 1-2 hours. I have a snack of a couple of biscuits or a snack bar around 4 ish, then evening meal at 6.
I’ve attached 2 random days graphs,just so you can see how up and down they can be. Please don’t think you need to scrutinise these,just wanted to give you a couple of examples.
Judy

 

[Proud to be erratic]

Hi again,thank you once more for taking all this time to help me understand my condition and deal with it more efficiently.
Yes,my mid-morning dip was whilst walking. I expected a dip in my levels,so constantly monitored throughout the walk. I reduced my bolus by 50% and it seemed to work.
I take my bolus and basal together ( my nurse said this was fine)at 8am,breakfast of granola/fresh fruit and yogurt at approximately 8.30. I haven’t logged any food intake on the libre as not carb counting yet but do log jelly babies/dextrose when heading for a hypo. I do eat very healthy,eat very little junk food and prepare meals from scratch 90% of the time.
I tend to be pretty active in the mornings,keeping busy,cleaning,shopping etc and I don’t tend to have any massive drops/rises. Early afternoons is when I seem to hit a brick wall and sleep for 1-2 hours. I have a snack of a couple of biscuits or a snack bar around 4 ish, then evening meal at 6.
I’ve attached 2 random days graphs,just so you can see how up and down they can be. Please don’t think you need to scrutinise these,just wanted to give you a couple of examples.
JudyView attachment 19827View attachment 19828

Hi Judy, I'm going to respond to this narrative and try to weave in outstanding points from yesterday - hopefully.

I'm glad you're finding this long-running saga helpful. I am however slightly concerned that this lengthy dialogue is pretty much me to you and vice-versa, and you aren't getting the full benefit of others from this forum contributing on any one aspect and you're seeing everything through my prism only. I'm almost 2 yrs into this, still learning lots as I go along and there may be much better advice available from others. I was quietly relieved when @trophywench commented recently. I am going to propose that our next batch of dialogue is in a new thread with a better title, that might catch the attention of others on the forum. More on that at the end. Meanwhile I am very happy to press on today.

Glad the 50% bolus worked for yesterday's walk. Did you have to snack at all? It's a nuisance walking and scanning frequently, but if you set the low alarm at the top end, ie 5.6, then you can walk freely and only need to react at that top threshold. How you react depends on how extreme the drop is. And adjust the alarm while you are below that 5.6 to, say 5 or 4.8; then you get a 2nd "tripwire" or safety net before reaching the dreaded 4!
This frequent scanning is, of course much easier once you have CGM, and I have a smart watch responding to the Diabox app so I don't really need to get my phone out of my pocket. The wonders of technology.

I used to take my basal and bolus together. I don't usually these days, because I frequently have a late breakfast and I prefer to use my basal jab as a reason to get out of bed and start my day; I have my phone clock alarm waking me at 07.55, for my basal at 8am. But Tresiba is in practice very forgiving and you can take your basal +/- 2 or 3 hrs without affecting your 24hr loading.

My breakfast is cereal, fruit, seeds, nuts, milk and a latte. My carb count for that is 96gm CHO, which at my breakfast bolus ratio of 8:1 means I need 12 units of insulin. This is a big breakfast, but it seems to suit my daily routine, although it contradicts the guidance I've seen somewhere that we should try to have 3 equal meals spread moderately evenly across the day. Because I still don't have what I could call good control, I have been contemplating changing my meal routine. If I do I'll do it for a full month and then take stock. I think there is no point in changing for just a few days, since so many other factors could come and play - distorting my trial.

May I suggest that you, as a small experiment, try counting (or at least estimating) the carbs in your breakfast; I think it might be interesting to see how your breakfast relates to your 1st pre-bolus of 4 units.

It's not too complicated, just fiddly (I think) - first weigh each item: the carbs for your granola will be stated on the packaging. If you don't have the packaging you can look it up online; if you make it yourself use an arbitrary figure of 60gm CHO per 100 gm wt. But granola can vary quite a lot depending on the brand and type, so it would be helpful, but not vital, if that can be tied down a bit. If you have 30 gm wt, then the carbs would be 30 x 60%, ie 30x .6 = 18 gm CHO.

Fresh milk will be around 4.5 gms carbs per 100 gms or ml (same thing for milk and water) and measure or weigh how much milk you consume. So for 120ml or 120 gm @4.5% = 120 x .045 = 5.4 gm carbs. Fresh Milk varies very slightly and the difference is insignificant, but long life milk is a bit different as are some of the nut or soya milks; but the nutrition value is on the carton. Cream is free, bliss for me.

Repeat for all the other ingredients; fruits range from 6 for strawberries to 20 for peeled banana; but a google search will give you a figure for any one fruit type that is close enough. The weight of a piece of fruit will vary: easy peelers and kiwis are fairly standard, but how heavy is the pear? Then add all the individual figures together. If this is too challenging send me by Private Message (PM) a list of each ingredient and their weight or volume and I'll do it for you, to get you started.

Now, ideally every day for a week have the same amount of carbs for breakfast: by all means change items eg different fruits but juggle wts to get near the overall total. This is a bit tedious at first, measuring and weighing etc but is worth the effort - then we can see whether your 4 unit breakfast bolus is about right. From your graphs it looks as though it might not be OK - but your basal could be wrong and thus pulling you down between 9am and 3pm. Or your level of activity (too much housework!!!). Its difficult to wrestle with this conundrum without a little more info and a few days consistency with the breakfast meal. No need to do this for any other meals at present, I just think it would be helpful to see how your day starts in terms of carbs and insulin. If you can calm down the first 9 waking hours you'll very likely calm down the rest of the day's graph.

Moving on, regarding logging entries into your LibreLink app: If you could scan and put a note in for each time you take insulin or any food, then your DNS will get a much better feel for what is going on overall, when he/she looks at your LibreView data. So scan just as you start eating, click on that entry in the logbook and ADD NOTE. Tick the Food box, select meal from the drop down menu and select the meal type. If you don't have a carb value, leave that bit blank, if you have a guesstimate from the packaging etc then put that number in; it won't matter if that's fairly adrift. You and your DSN know your carb nos are "rough and ready". But some of the reports on LibreView will make a bit more sense and help in gauging why, at certain times, your control is not so good. If you forget, go into the logbook and retrospectively use ADD NOTE to annotate that you had a meal at whatever time that was. You don't need to be really precise about when, just give it your best guess. You asked how much do the DSN's ACTUALLY read the reports? I suspect not too much at this time, partly because you aren't carb counting yet and partly because you are still settling down to this new world. BUT when you have a specific problem that repeats 3 or 4 days in a row and you reach out for help, you are giving the DSN a fighting chance of scrutinising properly, knowing that what data that is there, is valid.

It's good that you are able and willing to sustain a healthy diet. I imagine this is at least an outcome of your original pancreatic problems. Well done. We used to prep most of our meals room scratch, but since I started carb counting we do sometimes use some ready made stuff. For example we could never have confidence in cooking rice from raw; I've seen on this forum that we are not alone with that. But we now buy the prepared rice packs that need a couple of mins in the microwave and so far the carb count on the packet has proved very reliable.

If a meal is cooked from scratch we make a batch; the ingredients are listed, weighed and total carb count established. Then the cooked batch is weighed which gets me to a carb % and my portion weighed onto the plate; the remainder is divided as appropriate and put into the freezer, clearly labelled with its weight and carb count for each portion. Then, when pre-bolussing the carbs are readily available. It's moderately straightforward, except I have to define in advance my portion size from the initial batch and bolus for that weight of meal. We now have a list of the weights for each bowl, jug, saucepan etc, so the batch weight can be calculated from deducting the pot weight from the gross weight. This does lead to "moments of domestic tension" sometimes! My wife does more cooking than me and I'm hindering her way of doing things. We also use standard measuring cups or spoons, with known volumes, always levelled off (no heaping). If this all sounds ridiculous - it is ... but after 12 months we have a carb value for most meal combinations and the counting process is generally quicker than it takes to explain here!

I couldn't resist looking, rather than glancing, at your graphs and from the 3 there are, I think, clear trends. You fall during the night, even when you start from a high level. This looks suspiciously like your basal is too high. You are in fasting mode and your evening bolus has dissipated. UNLESS you are applying a correction as you settle down for bed and that correction is too much causing the fall to be too much. But I think its both too strong bosul correction and excess basal. Please remember I am not medically qualified, so just my impression. You should discuss this with your DNS: send her an email with these 3 screen shots and seek advice.

You fall dramatically from mid morning to mid afternoon; the rebound is almost inevitable (for most of us). I need a bit more detail about food and insulin taken to pin down the "why" and so my thoughts on "what to do". But knowing the first fall is a trend you can defend against that by monitoring and small snacking - while "keeping busy"! Gradually you'll get a sense of when to start snacking and how big a snack; with Libre you can do small and often and scan accordingly, initially with medium to higher GI snacks for fast response, but not very high while still well in range. Save the JBs for when you're near the floor of 4. You're trying to slow the fall. Again only trial and error will allow you to find what works for you; I use Nairns oatcake biscuits generously loaded with peanut butter and Harvest Valley granola bars as my "controlling" carbs; sometimes a small bag of crisps, even half a Belvita @ c16gms carbs; generally not chocolate, it is too slow although I do take chocolate coated snacks when doing heavy stuff in the garden. I cut choc digestive biscuits in half, 5 gm each half and eat these perhaps 15-30 mins apart - a sort of continuous buffet!! But my CGM helps enormously.

Once you've gone hypo it is very easy to overreact and very hard to stay patient and wait long enough to see if you've turned the corner and are going back up the curve. There is a case for finger pricking before a 2nd set of carbs while hypo. Remember your Libre (interstitial BG) is lagging behind actual by 2.5 to 5 mins; so if it was a long train going along your graph, while the tail (Libre) is at the bottom of the hill the engine (your actual BG) is already part way up the other side. Again my CGM helps since it is usually calibrated against actual and (I think) taking the interstitial but adjusting the algorithm to show closer to actual. So I feel I'm seeing more clearly the turn back up the graph.

So that's my crude analysis: how to get a better handle on this? I would set my Libre low alarm at 5.6, the top of its range. I'd want to know at the earliest possible time I'm falling and seeing that you have this trend and at quite a fast rate I think YOU should also want to know as early as possible. Its very easy to get immersed in something while "keeping busy" and fail to scan as frequently as one might / should. Then at least you can make a decision about how aggressively you need to respond. You will get a better understanding of how aggressive and when, as you get more experience of responding ahead of being hypo. The up and down yo-yoing happened to me, just as harshly and it takes a lot of self-will to not panic when hypo and hold off from over-reacting. It is a contradiction: it's stressful and stress elevates one's BG. All of this is very demanding on your time and quality of life, I know. But time invested now in gaining better control from experiments and experience is, I think, worthwhile.

I'm not surprised you hit the wall and need some sleep during the afternoon; I did. You're around 4 months since surgery and still in recovery from that. I was going for chemo by this stage, but slept through much of that period, because I needed to.

My last point was about activity and exercise; but I'm going to start a new thread and ask others for their experience. I know some of the theories but it's an area I still am a long way from being in control of. I'll do this tomorrow; but I need to think up a catchy title that is short yet succinct. Not my forté (short and succinct!).

Regards, stay strong.

 

[The robin]

Morning Roland, again my thanks for all the time you are taking to advise me. I completely understand you wanted others peoples input,that’s fine,what ever makes you feel more comfortable. It does make it more beneficial us being the same diabetes type,I appreciate all your suggestions.

I did have a snack on my walk when my levels began to drop,a Jaffa cake light snack bar. I tend to vary my bars.
Ive had a go at calculating my cabs at breakfast this morning,it will be easiest one to do as I have the same every morning.
I think this is correct but please let know if I’ve messed up,it’s maybe not 100% accurate but near enough.
Breakfast is granola,mixed berries,mandarin (in juice) quarter of a fresh banana,low fat Greek yogurt . 1 cup of tea. This totals;57 g, 57x.7=32.5.? I don’t have a big appetite so only have small portions. I’ve logged it on my libre aswell. Hope this makes sense.
Ive began logging everything in my own journal today aswell.
I get frustrated sometimes when I hear of people who are type 1 say” you can eat what ever you want, use portion control,any problems then just adjust anything with insulin”
Ive even heard diabetic nurses say this, not mine though.
Thanks again Judy

 

[Leadinglights]

Morning Roland, again my thanks for all the time you are taking to advise me. I completely understand you wanted others peoples input,that’s fine,what ever makes you feel more comfortable. It does make it more beneficial us being the same diabetes type,I appreciate all your suggestions.

I did have a snack on my walk when my levels began to drop,a Jaffa cake light snack bar. I tend to vary my bars.
Ive had a go at calculating my cabs at breakfast this morning,it will be easiest one to do as I have the same every morning.
I think this is correct but please let know if I’ve messed up,it’s maybe not 100% accurate but near enough.
Breakfast is granola,mixed berries,mandarin (in juice) quarter of a fresh banana,low fat Greek yogurt . 1 cup of tea. This totals;57 g, 57x.7=32.5.? I don’t have a big appetite so only have small portions. I’ve logged it on my libre aswell. Hope this makes sense.
Ive began logging everything in my own journal today aswell.
I get frustrated sometimes when I hear of people who are type 1 say” you can eat what ever you want, use portion control,any problems then just adjust anything with insulin”
Ive even heard diabetic nurses say this, not mine though.
Thanks again Judy

57x.7=32.5.? I assume that is 57x 0.7
By my reckoning it is 39.9

 

[The robin]

57x.7=32.5.? I assume that is 57x 0.7
By my reckoning it is 39.9

Thankyou leading lights, of course it is,don’t know where I got my calculation from…. brain not functioning well at that time in the morning .

 

[Proud to be erratic]

57x.7=32.5.? I assume that is 57x 0.7
By my reckoning it is 39.9

Hi again Judy.

Apologies, I'd hoped to get back to this sooner, but all of this week has been "interesting" - which really means exasperating and dispiriting, but a couple of lessons learnt. Last weekend I was taking stock and confirmed what I suspected, that for the last 21 days I'd had no low glucose events and no real hypos - only briefly dipping to 3.9. So, encouraged by that success thanks to my Diabox CGM in conjunction with Libre 2, I determined that this week I would intercept all potential hypers and try to get at least one 100% day in range. Oh how well that didn't happen !!! On Mon, Tue & Wed I was defeated within an hour of starting breakfast, then in the afternoon and again in the evening; average time in target for those 3 days c.60%. So yesterday I adjusted my strategy and dedicated every waking moment to monitoring my BG (completely unsustainable in the longer term, of course): as soon as my BG started to rise I "got active" - out my chair, house jobs (anything that needed doing, particularly if it meant upstairs then downstairs), outdoors wire brushing the weeds in the block paving, walking ... you can see the intent. Outcome: between breakfast and the possible 5 hrs of my bolus being active I had 4 steep rises and 4 crashes! A couple touched 10.1 and 3 reached 4.1. I was really unstable and I can't explain to myself why. Then after dinner I lost! I raced up to 13.8, I still had insulin "on board" so didn't want to take a correction and "stack" my insulin. So I went for an hour's walk between 10.30 and 11.30pm and worked my BG back to 7 which continued to gently drop further. Net outcome: I'd again not succeeded in getting 100% in range, but tried. My watch records I took 17,464 steps.

Moving on: about your breakfast carbs. Ignoring 32.5 vs 39.9, I'm not clear why just 1 "sum"?

I was anticipating you'd either present a final total figure or more likely, a small list of ingredients, the weight of each, the carb % applied and hence a total. Eg:

Granola 30gms @ 67% = 20.1
Mixed berries 40gms @ 8% = 3.2
Mandarins in juice 75gms @7.7% = 5.8
Banana 1/4 (w/o skin) 30gms @ 20% = 6
Low fat Greek Yoghurt 40 gms @ 4.7% = 1.9
Total = 37 gm CHO

Obviously you need to enter the correct weights, your best guess. For the carb content I took the granola % from Carbs & Cals; mixed berries I guessed; mandarins from the Tesco tin in our cupboard, Del Monte is slightly different 9.8% (insignificant difference); all low fat plain yoghurt is c.4.7; banana is a bit odd - most places only give a figure with skin on, usually at 13%, I kept some records for a while and arrived @20% without skin, but as bananas ripen they lose weight AND convert skin into ripe banana adding sugar. So it's an estimate; and since I always have a whole banana my own b'fast estimate could be weak, often!

The important thing is to derive a relatively standard count from your fixed ingredients and run with that for a few days, ideally at least a week. Whatever no the total CHO is, you can retrospectively edit wrong carb entries. It will be interesting to see if there is a trend; I'm still suspicious about your basal dose. But with at least 7 days of sound b'fast data your DSN should be able to appraise your basal and whether you need 4 units before b'fast. All for now, BG rising after dinner (Why??), must get active!

Stay strong, regards, Roland

 

[The robin]

Hi Roland,apologies not needed at all. I find it very interesting when I try and figure out why I have highs and lows ,sometimes I think I’ve cracked it but then do the same the following day and the pattern doesn’t continue. I’ve attached yesterdays libre graph,crazy day,hypos (finger prick confirmed)hypers galore.
Had my bloods (lfts)done again this week and as expected abnormal,so my doctor is getting in touch with my consultant for advice.
I attempted to count my carbs and think I’ve made a complete mess of it. This is my breakfast,I weigh every item to 30g;
granola= 30g
mixed frozen berries =. 30g
lidl mandarins in juice =30g
1/4 banana=30g
lidl low fat Greek yogurt=30g
I got completely confused re carbs applied so googled each item,then confused myself I think.
Impressive step counts.
Judy

 

[Leadinglights]

Hi Roland,apologies not needed at all. I find it very interesting when I try and figure out why I have highs and lows ,sometimes I think I’ve cracked it but then do the same the following day and the pattern doesn’t continue. I’ve attached yesterdays libre graph,crazy day,hypos (finger prick confirmed)hypers galore.
Had my bloods (lfts)done again this week and as expected abnormal,so my doctor is getting in touch with my consultant for advice.
I attempted to count my carbs and think I’ve made a complete mess of it. This is my breakfast,I weigh every item to 30g;
granola= 30g
mixed frozen berries =. 30g
lidl mandarins in juice =30g
1/4 banana=30g
lidl low fat Greek yogurt=30g
I got completely confused re carbs applied so googled each item,then confused myself I think.
Impressive step counts.
Judy

How are you confusing yourself, if you google the product it will usually give you the Total carbs/100g
So for example the mandarin segments (Sainsbury's as no info for Lidl ) is 14.4g carb /100g so your 30g portion would be 14.4 / 100 x 30 = 4.3g carb.
You can do the same with the other items and add them up to get the total for your breakfast. A quick estimate would be about 35g carb

 

[Proud to be erratic]

Hi Roland,apologies not needed at all. I find it very interesting when I try and figure out why I have highs and lows ,sometimes I think I’ve cracked it but then do the same the following day and the pattern doesn’t continue. I’ve attached yesterdays libre graph,crazy day,hypos (finger prick confirmed)hypers galore.
Had my bloods (lfts)done again this week and as expected abnormal,so my doctor is getting in touch with my consultant for advice.
I attempted to count my carbs and think I’ve made a complete mess of it. This is my breakfast,I weigh every item to 30g;
granola= 30g
mixed frozen berries =. 30g
lidl mandarins in juice =30g
1/4 banana=30g
lidl low fat Greek yogurt=30g
I got completely confused re carbs applied so googled each item,then confused myself I think.
Impressive step counts.
Judy

So:
Granola 30gm @ 67% (from carbs & cals) = 21
Mixed berries 30gm @ 8% (my guess)= 2.4
Lidl mandarins 30gm @10% (guess, what's on tin?) =3
1/4 banana 30gm @ 20% =6
Lidl low fat yog 30 gm @ 4.7% (my assump)=1.4
Total = 33.8 gms CHO for breakfast, say 39.

My breakfast insulin to carb ratio is 1:8 and for 39 units I would need 5 units. But if your breakfast ratio is 1:10 then your 4 units is correct. So once we've got a look at 7 days logged onto Libre and trends from that we (you, me and your DSN) may get a better insight.

Put another way: if you take 4 bosul units but actually need 5, then once you've eaten breakfast your BG is destined to always climb. Once you start to get active, be that delicate dusting, vigorous vacuuming or energetic exercise, then that activity will start to reduce your BG. This is what I'm currently doing - knowing that my 1:8 was right; these ratios do alter over time - just to add to the complication, but usually not quickly.

But if your basal is too big, it will always be dragging your BG down; in itself that might not seem too bad a thing, but it increases your likelihood of drifting into hypo and even if you successfully defend against that you are in effect "feeding the insulin". Also it makes calculating bolus needs much more complicated; the bolus is not just how much carbs are you about to eat, but also possibly some units to correct an existing high, as well as a % factor if activity is planned outside a normal daily routine.

I'm a bit busy right now, so will look again at your snapshot etc later. But the trend is clear and if you can intercept your fall between 9am and midday and PREVENT that deep hypo, then the rest of your day will be better. So as an experiment snack NOW. Better to go high than hypo in the short term. Will get back to you. I fully empathise with repetition and analysis sometimes makes no sense!!
Roland

 

[The robin]

How are you confusing yourself, if you google the product it will usually give you the Total carbs/100g
So for example the mandarin segments (Sainsbury's as no info for Lidl ) is 14.4g carb /100g so your 30g portion would be 14.4 / 100 x 30 = 4.3g carb.
You can do the same with the other items and add them up to get the total for your breakfast. A quick estimate would be about 35g carb

Thank you, I suppose it’s like anything,once I get my head round it all ,it will become a lot easier.

 

[helli]

only yesterday I realised that I haven't had a single day 100% in range since October.

There is a reason why 100% in target days are called “Unicorn Days”.

There are too many things which can affect out blood sugar levels to aim for perfection, especially if you live a varied life with a varied diet.

When I was first diagnosed, I quickly found that fixed insulin doses would not work for me. Like @The robin i found my graphs were different every day. In hindsight, this is not surprising when my food (and carb content) varied every day. I am unusual that I do not have the same breakfast every day, I vary my lunch hugely because I quickly get bored with sandwiches and my evening meal could be anything from a low carb frittata to a huge bowl of high carb pasta.

It has always surprised me that a carb target is no5 given when we are started on fixed doses.

 

[Proud to be erratic]

Thank you, I suppose it’s like anything,once I get my head round it all ,it will become a lot easier.

I made your school error!! Total 33. 8 should be say 34. Sorry. So, close to your 4 units at 1:8 (=32).

I should really check what granola you have. Most are in the range 60-70%, but there are some low carb variants in the +/- 15% zone.

And this leads me to discussion about what is and is not significant in carb counting. Milk and plain yoghurt are very similar in carb %, both low 4.5 - 5%. So even when the weight (or volume for these liquids) is a bit hit and miss, the error is insignificant. Even if 50% more milk or yog, the change is still small. But granola is, usually, high carb, so measuring the amount is important; 10 % error in the measure can change the final number - significantly for me with my generous breakfast. Less so for you because your start point is 34 and even a drift to 37.5 (+10% difference) only makes a small change to your bosul calcs at 1:8. Thus 34 @ 1:8 needs 34/8= 4.5 units, and 37.5/8= 4.8 units; not a big difference.

Earlier @Leadinglights remarked on tinned mandarins. We have a Tesco's own tin telling us they are 7.7% carbs, in juice. If we'd erroneously got those in syrup they would 14%, near double (but not too big a problem for your modest b'fast). Del Monte are 11.8% and Sainsbury's 14.4%, apparently. Tinned produce can be quite varied in their natural form and for foods that are higher in carbs from the outset are equally varied when in a tin. I too often see people have cut out potatoes, but substituted them for sweet potatoes in the naive assumption they are less, but usually more. A

Anyway the broader point is be aware of what is significant and what is not, once you get enmeshed in carb counting. I make guesses for the low value items. But I weigh or measure stringently for higher items, on the basis there is lots of error elsewhere in the full process to confuse and cause difficulty; at least I've got the carb count pretty close.

There is a reason why 100% in target days are called “Unicorn Days”.

There are too many things which can affect out blood sugar levels to aim for perfection, especially if you live a varied life with a varied diet.

When I was first diagnosed, I quickly found that fixed insulin doses would not work for me. Like @The robin i found my graphs were different every day. In hindsight, this is not surprising when my food (and carb content) varied every day. I am unusual that I do not have the same breakfast every day, I vary my lunch hugely because I quickly get bored with sandwiches and my evening meal could be anything from a low carb frittata to a huge bowl of high carb pasta.

It has always surprised me that a carb target is no5 given when we are started on fixed doses.

Thank you @helli , I hadn't previously registered the "Unicorn Days" analogy - but it's appropriate. I'm in no doubt that I'm chasing the impossible, but my current experiment is (I hope) helping me to find just how active I have to be to intercept my highs and the boundaries of that so I don't precipitate a further steep fall. Also I'm hoping to persuade my Endo to help me get a pump and it's not unreasonable to provide hard evidence of what I need to do to remain stable and broadly in range and demonstrate this is a huge intrusion on my quality of life. Which it is.

Yes, I too was surprised when I was discharged from hospital with kit and unexplained doses to take. To be fair the hospital lead diabetes sister spent some time with me explaining about carb counting and I made some primitive attempts while in hospital; but I was still struggling post op. So when I met my local DSN in Bucks the next day she encouraged me to not carb count and I regret I took her easy (lazy) option.

I was (still am at heart) a civil and structural engineer by profession, so relatively numerate and loved engineering challenges. I see my DM in this light: a problem to be resolved and controlled. So my fixed breakfast suits me, not least it's what I used to do. But it's pretty varied, 15 different ingredients and around 100 gms CHO. My lunches, if I bother, are totally irregular, lots of protein and whatever is around. My dinners are also very varied, but rarely belowv30gms CHO.

And yes my graphs were all over the place. They still are, but less so. However as you already know its depressing and horrible to get frequent hypos, so it's natural to want to stop those. Then the deep hypos bring ridiculous rebounds and I found that pretty daunting. I don't seem to be affected by moderate hypers, but when repeatedly in the 20s it bothered me. It also frightened me because I had no idea what deeper damage it was causing, but I knew that my late brother lost both legs to DM and that remains at the front of my mind. So every reason to get on top of this pernicious disease. But perfection is unrealistic and not justifiable.

But again thanks for providing some insight on your early experiences.

 

[Proud to be erratic]

Hi Roland,apologies not needed at all. I find it very interesting when I try and figure out why I have highs and lows ,sometimes I think I’ve cracked it but then do the same the following day and the pattern doesn’t continue. I’ve attached yesterdays libre graph,crazy day,hypos (finger prick confirmed)hypers galore.
Had my bloods (lfts)done again this week and as expected abnormal,so my doctor is getting in touch with my consultant for advice.
I attempted to count my carbs and think I’ve made a complete mess of it. This is my breakfast,I weigh every item to 30g;
granola= 30g
mixed frozen berries =. 30g
lidl mandarins in juice =30g
1/4 banana=30g
lidl low fat Greek yogurt=30g
I got completely confused re carbs applied so googled each item,then confused myself I think.
Impressive step counts.
Judy

Hi Judy, how did you get on yesterday? Do let me know, but only if you have time.

That was a deep hypo you had on the 28th, as a matter of interest do you have your libre alarm set for lows and if so are you using the highest setting of 5.6 to give you a chance of intercepting a potential hypo? With the same logic have you tried having your high alarm set at, say, 8.5 to alert you when you're heading rapidly up hill? Then you could explore degrees of activity to curtail that high?
Regards Roland