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[Inka]

I agree with @rebrascora about your possible Dawn Phenomenon. I’d also suggest that delaying breakfast (you wake and stay in bed) can cause a rise. I find this, and the longer I leave breakfast, the more stubborn the rise gets. Try eating breakfast earlier.

Your blood sugar seems to plunge down during the morning - did you do a correction with your breakfast bolus?

Then after lunch you have that big drop into hypo territory. I’d try reducing your lunchtime bolus (ie changing your ratio). Eg if your ratio is now 1:10g, I’d try 1:12g and see how that goes. Also, where do you inject your lunchtime bolus (ie which body area)? Today you also dropped after lunch. Really do try a different ratio. Your basal could be contributing too.

What caused that big rise around 6pm?

Eating your evening meal earlier might help you. I try to eat 6pm and I find that if I eat at, say, 7.30pm, my blood sugar is harder to control.

I think there’s an imbalance in your insulin/food and it’s that that’s causing your erratic levels. You’d be surprised how big an effect a small thing can have. Once you’re thrown off kilter it often has a knock-on effect, causing a mad rollercoaster of blood sugars.

Nature Valley bars, flapjacks, biscuits, grains, potatoes - you can eat what you want. When someone with Type 1 has blood sugar problems, it’s the insulin not the food. You could eat the most perfect diet in the world, but if your insulins are wrong, then you’ll get ‘bad’ results.

 

[Purls of Wisdom]

I agree with @rebrascora about your possible Dawn Phenomenon. I’d also suggest that delaying breakfast (you wake and stay in bed) can cause a rise. I find this, and the longer I leave breakfast, the more stubborn the rise gets. Try eating breakfast earlier.

I can relate to that pretty well. I dilly dally before deciding to eat breakfast, specially on my days off.

Your blood sugar seems to plunge down during the morning - did you do a correction with your breakfast bolus?

No correction. I ate 38g at breakfast and injected 8u, 1:5 ratio, on the right mid thigh.

Then after lunch you have that big drop into hypo territory.

Could it be that it was 30mins between injecting 3u NR and eating lunch?

I’d try reducing your lunchtime bolus (ie changing your ratio). Eg if your ratio is now 1:10g, I’d try 1:12g and see how that goes.

sounds like a good idea.

. Also, where do you inject your lunchtime bolus (ie which body area)? Today you also dropped after lunch. Really do try a different ratio

lunch time bolus was injected on the mid riff on the right side.

. Your basal could be contributing too.

Took 14u of Levemir, being a Saturday.

What caused that big rise around 6pm?

No idea as I refrain from eating snacks as far as I can help.

Eating your evening meal earlier might help you. I try to eat 6pm and I find that if I eat at, say, 7.30pm, my blood sugar is harder to control.

Point taken.

I think there’s an imbalance in your insulin/food and it’s that that’s causing your erratic levels. You’d be surprised how big an effect a small thing can have. Once you’re thrown off kilter it often has a knock-on effect, causing a mad rollercoaster of blood sugars.

Understand and agree. All suggestions are welcome.

Nature Valley bars, flapjacks, biscuits, grains, potatoes - you can eat what you want. When someone with Type 1 has blood sugar problems, it’s the insulin not the food. You could eat the most perfect diet in the world, but if your insulins are wrong, then you’ll get ‘bad’ results.

Hugely relieved that i have loads more food options now. Past couple of days have truly been eye openers. I am feeling better equipped already.

Thanks.

 

[Purls of Wisdom]

As usual, all my best laid plans fall flat. My BG levels have been playing up since 6:30pm. Only had a cup of tea in the evening.

Dinner was late again due to my brother in law's b'day dinner. I took 9 plus 3 correction units. Still not much joy. I declined eating the cake and had fruit instead. No fizzy drink, just plain water and herbal tea for me. Readings are still way high. Took 1 extra unit of Levemir in the hope that it will bring numbers down.

 

[rebrascora]

Sorry to hear you have had another difficult day with your levels.

Did you treat that 3.7 just after lunch as a hypo and if so what did you treat it with ie how many jelly babies or dextrose tablets etc and did you also have slow release carbs afterwards or just the fast acting carbs?

Am I right in thinking your finger prick actually showed 4.8 at this time (I am not sure what you mean by a GM....maybe a typo for BM?) but guessing it is a finger prick test ie a BG (Blood Glucose) reading? The Libre takes time to adjust to your levels changing direction so if this was just after lunch the Libre will be predicting your levels are continuing to drop whereas the food is actually starting to release it's glucose into your blood which is why your BG reading is higher but it hasn't quite reached your interstitial fluid yet. ie. that 3.7 was not correct and in fact your meal was likely releasing it's glucose and bringing you up. The finger prick test is the one to trust and it shows you are not hypo and you have eaten your lunch at that time so you already have carbs in your system, so if you add more by way of an unnecessary hypo treatment, then you will go too high later.
In that situation myself, I would not take a hypo treatment and even if the finger prick showed I was in the 3s I would only take one jelly baby or one/maybe two dextrose tablets but not a full hypo treatment, because I know that the carbs from the meal will also be starting to kick in too and any extra carbs I eat will send my levels too high later.
Once levels are really high then your insulin will become less effective and you will need extra to bring you down usually requiring a much larger correction factor. Plus it looks like you ate whilst your levels were very high which I appreciate in that social situation there wouldn't be a lot you can do when everyone else is eating. I personally would be checking my levels before I left home to go to an event like that and injecting a correction before I set off if my levels are high, but I know this then means that you are going to have 2 injections of bolus insulin within probably an hour of each other which no doubt you have been told not to do but in practice is the best way to deal with a situation like this, otherwise it just escalates. I would have jabbed 5 units (I have a correction factor of 1unit drops me 3 under a BG of 10, but I need nearly double that above 10) so 5units would be somewhere near bringing me down into range from 16 and I can always have a jelly baby later if my levels are dropping a bit too low, indicating I was a bit too heavy handed. I would inject that correction before I left the house and at least an hour before I expected to eat and then just bolused for my meal regardless of my reading at the venue, because I had already injected the correction earlier and that correction would still be working on reducing my levels.

You are still in the mentality of being type 2 by not having cake. You can have cake, but you need to inject extra for it depending upon the carb count....Just like if I went out for a meal and I injected for my main course and ate it and then decided that the desserts looked irresistible, so I would choose my dessert, assess the carbs in it, inject however much insulin I calculated it needed and eat the dessert. What I would not do is add a correction to that dessert injection because my previous injection for the main course is still working. So you can inject more bolus insulin for food in between meals provided that you don't do any corrections until at least 4 hours after the last injection. If your levels are low when you want a snack and it is just a small snack then you will likely not need any insulin, but if your levels are in range or above, then you will need to inject for it. You have mentioned recently about having a cup of hot milk or Horlicks at bedtime. If my levels were below 6 I probably would not inject any insulin for a hot drink like that, but if my levels were above 6, I would need to inject insulin to cover it. A mug of milk will likely have 10g carbs, so you might get away with it, a Horlicks will be nearer 20g so you would need to bolus for it. What you would not do is inject a correction at bedtime, especially if you had eaten your main meal late (within 4 hours) because that meal time insulin is still working to bring those levels down, so you just inject for the extra snack or bedtime drink.
Hope that makes sense. If not ask and I will try to explain it better because I know it is a lot to take in.
Ideally it is better not to go to bed with active quick acting insulin in your system, but if you really want a comforting bedtime drink then you either have to accept that your levels will be high most of the night or you carefully calculate and inject for whatever it is you want.

There are all sorts of "rules" that clinicians give us to follow to try to keep us safe but if we follow all those rules we cannot live with any great quality of life. If we bend those rules we need to understand what the risks are and how to mitigate them. For instance I need to prebolus 45mins before breakfast on a morning. Nurse says no more than 20mins, but if I only wait 20 mins then my levels will spike to mid teens and then come crashing back down later which makes me feel rubbish and is not great for my body to have to cope with that every morning, so I wait a few minutes later each day until I find the point at which my insulin and glucose from breakfast, cross the line together and my levels don't spike at all or maybe just a slight hillock. The precautions I take are that I scan my levels regularly during this time so that I can see when my insulin starts to kick in and I need to eat breakfast. For me, 5.5 with a downward sloping arrow is about the ideal time to eat. This gradually becomes part of my morning routine, so I inject before I get out of bed, put the kettle on, visit the bathroom, prepare breakfast drink my coffee whilst catching up on the news and scan every 5-10 mins until I can see the insulin starting to lower my BG and when I get to mid 5s I eat. Your digestion might be slower and you might need to eat mid 6s, but you watch and experiment and see what works. I always have my breakfast mad first so that if my levels start dropping faster than usual, it is there ready to eat.

Many of the "rules" were for people who were finger pricking so they only had very limited information about what their BG levels were doing. Libre and other CGM enables us to see much more clearly what is happening and therefore fine tune our diabetes management whilst still keeping ourselves safe.... providing we keep a close eye on things. I scan an average of 30 times a day to keep myself safe, because I break a lot of those "rules". I often eat very late..... sometimes after midnight, I stack corrections and I prebolus much longer than 20mins and I adjust my Levemir daily sometimes, but I keep a close eye on my Libre to keep myself safe and make wise choices. Of course I still get it wrong occasionally but so does everyone, because it is impossible to get it right all the time with diabetes and most of the time is good enough.

 

[Inka]

Obviously the late dinner isn’t ideal, but your problems started before that @Purls of Wisdom when you went up to 9.3 and then shot up to 16. This doomed your evening blood sugars. As well as the correction @rebrascora mentioned above, if my blood sugar was that high I’d be very careful about what I chose to eat. I probably would have had a small amount of carbs only to limit the damage. I know it’s difficult when it’s a special meal, but I’d do my best.

I meant to say earlier that with your hypos after lunch, you could try not injecting in your stomach area because it’s the fastest area. Injecting in your thigh might help slow the absorption of the insulin and stop that steep drop. Experiment with different body areas and see which works best. It can make quite a difference.

 

[Purls of Wisdom]

Sorry to hear you have had another difficult day with your levels.

Did you treat that 3.7 just after lunch as a hypo and if so what did you treat it with ie how many jelly babies or dextrose tablets etc and did you also have slow release carbs afterwards or just the fast acting carbs?

No treatment required. GM read 4.8 mmol/L.
I took no further action.

Am I right in thinking your finger prick actually showed 4.8 at this time (I am not sure what you mean by a GM....maybe a typo for BM?) but guessing it is a finger prick test ie a BG (Blood Glucose) reading? The Libre takes time to adjust to your levels changing direction so if this was just after lunch the Libre will be predicting your levels are continuing to drop whereas the food is actually starting to release it's glucose into your blood which is why your BG reading is higher but it hasn't quite reached your interstitial fluid yet. ie. that 3.7 was not correct and in fact your meal was likely releasing it's glucose and bringing you up. The finger prick test is the one to trust and it shows you are not hypo and you have eaten your lunch at that time so you already have carbs in your system, so if you add more by way of an unnecessary hypo treatment, then you will go too high later.

I thought the same and hence took no action. GM means Gluco Meter.

In that situation myself, I would not take a hypo treatment and even if the finger prick showed I was in the 3s I would only take one jelly baby or one/maybe two dextrose tablets but not a full hypo treatment, because I know that the carbs from the meal will also be starting to kick in too and any extra carbs I eat will send my levels too high later.

Been doing exactly the same.

Once levels are really high then your insulin will become less effective and you will need extra to bring you down usually requiring a much larger correction factor. Plus it looks like you ate whilst your levels were very high which I appreciate in that social situation there wouldn't be a lot you can do when everyone else is eating.

in fact I waited while others ate. The BG levels did not budge after 12u and I gave up.

I personally would be checking my levels before I left home to go to an event like that and injecting a correction before I set off if my levels are high, but I know this then means that you are going to have 2 injections of bolus insulin within probably an hour of each other which no doubt you have been told not to do but in practice is the best way to deal with a situation like this, otherwise it just escalates. I would have jabbed 5 units

Another birthday lunch today. I shall be following your advice to a T. I always wondered about stacking cos i have never done it before.

(I have a correction factor of 1unit drops me 3 under a BG of 10, but I need nearly double that above 10)

i rarely see 10.0. Could you pls simplify " double if above 10.0"?

so 5units would be somewhere near bringing me down into range from 16 and I can always have a jelly baby later if my levels are dropping a bit too low, indicating I was a bit too heavy handed. I would inject that correction before I left the house and at least an hour before I expected to eat

great plan.

and then just bolused for my meal regardless of my reading at the venue, because I had already injected the correction earlier and that correction would still be working on reducing my levels.

Wait for how long before eating?

You are still in the mentality of being type 2 by not having cake. You can have cake, but you need to inject extra for it depending upon the carb count

i wouldn't dare with those numbers last night. I must say that i am more relaxed around food now.

...Just like if I went out for a meal and I injected for my main course and ate it and then decided that the desserts looked irresistible, so I would choose my dessert, assess the carbs in it, inject however much insulin I calculated it needed and eat the dessert.

time scale between top up NR before divulging in a dessert?

What I would not do is add a correction to that dessert injection because my previous injection for the main course is still working. So you can inject more bolus insulin for food in between meals provided that you don't do any corrections until at least 4 hours after the last injection.

Understood. Would you scan in between the meal and dessert? Or it is needless as no corrections are added?

If your levels are low when you want a snack and it is just a small snack then you will likely not need any insulin,

How much low and does the trending arrow matter? My average is 10.0. High glucose alert is set at 14.0.

but if your levels are in range or above, then you will need to inject for it.

Meaning at 10.0 or above?

You have mentioned recently about having a cup of hot milk or Horlicks at bedtime. If my levels were below 6

when do I see levels around 6 specially after eating?

I probably would not inject any insulin for a hot drink like that, but if my levels were above 6, I would need to inject insulin to cover it. A mug of milk will likely have 10g carbs, so you might get away with it, a Horlicks will be nearer 20g

I ve even reduced the amount of Horlicks added by 1/4 in order to keep carbs low.

so you would need to bolus for it. What you would not do is inject a correction at bedtime, especially if you had eaten your main meal late (within 4 hours) because that meal time insulin is still working to bring those levels down, so you just inject for the extra snack or bedtime drink.
Hope that makes sense. If not ask and I will try to explain it better because I know it is a lot to take in.

I am going to re visit your explanations and suggestions for sure.

Ideally it is better not to go to bed with active quick acting insulin in your system,

how to rectify that?

but if you really want a comforting bedtime drink then you either have to accept that your levels will be high most of the night or you carefully calculate and inject for whatever it is you want.

Would careful counting help with keeping BG levels in range?

There are all sorts of "rules" that clinicians give us to follow to try to keep us safe but if we follow all those rules we cannot live with any great quality of life. If we bend those rules we need to understand what the risks are and how to mitigate them.

one needs a mentor like yourself.

For instance I need to prebolus 45mins before breakfast on a morning. Nurse says no more than 20mins, but if I only wait 20 mins then my levels will spike to mid teens and then come crashing back down later which makes me feel rubbish and is not great for my body to have to cope with that every morning,

Ruins a prospective good day for sure.

so I wait a few minutes later each day until I find the point at which my insulin and glucose from breakfast,

Will 5 mins additional wait each day work?

cross the line together and my levels don't spike at all or maybe just a slight hillock. The precautions I take are that I scan my levels regularly during this time so that I can see when my insulin starts to kick in and I need to eat breakfast.

please explain this with using numbers for me to have a clearer pic. Thanks.
yesterday half an hour's wait at lunch time brought me down with a thud.

For me, 5.5 with a downward sloping arrow is about the ideal time to eat. This gradually becomes part of my morning routine, so I inject before I get out of bed, put the kettle on, visit the bathroom, prepare breakfast drink my coffee whilst catching up on the news and scan every 5-10 mins until I can see the insulin starting to lower my BG and when I get to mid 5s I eat. Your digestion might be slower and you might need to eat mid 6s, but you watch and experiment and see what works. I always have my breakfast mad first so that if my levels start dropping faster than usual, it is there ready to eat.

Breakfast mad or meds?

Many of the "rules" were for people who were finger pricking so they only had very limited information about what their BG levels were doing. Libre and other CGM enables us to see much more clearly what is happening and therefore fine tune our diabetes management whilst still keeping ourselves safe.... providing we keep a close eye on things. I scan an average of 30 times a day to keep myself safe, because I break a lot of those "rules". I often eat very late..... sometimes after midnight, I stack corrections and I prebolus much longer than 20mins and I adjust my Levemir daily sometimes, but I keep a close eye on my Libre to keep myself safe and make wise choices. Of course I still get it wrong occasionally but so does everyone, because it is impossible to get it right all the time with diabetes and most of the time is good enough.

My DSN will faint if I scanned 30 times but what I can do is not to fret at higher readings.

 

[Purls of Wisdom]

Last night the plot thickened further ... I injected 14u Levemir and 8u NR. Time watched and ate after 15mins exactly. I had hardly put the bowl down and CGM alarm alerted me. An hour and half later, it is still going up and fast ... ...

 

[Tdm]

how long in advance? I can see where you are coming from.

I read about this theory and practiced it too. When i caually mentioned it to DSN, her response was that i only have to wait for 15mins and no more.

i fully understand the reasoning and you ve explained it well too.

If you ve asked me a couple of weeks before, I rarely saw my readings as low as 8mmol/L. At times the readings were as high as 19!

Yes, I ve been told of correction dose but only pre bolus, not afterwards, in the case of seeing an extra high readings after eating.

1 extra unit will drop me by 3.0 mmol/L. Also advised only increase by a unit or 2 at a time for no less than 3 consecutive days.

Please confirm that any time I am over 10.0; I should go ahead and take extra insulin and either bolus earlier and wait for longer until it has decreased back to 10.0mmol/L.

The DSN has also pointed out that may be I am over scanning and keep fretting at the hyper readings. She has repeatedly said that in pre CGM times, people only tested twice a day and got on with their lives!


I reckon that is my one of the major downfalls. What time would you say is ideal for dinner? Specially if I am going to have a hot drink before bedtime.

Must mend my ways with the expection of once in a blue moon.

Re Dsn saying you are overscanning...scanning gives you knowledge. Scanning will allow you to predict hypos and nip them on the bud. Knowledge is power when it comes to diabetes. I scan on average 44 times a day if that helps

 

[Tdm]

Last night the plot thickened further ... I injected 14u Levemir and 8u NR. Time watched and ate after 15mins exactly. I had hardly put the bowl down and CGM alarm alerted me. An hour and half later, it is still going up and fast ... ...

View attachment 23178

What did you eat? Was it something with a high Gi? If so may need longer prebolus. I prebolus 25-30 min for breakfast muselli (normally 60g muselli) on novorapid, and even then i spike badly with tescos cheaper nutty muselli - but not with sainsbury's nutty.
Try getting a meal you eat a lot and experimenting with different prebolusing. When you get it right for a meal, write it down. Some things i spike with regardless prebulusing. More than one slice of bread, for example, can't figure out how to eat a sandwich without going out of range. So, i don't eat sandwiches. My choice, others may make different choices.
If your starting in the 9s you should be safe to experiment re prebolusing.
I also find a walk some 10 min or so after eating, when the blood sugars start to rocket, helps flatten spikes...i walk until bs start to down down then stop. About 20 min.
What i would say is try to change just one thing at a time (insulin dose, food) and write down what happens. Keep a list of things to try. Keep a list of things that work. Be your own research scientist. Do you have good scales? Normal kichen scales can be a bit rubbish and give different readings with same weight. I got some heston blumantal branded scales and they are blooming reliable. Perhaps a bit excessive butit works for me
And be happy to get 10% there. 10% will become 20, and so on. But even when you have it all nailed down it will do odd things some days, and thats ok. Perfection isn't possible, but improvement is.
Plus, i got into keto baking. I find many keto cakes etc, eaten in moderation, have little effect on my blood sugars. Helps with bs control and a lot with morale. Carolyn ketchum does good keto recipe ...she is a diabetic. Though there are lots of rather esoteric ingredients, and its not cheap, but, well, its worth it for cake

 

[Bruce Stephens]

Re Dsn saying you are overscanning...scanning gives you knowledge.

Agreed, I think that's somewhat outdated thinking. There's been at least one report (funded by Abbott) that showed scanning more often is correlated with better control. (It was observational so couldn't show causality but I don't think it's much of a stretch to suggest some causality.)

I may be misremembering, but I think someone said that DAFNE advised not testing between meals: so just to test before them, on the grounds (presumably) that you shouldn't change anything because of the results of such a test.

I also remember DSNs looking through the Log Book on my reader to see the results and commenting that it was rather hard to find a particular time's result because I was scanning so frequently. (I never used it for that: I just wanted the graphs.)

There are obvious risks in reacting too soon, especially with their current algorithm (which seems to exaggerate fast changes a bit), but so long as you accept the readings as imprecise and somewhat provisional (so try not to overreact) I don't see there's much problem. Scan as much as you want.

 

[Inka]

Last night the plot thickened further ... I injected 14u Levemir and 8u NR. Time watched and ate after 15mins exactly. I had hardly put the bowl down and CGM alarm alerted me. An hour and half later, it is still going up and fast ... ...

View attachment 23178

I really think a basal test would be informative here. It’s hard to work out what’s going on when you have food and bolus insulin in the mix as well. You seem to be fighting a lot of highs, which is exhausting and stressful.

 

[Purls of Wisdom]

I ve received a lot of valuable advice over the weekend which I ve fully comprehended. It had been an over indulgent time. 2 family b'days and a meal out with my son's first serious girl friend. Need I say more?

I think what will really help me at this stage is for someone in the know how to read my charts / graphs and give me their feedback.

Any takers?

 

[Lucyr]

I think reading the graphs and making adjustments is something that you should be learning to do yourself, by making notes and spotting patterns. Have you worked through the libre academy sessions and through the Bertie online carb counting course?

 

[Purls of Wisdom]

I think reading the graphs and making adjustments is something that you should be learning to do yourself, by making notes and spotting patterns.

i know but still feel that I can do with little more support to be confidently on the path of managing my Type1 DM. Reading CGM graphs is out of my abilities.

Have you worked through the libre academy sessions and through the Bertie online carb counting course?

Libre Academy sessions are news to me and I am working thru Bertie online. Hoping for some reprieve after months of struggle, stress and confusion.

Learnt so much since last weekend, thanks to the forum members and feel that I also can learn and live with this ailment.

Thanks.

 

[Bruce Stephens]

Reading CGM graphs is out of my abilities.

It's easier if you can do it with a DSN, but there are some really good videos. The Abbott Libre Academy ones are good (and long). ABCDiab have some: https://www.youtube.com/playlist?list=PLTmzbYIu6mAmiwdzoAuZP8DkxcdfnPlrN

Specifically, Reviewing Data, Interpreting Daily Traces, Understanding Arrows. But they're all worth watching (and are 10-25 minutes long). (And there are some tutorials, https://www.freestylelibre.co.uk/libre/help/tutorials.html but I think they're a bit too short to really be what you want.)

 

[Purls of Wisdom]

It's easier if you can do it with a DSN,

my DSN has made it pretty clear to me that
I have already latched onto her for too long for support, which is usually given for the first month only. I could ve cried.

but there are some really good videos. The Abbott Libre Academy ones are good (and long). ABCDiab have some: https://www.youtube.com/playlist?list=PLTmzbYIu6mAmiwdzoAuZP8DkxcdfnPlrN

I shall definitely watch these videos.

Specifically, Reviewing Data, Interpreting Daily Traces, Understanding Arrows. But they're all worth watching (and are 10-25 minutes long). (And there are some tutorials, https://www.freestylelibre.co.uk/libre/help/tutorials.html but I think they're a bit too short to really be what you want.)