Still struggling to get things smoothed out..any tips?

[Sara Grice]

My levels are basicly a roller coaster at the moment and I wish i knew what to do about it

I have increased my insulin to 8 for every meal like my diabeties team recommended, and while it does bring me down back to the level I was before I ate under 2 hours, I'm kinda struggling what to do in-between meals, as by the 3rd hour after I eat I am still dropping pretty readily with still 1 hour of insulin effect left in me,

I just wish with amm my life that would start to level out but it just seams like it doaent.
I try to add "healthy fiber and protein" to every meal aswell.

For breakfast at 9.30 I had wholemeal toast (just 1 slice) with butter (only a bit) philadelphia and smoke salmon, and a drink of milk for after

When it got around 1 o,clock I was around like 7.8 mmol/ml range so I decided to have a normal sozed glass of milk, now stupidly I got a bit worried when things didn't stabilise in like 7ish mins (it kept going down) I had a bit more milk, but pretty soon after i did that it started going up, so next thing i know Im up at 11mmol/ml by 1.30 and I thought we'll.. normaly I wouldn't eat lunch untill 2 but since I'm going high again and and need insulin I'll just eat now.

For lunch I had wholemeal toast with avacardo and philadelphia (oh and butter) and again a drink of milk for after (so I can take my metformin..plus I like milk so)

I didn't go as high, and again came back down about hour and a half to hours after eating... (3.30)

But I am not having tea till 6...
I'm gonna have a handful of cashew nuts to see if that helps keep me a bit level..

I just wish there was a Insulin type that only lasted like 3 hours or so then it's done...

It feels like to much insulin but I was going up high every time I ate and my keytones where creeping up so I agree I needed a increase it's just makes it seam that harder to manage (aka the roller coaster-Ness of it)

Am I doing something wrong I can't figure it out? Not looking for medical advice maybe just some tips from people who are on a high amount of insulin. Do my numbers look good to you?
..... I will definitely be sending a update to my diabties team on Monday asking how I can get better controll over it.


Important edit:

Ok....I've got a confession to make...I know it's stupid and I know I shouldn't have lied. But I got myself into this habit due to my own stupid fear from this once instance where I ate my food and had finished then not long after that I got an alarm on libre saying I was at 4.5. I didn't handle that the best but the point it that scared me sinse after that..well

Honesty is the best policy

My confession is when i said i wait 15-20 mins after injecting to eat, like they recommend...i lied

I mean I at least do with the food...but after i inject the frsit thing I do is glug a few swigs of milk... like right after. Then I wait the time to pass until i eat. I've been doing this awhile and it didnt really seam to change much? So I dunno..told myself alot to justify it....even if deep down I knew it was the wrong thing to do. I

I told myself hat it was just liquid and they told me wait with food so it was fine, and that time I asked for help eating out in a restaurant my team told me "it's fine in restaurants sinse i dont want my food to be cold to inject just before you eat the insulin should still work*" And most of all..i told myself i was just me keeping myself safe

And then they kept upping my insulin so I got scared to stop...because as someone pointed out, 20-25g of carbs for my breakfast and lunch and only 14 (one potato waffle, one and a half chicken thighs and roasted peppers is my go to meal, 14g only being in the waffle)

This could be one of the biggest causes of my issues with going high right now, I'll come clean to my team and I don't think they will be happy with me, but I do need to let them know


* I suspect this was just a one time thing since it was my Xmas meal with work and then baiscly told me to enjoy this one day..

 

[rebrascora]

It seems like you are getting confused with Type 2 management by looking at your levels 2 hours after meals and expecting them to be back down to premeal level. With Type 1 you are looking for your levels to be down to your premeal level by the next meal. 2 hours post meal is not really relevant because there is still active insulin working for another couple of hours. 8 units of insulin per meal is quite a lot if you are only having one or even two slices of bread, so I suspect your meal doses are possibly too high especially if you are down below premeal level 2 hours after a meal and as a result you are having to use the milk to stop the remaining insulin dropping you lower than you are comfortable with.

Are you starting to carb count yet, even if you are not actually adjusting your doses? Measuring the milk and working out the carbs in them and in your toast and keeping a record in your Libre log will all really help to adjust your doses better and is something you need to learn anyway. The milk will probably have about 5g carbs per 100mls and a glass could be 300-400mls so 15-20g carbs, so that will of course take you higher.

That graph would actually be pretty normal if it was transposed down about 3mmols. BG levels go up and down throughout the day, so if you are hoping for a straight line or anything near it, your expectations are too high.

You are also expecting too much if you hope to see Libre showing your levels coming back up just 7 mins after drinking the milk. It will take about 30-40mins if your levels were dropping before you drank it, for Libre to show that they are coming back up again as changes of direction take longer to register, even though your actual BG levels will already have started to come up after 10-15 mins, so you must stop looking at your Libre and panicking when it doesn't show a change happening straight away. 7.8 is a good number and a long way from a hypo, even if the arrow was sloping downwards you still have lots of time and the remaining bolus insulin will be gradually running out as that time passes, so the rate it is dropping will be getting slower.

 

[Sara Grice]

It seems like you are getting confused with Type 2 management by looking at your levels 2 hours after meals and expecting them to be back down to premeal level. With Type 1 you are looking for your levels to be down to your premeal level by the next meal. 2 hours post meal is not really relevant because there is still active insulin working for another couple of hours. 8 units of insulin per meal is quite a lot if you are only having one or even two slices of bread, so I suspect your meal doses are possibly too high especially if you are down below premeal level 2 hours after a meal and as a result you are having to use the milk to stop the remaining insulin dropping you lower than you are comfortable with.

Are you starting to carb count yet, even if you are not actually adjusting your doses? Measuring the milk and working out the carbs in them and in your toast and keeping a record in your Libre log will all really help to adjust your doses better and is something you need to learn anyway. The milk will probably have about 5g carbs per 100mls and a glass could be 300-400mls so 15-20g carbs, so that will of course take you higher.

That graph would actually be pretty normal if it was transposed down about 3mmols. BG levels go up and down throughout the day, so if you are hoping for a straight line or anything near it, your expectations are too high.

You are also expecting too much if you hope to see Libre showing your levels coming back up just 7 mins after drinking the milk. It will take about 30-40mins if your levels were dropping before you drank it, for Libre to show that they are coming back up again as changes of direction take longer to register, even though your actual BG levels will already have started to come up after 10-15 mins, so you must stop looking at your Libre and panicking when it doesn't show a change happening straight away. 7.8 is a good number and a long way from a hypo, even if the arrow was sloping downwards you still have lots of time and the remaining bolus insulin will be gradually running out as that time passes, so the rate it is dropping will be getting slower.

Hmm that makes sense, I do feel like it's alot..but I'm also going up to 15 on just my one slice of bread with stuff on it. So I see why my team said to up it..especially considering I noticed my keyetones going it

The whole 2 hours for the level to be back to premeal from my diabeties team themselves (and I don't think they are confusing it with type 2) No I'm not carb counting yet they won't let me, think it will stress me out to much, I did try an adjustment ( going from 6 to only 5 for my evening meals) and that seams to be what caused the biggest spike in my keytones (normaly 0.1 but was 0.4 that day) so....it kinda said to me you need more Insulin not less


You say having a relatively flat line is unrealistic but I used to get quite close to that, only spiking up to 12 when Eating then back down. Then sort of settling down between meals...wish I could get back to that..but maybe it's the honeymoon phase running out? I was only diagnosed in October last year

I don't know what to tell my team...I complained to them that my levels where going high while eating foods that didn't before and that I had noticed a slight increase in my keytones. They replied to my email saying they looked at my levels and suggested I go from 6 to 8 units for my fast acting premeal insulin... but now it feels like It's to much... have to micromanage it between meals or it will go lower than ide want..but I don't want to be staying high to long either as that can cause issues to

I don't like having to keep snacking and stuff...for one it makes me less lightly to be hungry for my main meals..and for second...what if I just want to chill..have a nap in the middle of the day..I can't.

 

[helli]

Sorry you are struggling.
If you are going high, I suspect your problem is not too little insulin but insulin too late.
The challenge is to match the peak of insulin activity with the peak of carb digestion. If you are going too high and then too low, the insulin peak is coming later than the carb peak and you need to pre-bolus earlier.
You may turn find you need less insulin.
The other thing that may help is a half unit pen so you could try 5.5 units instead of 6.

 

[rebrascora]

You are not taking into account that your pre breakfast reading was about 12 so you only rose by 3mmols up to 15mmols which is not a big rise, it is just the fact that you were starting at 12 which makes it look bad. If you were waking up on 5mmols and then going up to 15 that would be very different, but you aren't and you are not comfortable by the sounds of it at the moment being lower than 8, so rising up to 15 isn't a problem at the moment until you get more confident with your baseline being lower.

Your prelunch reading was 11 (after the milk), so again going up to 13 or 14 after lunch is not a problem. Once you get your baseline down to 6 you will probably not go much above 10 after meals. It is the fact that your premeal levels are high which is making it look worse than it is.

 

[Inka]

So your blood sugar was high before your breakfast @Sara Grice ? How many carbs were in your bread and milk?

Are you sure your basal insulin is at the right dose? If it is, then bolusing slightly earlier for breakfast should help. I know you don’t want to just fingerprick, but try to avoid looking at your Libre too much. If you’ve got your alarms set, they’ll alert you. It’s not unusual to drop a bit low before your next meal if you’re still in the honeymoon period, as your own insulin can kick in late and cause a drop. The way to deal with this is to have a small carby snack when needed.

 

[Sara Grice]

Sorry you are struggling.
If you are going high, I suspect your problem is not too little insulin but insulin too late.
The challenge is to match the peak of insulin activity with the peak of carb digestion. If you are going too high and then too low, the insulin peak is coming later than the carb peak and you need to pre-bolus earlier.
You may turn find you need less insulin.
The other thing that may help is a half unit pen so you could try 5.5 units instead of 6.

This could be right, but I genraly wait 10-15 minutes. With the nova rapid peak being around the 2-3 hour mark...are you saying I should inject and and wait a couple of hours? That dosent seam right.

 

[SB2015]

Hi @Sara Grice

As @rebrascora said your fixed doses for meals seem a bit high and this is reflected in your being back to the starting BG just two hours after the meal with your remaining insulin still active. If you are on Novorapid that will remain active for between 3-4 hours. As you were on 6 units and then went up to 8 could you try 7 units instead.

I do wonder since the difficulties you are having in getting a stable level is causing stress to you I think it is worth talking to your team about carb counting. Even if you are in the honeymoon period this, along with teaching you how to do corrections will enable you to make your own adjustments and possibly flatten things out a bit. For a breakfast of 1 slice of toast with jam I would be using around 3 units of insulin as that would be about 30g of carbs. 8 units would be sending me into hypo land.

If you are on fixed doses of bolus for meals you would probably need to be eating a fixed amount of carbs to match this at each meal. Otherwise you will get peaks and troughs happening depending on the meal. Well worth talking to your team about carb counting. I suspect the flexibility this could give you may reduce the stress, but your team know you. You could certainly start to get a feel for the amount of carbs you are eating at each meal as you will need to do this eventually. Perhaps a record of this alongside the Libre data could be useful to discuss with your team, and you could see how the peaks and troughs match higher or lower carb meals.

I worked very hard to when I first got my Libre, to get absolutely perfect levels in spite of lots on here telling me it was impossible. At the time I just thought that they didn’t care about their diabetes like I did mine, and I carried on trying to do the impossible. I eventually realised that they were right, and now accept the overall advice of being in range for over 70% is very good.

If you are getting a dip that you want to halt (which for me would be around 5/rather than in the 7s) it might be better to use a measured amount of very quick acting carbs such as dextro tabs of jelly babies. I use one, tow or three JBs depending on what my levels are and what the rate of descent is. At 7.6 I would not be wanting to raise my levels but hoping the insulin that I have on board would be bringing that down further to between 5 and 6.

It is a lot to take in and get your head round at the start and it takes time to find what works for you.
Keep asking questions and keep talking to your team.

 

[Inka]

This could be right, but I genraly wait 10-15 minutes. With the nova rapid peak being around the 2-3 hour mark...are you saying I should inject and and wait a couple of hours? That dosent seam right.

Many people find they need to wait longer to eat at breakfast time because it’s usually when we’re most insulin resistant. I wait 30 or 40 mins before breakfast, only 10 before lunch and usually I don’t wait at all before my evening meal. You need to find the right times for you.

 

[SB2015]

This could be right, but I genraly wait 10-15 minutes. With the nova rapid peak being around the 2-3 hour mark...are you saying I should inject and and wait a couple of hours? That dosent seam right.

Hi Sara
No definietly not. A good starting point is to wait 15 minutes after injecting before eating, and if you still get a spike you could increase that gap, although your spike could be because of the fixed doses rather than timing of the bolus.
The 2-3 hour action time for Novorapid tells you have long it will be doing its stuff once it has started work. The delay in eating is to create some time for the Novorapid to get from the subcutaneous injection into your blood stream to ‘meet’ the glucose from your food.

 

[Sara Grice]

So your blood sugar was high before your breakfast @Sara Grice ? How many carbs were in your bread and milk?

Are you sure your basal insulin is at the right dose? If it is, then bolusing slightly earlier for breakfast should help. I know you don’t want to just fingerprick, but try to avoid looking at your Libre too much. If you’ve got your alarms set, they’ll alert you. It’s not unusual to drop a bit low before your next meal if you’re still in the honeymoon period, as your own insulin can kick in late and cause a drop. The way to deal with this is to have a small carby snack when needed.

My bread has 9.5g of carbs I would say I drink about 200- 250 ml of milk, I don't look at my cream cheese or butter (its actuly marge not butter) because I spread it thinly..so it can't be that much?

My team has said my basal is fine, at night I'm rather steady around 8 or 7 at the lowest then I tend to go up around a few points to 10
5 ish when I wake up, they told me thats normal it's your body getting you ready for the day. They said they didn't want to change that, just my meal time insulin.

I am definitely feeling fatigue and frequent urination though...which is not a good sign

 

[Sara Grice]

Many people find they need to wait longer to eat at breakfast time because it’s usually when we’re most insulin resistant. I wait 30 or 40 mins before breakfast, only 10 before lunch and usually I don’t wait at all before my evening meal. You need to find the right times for you.

Huh didn't know that that is something that can chnage depending on the time of day. Interesting

 

[Inka]

My bread has 9.5g of carbs I would say I drink about 200- 250 ml of milk, I don't look at my cream cheese or butter (its actuly marge not butter) because I spread it thinly..so it can't be that much?

My team has said my basal is fine, at night I'm rather steady around 8 or 7 at the lowest then I tend to go up around a few points to 10
5 ish when I wake up, they told me thats normal it's your body getting you ready for the day. They said they didn't want to change that, just my meal time insulin.

I am definitely feeling fatigue and frequent urination though...which is not a good sign

So not many carbs for breakfast then - very roughly 20-25g carbs. I know this might be a pain, but I find if I have a late breakfast, my blood sugar can go higher than normal. It’s possible that’s contributing. You could experiment by eating breakfast earlier. Also, the carbs in milk are probably being absorbed quite fast so they could be causing the quick rise. If you choose a bread with seeds and fibre, that might help offset the quick rise. What bread are you having?

 

[rebrascora]

I used to have to wait over an hour on a morning between injecting NovoRapid and eating, about 30 mins at lunchtime and 20 mins in the evening, but that is just me and would be far too long for some people, so you do have to carefully increase the time from where you are now at 10-15 mins by a few mins each day until you find the point that the insulin and glucose hit the blood stream about the same time.
I now use a slightly faster insulin and need 30-45mins before breakfast and 10-20 mins at other times of the day and if my levels are in the 4s then I can sometimes inject and eat straight away. It varies with time of day and what my levels are like and what I am going to eat. If it is something slow release like pizza or a creamy pasta dish then I might inject half of it right before I eat and the other half an hour later.

 

[Sara Grice]

My bread has 9.5g of carbs I would say I drink about 200- 250 ml of milk, I don't look at my cream cheese or butter (its actuly marge not butter) because I spread it thinly..so it can't be that much?

My team has said my basal is fine, at night I'm rather steady around 8 or 7 at the lowest then I tend to go up around a few points to 10
5 ish when I wake up, they told me thats normal it's your body getting you ready for the day. They said they didn't want to change that, just my meal time insulin.

I am definitely feeling fatigue and frequent urination though...which is not a good sign

Forgot to mention it was high this morning because I was putting on a new sensor, that always beings me a bit of stress .

 

[Tom1982]

Hello Sara. There are far smarter people on here for advice so I’ll not embarrass myself by trying to make suggestions on how to manage your diabetes……. BUT, I’ve seen a couple of posts you’ve made and it’s not easy to read because I can see a lot of myself (former self) in what you’re writing. When my daughter was first diagnosed I’d watch every dexcom movement, if she was high I’d panic/sulk for as long as it took to get back in range, I’d spend literally every waking moment thinking about what we where doing wrong or sometimes right. I’d even see a diagonally down dexcom arrow and I’d panic! I was properly hulking out!!! I’m not saying you’re doing any of that of course, but I do think you might need to calm down a bit. Definitely good to get answers on here but don’t be so hard on yourself when it’s not going 100% to plan. You’ll definitely get there, it just takes time.

 

[Sara Grice]

I'm having a hard time....I realy am, I need support and help but it's not gonna be available until Monday...

Currently fighting off a panic attack..

On top of everything
.my sensor had decides to just suddenly become super inaccurate after working fine a day....it just is refusing to come down, my actual levels have gone down to 10.1. But it's been stuck near 13 for hours.... why today

That flat line at 13? Yeah that's not accurate

I keep telling myself to relax but it's all to much right now

 

[Leadinglights]

I'm having a hard time....I realy am, I need support and help but it's not gonna be available until Monday...

Currently fighting off a panic attack..

On top of everything
.my sensor had decides to just suddenly become super inaccurate after working fine a day....it just is refusing to come down, my actual levels have gone down to 10.1. But it's been stuck near 13 for hours.... why today

That flat line at 13? Yeah that's not accurate

I keep telling myself to relax but it's all to much right now

I wonder if you are putting too much reliance in your Libre without confirming readings with finger pricks when either high or low.
This thread summarises the Limitations of the Libre which may help you if you haven't already seen it.

H

Thread 'CGM limitations and precautions'

Sep 8, 2023

Moderator Note: This helpful reply was copied from another thread as it details some of the commonly experienced limitations of continuous glucose sensors.

My blood sugar has been in perfect range for days now, but although I haven't changed anything, I'm starting to get very short periods of hypos while I sleep and this morning I had a hypo alarm.

If these are very short periods of lows and occur overnight, they are more likely to be compression lows - when pressure is applied to a sensor, it will report a false low. The reason I say this is more likely to happen at...

• helli
• Replies: 23
• Forum: Pumping and Technology

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[Inka]

Just ignore the Libre and fingerprick @Sara Grice This is perfectly safe and will be more accurate. Remember, people only fingerpricked for decades.

I know you said you’re waiting for a therapy appointment. Do you have someone you can phone in that department to speak to? If not, could you phone your GP on Monday. This sounds more like an anxiety thing than the diabetes. Even ‘just’ the GP should be able to help you.

 

[mashedupmatt]

You do need to be careful in relying on Libre - I've done quite a bit of exercise this afternoon, and although accurately (ish) carb counting for my dinner the Libre says I am at 3.9 but have just finger-pricked and am at 6.1 (I feel no hypo symptoms at all) - you need to confirm with this method - and I would recommend calling the help line who can give you more tailored assistance on Monday or alternatively I can arrange for them to call you? The number is at the top of the page but it is 0345 123 2399