# How good do your Libre graphs look?



## Pigeon (Sep 3, 2016)

LibreWeek1



__ Pigeon
__ Sep 3, 2016


















LibreWeek2



__ Pigeon
__ Sep 3, 2016





PM[/GALLERY]

Hello, just reaching the end of my first 2 week sensor and it's quite depressing viewing! I think I've attached the summary graphs of each week, just wondering how these compare to other T1s- and if yours are better, how do you do it????

I was determined to make the 2nd week better than the 1st, by having low carb breakfasts and injecting 30 mins before lunch to try to reduce the spikes. However, my insulin sensitivity seemed to massively decrease in the second week and so I was increasing breakfast doses and morning correction doses daily... I was waking up high and staying high all day. Finally today I got it about right, a day before the sensor finishes! So the peaks are less in the 2nd week but my problem seems to be the dawn phenomenon between 3am and when I get up at 7am. I can't increase my night time levemir as then I'll have a hypo overnight (I only take 2.5u at night and 9.5u in the morning... was until recently taking 3.5u at night but a basal test showed this caused a drop of 10mmol)). I'm emailing my DSN the graphs with a few more details to ask if she has any suggestions, angling to get a pump as I don't know how else I can improve the morning readings, but I'm worried that as my HbA1C is 52 that's seen as ok so there won't be any need for a pump. I don't know how typical these graphs are, hence the question!

I really would like to iron out the peaks and trough somehow if I can... any suggestions?

Thanks!


----------



## Robin (Sep 3, 2016)

Hello Pigeon, I use a Libre, it certainly shows up what's going on, doesn't it.
One thing that strikes me, and you may want to run this past your DSN, is that your Levemir split is very lop sided. I'm on Lantus, so don't have any experience of it, but my feeling is, you've got it set up as if it only lasts 12 hours, whereas it might be lasting 16-20 hours, it depends on the individual. So you may think you've just got a bit in at night, but the 9.5 you take in the morning  could be acting most of the night. I wonder if levelling out the dose might help? ( You may have gone through all this already and worked out it doesn't). Levemir is supposed to be a Basal, and your daytime needs should mostly be covered by Bolus.
Smooth overnight lines are hard to achieve without a pump. My graph always looks a bit like a washing line. If you're like me, you will need a bit less towards 3am when your body is at its lowest ebb, and a bit more towards dawn when your liver gears up for the day - I've had to balance my basal to try and cover it as best I can, but looking at your chart, it seems to me that you aren't getting enough overnight, if you rise that much during the latter half of the night.
Looking at the rest of your charts, if you started at a lower figure, your levels for the daytime look spot on.


----------



## HOBIE (Sep 3, 2016)

I had mine on when I did Scarfell Pike.  I had perfect bg all day. Had porridge for breaky drove more than an hour & it took 4hrs to get on the top. Not bad for a T1 of more than 50yrs. I have a Medtronic pump & put basal down to 2%. Had a couple of bickies on the way up but nothing of any high carb.  I like the Libre & could not have done that (would have had no fingers left as tested every 10 mins in the rain)


----------



## bilbie (Sep 3, 2016)

I think most would start with making sure the basal is right.
https://mysugr.com/basal-rate-testing/

I was watching Bernstein's monthly Q&A, he would suggest the split be when you go to bed and when you get up, even for the new Tresiba
www.youtube.com/watch?v=kDtjZjPgJSo

Have you seen the FB group, they use a lot of CGM
https://www.facebook.com/Type1Grit/


----------



## SB2015 (Sep 3, 2016)

It took me a while to get te spikes sorted, but like others have said it is difficult to level out the overnight without a pump.  If you are able to wangle one based on these charts then go for it.

I am surprised at your split for Levemir and as Robin has said it may be that some of your morning one is acting over night.  Just keep going and see what you can improve.  Work on one things at a time, and if possible do a fasting test to sort out basal rates first.  Tenter wise the corrections that you do at other times will mask the basal problems.


----------



## Diabeticliberty (Sep 3, 2016)

Changing your insulin regime on the basis of results from a system that you appear to have been using for a very short period of time might not be such a good idea.  A number of us on here use the Libre but most users only seem to use it for general trending ionly. If your spot results are inaccurate then the information offered by your graphical analysis is equally inaccurate or worse still magnified. All Libre users will or should if they are being upfront with you tell you that results can be very accurate which is if course what we all desire.  By the same token they can be a country mile out compared to finger prick blood testing. Adjusting your insulin regime against flakey statistical information is plainly a bit like testing your glucose using a deck of cards and changing your insulin intake of you draw a higher card than the previous one you drew.  If you speak to Abbott, the Libre manufacturers and tell them that you are adjusting your insulin based on results from their glucose tester they will throw a major wobbler. They certainly did when I suggested this to them. Other Libre users on this forum will stick their fingers in their ears if you dare suggest to them that the Libre effect is like 'The Emperors New Clothes' I suspect if you ask them if they adjust insulin based on Libre results then most will say not likely


----------



## Robin (Sep 4, 2016)

Diabeticliberty said:


> Other Libre users on this forum will stick their fingers in their ears if you dare suggest to them that the Libre effect is like 'The Emperors New Clothes' I suspect if you ask them if they adjust insulin based on Libre results then most will say not likely


I'm not sticking my fingers in my ears, DL, but as I've said before, I know some people don't get on with the Libre, but some do, me included. I know its limitations ( For me, but maybe not for others, it tends to read lower at the low end, and higher at the high end, but in the middle it's spot on.). Each individual has got to evaluate it for themselves, using back up finger prick tests, and decide which camp they fall into. I certainly do mor finger tests at the start of a new sensor, to check it's working as it should.
 I have certainly altered my basal from looking at my Libre graph. I could never spot an overnight shift other than by waking up to test several times a night for a week, because my Dawn Phenomonon is so unpredictable, but by the time I've got months worth of Libre graphs, I can tell whether the line has shifted, and I have adjusted basal accordingly, both the amount, and when's the best time of day to take it.


----------



## Diabeticliberty (Sep 4, 2016)

Robin said:


> I'm not sticking my fingers in my ears, DL, but as I've said before, I know some people don't get on with the Libre, but some do, me included. I know its limitations ( For me, but maybe not for others, it tends to read lower at the low end, and higher at the high end, but in the middle it's spot on.). Each individual has got to evaluate it for themselves, using back up finger prick tests, and decide which camp they fall into. I certainly do mor finger tests at the start of a new sensor, to check it's working as it should.
> I have certainly altered my basal from looking at my Libre graph. I could never spot an overnight shift other than by waking up to test several times a night for a week, because my Dawn Phenomonon is so unpredictable, but by the time I've got months worth of Libre graphs, I can tell whether the line has shifted, and I have adjusted basal accordingly, both the amount, and when's the best time of day to take it.




If you remove your fingers  from over your eyes for long  long enough to fully read my reply  I was suggesting that a new Libre user which is what the original poster is might want to establish that their Libre is reading correctly before they go glibly altering insulin doses. With all due respect in your own reply you completely breezed over this suggestion which in offering advice to a nea user might actually be a little dangerous


----------



## Robin (Sep 4, 2016)

Diabeticliberty said:


> If you remove your fingers  from over your eyes for long  long enough to fully read my reply  I was suggesting that a new Libre user which is what the original poster is might want to establish that their Libre is reading correctly before they go glibly altering insulin doses. With all due respect in your own reply you completely breezed over this suggestion which in offering advice to a nea user might actually be a little dangerous


Ouch! 
Addressing the original poster, Pigeon,  I hope I made it clear that I suggested you should discuss all this with your DSN, before making any changes.


----------



## bilbie (Sep 4, 2016)

I would say, only give insulin with the finger check. I think there is a 10-20 minute lag between the sensor and finger, so the fasting and before meals may give the closest sensor and finger reading, to check accuracy


----------



## Diabeticliberty (Sep 4, 2016)

Simebody call a doctor, an undertaker my mother i fear that i must have croacked and am lying rotting on my deathbed. At least I should dramatically reduce my evening dose of insulin. This would maybe stave off this horrible hypo that I am currently not actually having. My blood sugars are really at 5.6mmols using my Accuchek Mobile. Lordy, it really is lucky that I dont trust anything all that much.


----------



## Robin (Sep 4, 2016)

Let's have a bit of common sense here. Nobody should ever alter anything on the basis of one reading. I wouldn't alter anything on the basis of one Libre trace. But I wouldn't give myself a hefty correction dose either, if my meter read 14.2 (for example) until I'd washed my hands and retested, just in case I'd got jam on them. There's something else that always appears in any guidelines which is sensible to take into account:- How do you actually feel? 

This thread started off as a request for suggestions to take into a meeting with a DSN. Nobody's talking about giving dangerous advice to alter stuff willy nilly, it would be quite wrong of us to do that. All we can do is give food for thought based on our own experiences - which we all have done.


----------



## Pigeon (Sep 4, 2016)

Thanks all for your replies. DiabeticLiberty and Robin, I guess I didn't mention that I have continued to do finger prick tests as normal all of this time, I have found that when (rarely!) in normal range the sensor read about 1mmol high, when high the sensor read 2-3mmol high. So I'm not making adjustments based on the sensor alone, as my finger prick tests backed them up, I'm just looking at the general shape and trends. 

I did basal testing a month or so ago, see here: https://forum.diabetes.org.uk/boards/threads/disastrous-basal-tests-any-suggestions.60825/ from which my DSN suggested reducing the night time levemir further, which is how I ended up at 2.5u in the evening. When I first started levemir I did split it 50:50 but have gradually adjusted to try to avoid the night time hypos and hence had to increase the morning amount accordingly... Maybe it would be worth going back and trying this again though, although my DSN was anti the idea. I did a basal test one night with the sensor, the graph of which is here (Tuesday night to Wednesday morning): 













Overnight Basal Test



__ Pigeon
__ Sep 4, 2016






Bilbie, I'm not quite sure what you mean from Dr Bernstein's Q+A (haven't watched it yet!)- do you mean take the basal at bed time and waking even though these aren't 12 hours apart? Will have a look at that Facebook group, thanks!

Hobie, I know what you mean about how helpful it is. The best day was bank holiday monday when i was out walking all day, reduced by lunchtime insulin by 50%, had the odd swig of Ribena as I went and was fairly steady all day. Just need to sort out every other day now!

Is anyone on MDI who doesn't low carb willing to share their graphs?

Thanks,

Pigeon


----------



## Diabeticliberty (Sep 4, 2016)

I will message you some of mine when I get home if you like.


----------



## Robin (Sep 4, 2016)

Pigeon said:


> Is anyone on MDI who doesn't low carb willing to share their graphs?


I don't know if this will be any good. I normally low(ish 50-100 per day) carb, because I find it irons out spikes. The top chart is one for a normal week when I'm at home. But the lower chart is while I was on holiday; we were in a carb-fest hotel in the Italian Dolomites, which combined Italian pasta with apple strudel for evening meals! The packed lunch was a white roll and an apple, the least worst breakfast choice was fruit salad, yogurt and a croissant, which I attempted to slow down with a boiled egg.(We were doing plenty of walking in between.) Oh, and I threw in the odd cake at teatime. 
So you can see from the 'before' and 'after' charts that I spiked loads more on hol, ( the highs resemble the Dolomites!) and went low more often, and I wasnt as close to the median line (which is why I normally curtail the carbs.) You can also see what I mean by my 'washing line' overnight. I fall, then rise again, and have had to juggle my basal to get the best overall result. (A pump might solve it for me, but I'm never going to qualify.)


----------



## Pigeon (Sep 4, 2016)

That's really helpful, thanks Robin. I'd be happy if my graph looked like your 2nd week, let alone the first! And yes please to DiabeticLiberty as well.


----------



## Robin (Sep 4, 2016)

Pigeon said:


> That's really helpful, thanks Robin. I'd be happy if my graph looked like your 2nd week, let alone the first! And yes please to DiabeticLiberty as well.


It will, it will, I've been using the Libre on and off for about a year now, so had much more time to spot the patterns and get it sorted, and it's a lot better than when I started. (That's not to say it still doesn't go pear shaped regularly, but it's quicker to get it back on track)


----------



## Diabeticliberty (Sep 5, 2016)

Hello Pigeon, I have messaged you 6 reports at random from my Libre. I hope that they prove of more benefit to you than they do to me. If you would like any more from it please just shout me


----------



## Pigeon (Sep 5, 2016)

Bilbie, thanks for bringing the levemir timing to my attention. Tried taking 2.5u last night at bed. Woke to 5.6, best value in months! Going to try again tonight to see if it was a fluke!


----------



## bilbie (Sep 5, 2016)

You're welcome, I found the video interesting, too. It may not be all the answer, do you do the miss a meal basal testing?
https://mysugr.com/basal-rate-testing/


----------

