Spiking and hypos since using libre

[Greys]

Hi. I've recently begun using the libre. It's great as I can keep a better check on what my bloods are doing, but it's showing spiking after meals. About 2 weeks in I was advised to try fiasp to combat these variables. After 3 weeks being on it I have changed my basal insulin from 18 to 15 and increased my meal ratios for breakfast and lunch. I'm still spiking after breakfast after increasing my ratio considerably. However before lunch I do an hour's exercise, either a run or bike ride. My bloods are generally ok just before this or sometimes a bit on the high side. I therefore take a snack of a banana and 3 Jelly babies to prevent hypos during and after. I have combated the lunch time spike and after work I go for a 45 minute walk (as working from home atm I need to escape). Once again bloods are fine pre-walk but I have to eat a snack and some Jelly babies to prevent hypos just from walking. I don't want to keep snacking but have to otherwise I have a hypo. If I don't take the ratios I am on I'll end up spiking. I'm also finding I am having a hypo after my dinner on a 1:1 ratio and experience hypos at night. Never before have I had as many.
I thought I always had good control but with my hbAc1 results being constantly at 7.7 the last few years, I am trying desperately to improve this. Just lately though I'm feel this is controling my life, whereas when I was more in the dark, without the libre, I lead a more carefree life. Any advice greatly appreciated.

 

[Kaylz]

What do you mean exactly by spiking? Give an example please

Before adjusting your bolus ratios etc did you try altering your bolus timing? I see a spike as an increase around 2 hours after eating but then coming back down by 4-5 hour mark, in those cases I wouldn't adjust my ratio but the timing of when I delivered my bolus
xx

 

[rebrascora]

Hi. How far in advance do you prebolus? That tends to be the key to preventing post prandial spikes. At breakfast time I often need as long as an hour with NovoRapid and 45 mins with Fiasp before I eat.

 

[rebrascora]

I keep scanning after I inject on a morning and start eating when I can see the insulin starting to kick in.
It is usually just 20 mins for me later in the day, but morning is particularly long time due I think to the insulin having to overcome "foot on the floor" syndrome.

 

[Greys]

The nurse told me fiasp works immediately but I tend to leave 5 mins before eating. This works for lunch and dinner time but breakfast it's a different story. For example my reading was 6, had breakfast, spiked to 15 two hours afterwards, went below 7 three and a half hours later.
Never heard of foot on the floor syndrome!!

 

[Greys]

I keep scanning after I inject on a morning and start eating when I can see the insulin starting to kick in.
It is usually just 20 mins for me later in the day, but morning is particularly long time due I think to the insulin having to overcome "foot on the floor" syndrome.

Foot on floor syndrome. Is this why my readings jump up quickly before I've even had breakfast? Woke up and it was 6.9 haven't had a chance to have breakfast and within an hour it jumped to 12 .5.

 

[rebrascora]

Foot on the floor syndrome is the lazy cousin of Dawn Phenomenon. It doesn't kick in until your feet touch the floor on a morning whereas DP tends to kick in with the dawn, whenever that is.... often before people wake up on a morning although at this time of year, the 2 can coincide. Fiasp never works within 5 mins for me and my Libre will easily prove it. The nurse is just going off what she has been told but we are all different and for me it takes about 45 mins on a morning and 15-20 mins during the rest of the day. My consultant was quite shocked when I told him how long I prebolus but he accepted that that is how long I need... you can't argue with the evidence. I have gone as long as an hour and a half with NovoRapid on a morning before eating and still not hypoed and just kept my spike in range

When you plenty of time, like days off, start experimenting by carefully extending the time between bolus and breakfast until you find the sweet spot. Having the Libre makes it so much easier because you can scan every few minutes and see when it starts to reduce your levels. I am doing that now as I type....Breakfast is in a pot in front of me waiting to be eaten. It was 7.42am and reading was 5.8 and heading upwards due to foot on the floor when I injected and it is now 8.37 and reading is 6.1 and just starting to come down so I will eat my breakfast now.

 

[helli]

@Greys I find the Libre a miracle and a curse. The joy of being able to see what is happening to my blood sugars between finger pricks but then the desire for perfection can be all encompassing. For this reason, I some times take a break. It also gives me confidence I can cope if my technology failed.
Reading your experience, I wonder if you have basal tested to make sure your basal dose is correct. There is no little point tweaking your bolus dose if your background insulin is not correct. With a LIbre, this is easier than the olden days of constant finger pricking.
My other thought is to consider what it is you are eating. (I am not going to suggest you change your diet.) Whilst packets and the internet and Carbs and Cals apps tell us how many carbs are in the food we eat, they do not take into consideration the time it takes for them to be digested. A healthy pancreas will release incredibly fast acting insulin when it gets the message that our blood sugars are starting to rise. Even Fiasp is no where near as fast as proper human-made insulin so we have to predict when that rise will be and match the timing of our bolus dose. For example, we eat very fast acting carbs such as jelly babies when we have a hypo - these can impact our blood sugars within 15 minutes. But something like curry or pizza could take 4 or 5 hours to cause the rise. In other words, the advice to inject bolus 15 minutes before or just before or 45 minutes before is a gross simplification and depends on what it is we are going to eat.
Finally, some advice I was given regarding avoiding lows during exercise was to put something slightly sweet in my water bottle. This gave me a constant flow of carbs rather than the need to load beforehand.

Good luck ... and try not to get too obsessed (even people without diabetes could see numbers below 4 and above 10 sometimes)

 

[rebrascora]

Yes, that is Foot on the floor or health care professionals may refer to it as Dawn Phenomenon.
I inject my basal and bolus insulin as soon as I get up and I add an extra 1.5 to 2 units to cover Foot on the floor but keep my breakfast ratio to the same as my other meals as I don't relate the extra Fiasp for FOTF I need to my food. Those 1.5-2 units are irrespective of what I eat or even if I don't have breakfast. You would have to rethink your ratios if you adopted this approach. Then I prep breakfast so it is all ready to eat as soon as my levels start to drop, have my coffee, get washed and dressed and say hello on the forum here and wait for my levels to change direction and ideally get below 6 before I eat.

 

[rebrascora]

I too feel that it is important to take a break from Libre every now and then as it can become too intense. The first few nights without it are a bit scary but it is good to learn to rely less on it and remind yourself that it is just a tool, not an essential. My consultant was quite happy for me to have a week or a fortnight off from it when I feel like it to reset my mental attitude towards it. I love it and the information it can provide but you can become a slave to it. Like any tool use it wisely.

 

[Greys]

Foot on the floor syndrome is the lazy cousin of Dawn Phenomenon. It doesn't kick in until your feet touch the floor on a morning whereas DP tends to kick in with the dawn, whenever that is.... often before people wake up on a morning although at this time of year, the 2 can coincide. Fiasp never works within 5 mins for me and my Libre will easily prove it. The nurse is just going off what she has been told but we are all different and for me it takes about 45 mins on a morning and 15-20 mins during the rest of the day. My consultant was quite shocked when I told him how long I prebolus but he accepted that that is how long I need... you can't argue with the evidence. I have gone as long as an hour and a half with NovoRapid on a morning before eating and still not hypoed and just kept my spike in range

When you plenty of time, like days off, start experimenting by carefully extending the time between bolus and breakfast until you find the sweet spot. Having the Libre makes it so much easier because you can scan every few minutes and see when it starts to reduce your levels. I am doing that now as I type....Breakfast is in a pot in front of me waiting to be eaten. It was 7.42am and reading was 5.8 and heading upwards due to foot on the floor when I injected and it is now 8.37 and reading is 6.1 and just starting to come down so I will eat my breakfast now.

This is very interesting. I will try this at the weekend. Should I still use my current ratios or air on side of caution?
Thanks so much for your help.

 

[Greys]

This is very interesting. I will try this at the weekend. Should I still use my current ratios or air on side of caution

Thanks so much for your help

@Greys I find the Libre a miracle and a curse. The joy of being able to see what is happening to my blood sugars between finger pricks but then the desire for perfection can be all encompassing. For this reason, I some times take a break. It also gives me confidence I can cope if my technology failed.
Reading your experience, I wonder if you have basal tested to make sure your basal dose is correct. There is no little point tweaking your bolus dose if your background insulin is not correct. With a LIbre, this is easier than the olden days of constant finger pricking.
My other thought is to consider what it is you are eating. (I am not going to suggest you change your diet.) Whilst packets and the internet and Carbs and Cals apps tell us how many carbs are in the food we eat, they do not take into consideration the time it takes for them to be digested. A healthy pancreas will release incredibly fast acting insulin when it gets the message that our blood sugars are starting to rise. Even Fiasp is no where near as fast as proper human-made insulin so we have to predict when that rise will be and match the timing of our bolus dose. For example, we eat very fast acting carbs such as jelly babies when we have a hypo - these can impact our blood sugars within 15 minutes. But something like curry or pizza could take 4 or 5 hours to cause the rise. In other words, the advice to inject bolus 15 minutes before or just before or 45 minutes before is a gross simplification and depends on what it is we are going to eat.
Finally, some advice I was given regarding avoiding lows during exercise was to put something slightly sweet in my water bottle. This gave me a constant flow of carbs rather than the need to load beforehand.

Good luck ... and try not to get too obsessed (even people without diabetes could see numbers below 4 and above 10 sometimes)

Thanks for advice. Think I need to try a carb free day to check my basal dose if correct.

 

[rebrascora]

If you are going to inject insulin specifically to cover FOTF then I would adjust your breakfast ratio to the same as your lunchtime ratio and just add on the extra bit for FOTF. The most important thing is not to get distracted after injecting. Keep scanning every few minutes and have your breakfast ready to eat as soon as levels start going down. As I said, below 6 is ideal for me but you are best watching for levels to stop rising or start decreasing before eating until you get more experienced with the timing and how your body works .

 

[rebrascora]

Always err on the side of caution!

 

[Kaylz]

My consultant was quite happy for me to have a week or a fortnight off from it

See I've often wondered this but never actually queried it as when I attended the education session we had to sign a contract and one of the conditions to keep it on prescription was you must scan a minimum of 6 times a day (although other areas were 4, 8 etc), I never even heard anything after my first six months but when I saw my consultant in January he said he wouldn't take it away from me lol, not that I'd take a break from it as its the only thing that gives me confidence to do out of the ordinary xx

 

[Bruce Stephens]

I too feel that it is important to take a break from Libre every now and then as it can become too intense.

Alternatively (or additionally): take the TIR guidance seriously, and don't worry too much when you're out of range so long as it's not for too much of the time.

 

[rebrascora]

@Kaylz
I agree it is a confidence booster and you do come to rely on it quite heavily and having a break from it is quite scary at first and I usually end up finger pricking 10+ times a day for reassurance, but for me it is important to have a break from it occasionally to reset my whole attitude as I can become a bit too intense with it... I think the word obsessive is a bit too strong but certainly feel I am becoming too reliant.
After self funding for 3 months, I was concerned that being prescribed it on the NHS would mean I was committed to constant use, so I asked my consultant and he was quite happy for me to take a week or 2 off from it whenever I needed it.... I was actually just thinking a few days every couple of months so was quite surprised he suggested such a long break!

 

[Inka]

I don’t have a Libre, partly for the reason you mentioned @Greys and because I do think it can be a ‘curse’ as suggested. We all have to live our lives - controlling the diabetes but not letting it take over and be our life.But I do echo all the above advice to pre-bolus more in advance. I’d also suggest a change of insulin if that definitely doesn’t work. Fiasp simply isn’t right for some people and can lead to worse control.

Did you change your basal amount after a basal test?

It’s concerning you’ve said you’ve never had so many hypos. If it was me, I’d look at my basal again, then look at each mealtime ratio and possibly lower all or some and simply pre-bolus more in advance. If that didn’t work, I’d dump the Fiasp.

 

[rebrascora]

I have to confess I am suffering more night time hypos now than I ever have before and it is since I started using Fiasp but can't be directly linked to it as last night's hypo was 12 hours after my last Fiasp injection (only 2 units anyway) and no night time basal. I do wonder if something in the Fiasp has changed how my body responds to insulin or how my liver works. I have however also increased my exercise since starting on the Fiasp so that will also me impacting things.

 

[Inka]

That’s interesting @rebrascora I’ve refused Fiasp for a number of reasons, and I can’t see me changing my mind ever. I read a lot about it when it first came out. I saw someone having problems so read up on it. I do think the way it acts is....different...and it’s too far removed from insulin for me to trust (all the insulin analogues are technically not insulin, hence the name).