# Low carb breakfast (well low for me)



## Deleted member 33898 (Apr 21, 2022)

So I've been trialling a lower carb breakfast. I've been looking for something to get close to the same amount of calories but less carbs. Normally I'd have rolled oats , milk , peanut butter and a piece of fruit for a total 60g of carbs. Came across chia pudding. I've been using no sugar soya milk, chia seeds, half a scoop of chocolate protein powder, peanut butter, peacan halves and then a some fruit. The fruit makes up the majority of the carbs. In total it's 30g of carb, 28g protein and 28g of fat. The protein and fat I'd normally have would be just under 20g each with the higher carb breakfast.

What I've found is I'm not getting any immediate peak instead I'll rise 2 hours later above my pre meal level. I'm taking 2 units upfront (insulin to carb ratio is 1 to 15), 15 mins before. I've read strategies in dealing with this ( protein and fat) but most involve a pump or regular bolus instead of rapid insulin (rapid bolus MDI is what I'm on) I just figured I'd try start the day with stable levels instead of spiking all the time. The higher carb breakfast normally spikes quickly and falls rapidly which never feels great but at least I level out until my next meal.

Anyone else like to share their experience with  lower carb eating, particularly breakfast ?

Thanks


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## rebrascora (Apr 21, 2022)

phil90 said:


> I've read strategies in dealing with this ( protein and fat) but most involve a pump or regular bolus instead of rapid insulin (rapid bolus MDI is what I'm on)


Hi. Not quite sure what you mean by regular bolus instead of rapid insulin. Do you mean something like Fiasp or Apidra or Lyumjev as oppose to NovoRapid?
I use Fiasp and for me a low carb breakfast would be full fat natural Greek style yoghurt with a few berries and seeds and a sprinkle of low carb granola. I always bolus for breakfast before I get out of bed and I usually need to add 1.5-2 units to cover (Foot on the Floor syndrome), so if I am not having breakfast or I'm having a very low carb breakfast like an omelette, I still need that 1.5-3 units up front.
For the yoghurt breakfast I usually need 30-45 mins prebolus time before I eat breakfast with Fiasp unless my levels are very low (ie low 4s when I wake up) and then it might just be 20 mins....it was 75 mins with NovoRapid. Otherwise I spike even with that low carb breakfast.
If I get the timing just right I don't get any rise at all. I tend to watch my Libre and eat when my levels get into the 5s and I can see the Fiasp is working... ie levels are starting to drop.
If I have a very low carb breakfast like an omelette with salad and coleslaw, I still inject the 1.5-2 units I need for FOTF before I get out of bed and then I have the omelette as soon as it is ready but I usually need a couple of units for the protein release about 2 hours later.... I watch out for it on my Libre and inject when I see it starting to drift upwards. The protein release is much slower than carb release so the insulin doesn't need a head start to keep pace with it like it does with carbs and you see an upward drift and decline rather than a spike..... graph looks more like gentle rolling hills rather than a mountain range. 
That is how I handle it but I work on a 1:10 ratio and I know how much I need to correct protein and FOTF which may be different to yourself and also how long I need to prebolus for my body with Fiasp. Libre helps enormously with timings for prebolus and protein release.


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## Deleted member 33898 (Apr 21, 2022)

I take Novorapid, It's just something I read. Don't know the exact names of these slightly longer lasting insulins to take with meals. I have noticed the foot on the floor more since the start of the year, usually a jump of a few mmol. Normally letting the insulin work for bit longer brings it down before the meal kicks in, and I've only ever had to add a bit of extra insulin the odd time. This morning I had a small spike but didn't come down and then started to rise again so I took another shot of insulin, that's 3 units for 30g of carbs. Does seem strange that 4 units for 60g of carbs that I usually have will bring me back down and as I say the protein and fat content is lower but not significantly lower compared to the 30g meal. Just the main difference is how high ill spike on high carb meal compared to low carb meal. 

I appreciate all the info on how you deal with low carb breakfast and I guess I could try a few things you have suggested. Just wonder is it even worth having to inject myself more than id like, I find the space I have limited already for injecting 3 times a day for meals. Though I could just do low carb for breakfast.  My average is already being pushed up because I'm sitting up in the 7s morning through to lunch with this low carb breakfast. I thought maybe my basal was wrong but seems okay. I guess I could try 2 units upfront and 1 unit an hour later. I thought i'd trial lower carb with one meal for a while to see how I get on, breakfast seemed to make the most sense to experiment with. Just looking for an easier life really


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## rebrascora (Apr 21, 2022)

I wonder if you are thinking of mixed insulins which are a combination of fast acting and slow release insulins in a particular ratio and mean you need to eat fixed amounts of carbs at set times of the day to keep your levels reasonably balanced. Those are not generally used by Type 1 diabetics so I would ignore anything you have read about those as it is not applicable in your situation.   

The best you can do is trial different strategies and see what works for you and fits in with your lifestyle. If you have Freestyle Libre sensors it makes it so much easier. Personally I don't find extra injections any problem at all. I am happy to inject where, when and whatever I happen to be doing.... With the exception of driving (obviously) or sitting on a horse probably and I doubt I could do it riding a bike or whilst sky diving   but then probably wouldn't need to anyway. It only takes a second to whip out my pen and jab a unit or two when I need them, but then I have followed a low carb way of eating for about 3 years so I am into a routine of it.


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## Deleted member 33898 (Apr 21, 2022)

I tend to only use additional injections for corrections or takeaways. Try to eat meals I know don't need a split dose as I find it difficult to get it right. I've noticed since changing my breakfast I've been getting spikes up to 13 or 14 for lunch and dinner again, don't know if that's linked. Its tough to know what to do going forward. I've always preferred carby food and feel like I've already changed so much of my diet since diagnosis(limiting portions, no sweets or chocolate etc (well the odd square or two)). Even started to eat less pasta and rice, surprisingly potato works better with me than other heavy carbs. 

I take it the only real benefit of fiasp is that it works quicker so you can bolus sooner to eating? It's not some miracle insulin to curb spikes? So instead of bolusing 20 mins before a meal I'd bolus 5 mins before and end up with the same spike is what i mean. Consultant mentioned to me going on fiasp to help spikes but I don't see how it would help, just convenience from being able to eat sooner. 

Routine would be nice.


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## rebrascora (Apr 21, 2022)

I found changing from NovoRapid to Fiasp really frustrating and it took me 2x 3 month trials before I got it to work for me but even then it isn't much quicker..... 45 mins prebolus as oppose to 75mins at breakfast which was the main factor in changing but still need 20 mins at other times of the day and if my levels get above 10 and I need a correction, it is like I injected water unless I do exercise as well, so I usually need to correct at 8 rather than 10. It also acts faster at low levels so if I am in the 4s it will kick in quickly but if I am 8-10 it takes ages. It isn't ideal for me but I am not ready to try anything else and risk another 3 months of frustration trying to figure out a different insulin for likely not much gain. I usually average 90% Time in range on Libre with Fiasp, so I have found a way of making it work well for me but I do have to be quite proactive and I need more of it than I did NR. It certainly wasn't a straight swap. 

In your situation I would cautiously extend your prebolus time for breakfast by a few minutes each day. My situation is unusual at 45mins but many people need 30 mins at breakfast before they eat and the sooner they get it into themselves, ideally before getting out of bed, the better it works.


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## nonethewiser (Apr 21, 2022)

Have same issue with low carb meals, need to bolus 2x for one meal, guess its body breaking down fat & protein in meal slowly.

Tried low carb diet once & was same for all meals as replaced carbs for higher % of fat & protein, was on injections then & needed to inject up to 3x each meal depending on what was on plate, not so much issue now as pump could handle that.


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## Deleted member 33898 (Apr 21, 2022)

@rebrascora 
Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment. 

Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there. 

Regarding pre bolus, I've found myself jumping between 15 and 30 mins depending on a few things like pre meal level. But its never that simple. A meal I've been used to having all of sudden is causing me to spike to 13 instead of 7. I extended the pre bolus as far as it can go without sending me into hypo territory and then it flies up. Cant understand it. 

@nonethewiser 

are you still following a low carb diet?


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## nonethewiser (Apr 21, 2022)

phil90 said:


> @rebrascora
> Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment.
> 
> Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.
> ...



I don't follow low carb diet now, it was only brief experiment about 14 years ago, did it for 3 months or thereabouts.

Still have occasional meal that's low in carbs, say like omelette with side salad & slice of sourdough bread.


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## rebrascora (Apr 21, 2022)

phil90 said:


> Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.


I think it is only careless if it is causing you to hypo regularly. I break all the "rules" with my diabetes management  , but I get good results so they can't criticize me and I shouldn't be answerable in that regard to the clinic staff unless I am doing something detrimental, which would show on my Libre.  
I regularly stack corrections, sometimes with as little as an hour between them if my Libre shows my levels are continuing to rise, despite the previous correction. My low carb way of eating lends itself to managing my levels by responding to my Libre rather than trying to carb count and protein count.  
I scan an average of 30 times a day, so I have a very good feel for how my body is responding and when I need more insulin. The "rules" or guidance about such things were made pre Libre so you only knew what your levels were doing maybe 5-8 times a day when you finger pricked and it was to keep you safe. With Libre you can check whenever you need or want to and of course Libre 2 has alarms so again it is mitigating some of the risk. 

I am not advocating that people should do as I do and stack corrections because on a normal diet that might be more risky. Protein and fat have quite a damping effect on BG levels because they release so slowly so they don't peak and drop so dramatically. What I think is important is that people are not restricted by "rules" and should be encouraged to experiment to see what works for them (with one eye firmly on keeping safe of course) rather than being worried about what their DSN will say if they find out they have "pushed the boundaries" or "broken the rules". We are all different and we should become the experts in our own diabetes and the nurses and consultants should be there to support us with that, not dictate to us.


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## Deleted member 33898 (Apr 22, 2022)

@rebrascora sounds almost like sugar surfing. I put off reading about it until recently. It suggested by my consultant the last time I was at the clinic. Using the libre is essential to that style of diabetes management. I thought I was scanning too much until I read about sugar surfing. I do think my current diet is closer to a normal diet although I pack bit more protein and fat into each meal to get the calories up instead of having too many carbs, still not gained weight back lost though. I got into a habit of making sure every meal had protein and fat in a certain range otherwise I'd expect huge spikes after. I convinced myself this was a winning formula. But now my average is up to levels not seen since just after diagnosis so I suspect maybe my honey moon period is ending, perhaps it was not only helping with the spikes but clearing up the slow rise from protein after meals. Only good thing is I haven't had a hypo for 4 days which is a record for me ! =/

I felt at the start the diabetic team were strict with what I could and couldn't do. But after a while they told me to keep doing what I am doing. Maybe that will change but you are right in saying that we should become the experts. Just wish I could skip forward to becoming qualified.


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## rebrascora (Apr 22, 2022)

Not heard of the term "sugar surfing".... Off to investigate that.... although I don't like the use of the word sugar in regards to diabetes as it is too misleading/blinkered in my opinion. 

Congrats on going 4 days without a hypo! I have never thought to keep an eye on that sort of stat. I average almost one a day according to Libre but it exaggerates   and the ones I have are generally very mild and only involve one or 2 JBs at most and I can usually carry on with what I am doing, so they are more of an inconvenience (and a red blot on my stats ) than anything worse. I try to keep my TIR hypo % to less than 4. I got it down to 1% once but it was hard work and not something I could maintain.
I bounced my attitude to hypos and the frequency of them off my consultant at my last appointment and he is fine with it at the moment. I think it is important to seek external input to assess whether you may be becoming complacent so I find it useful to discuss things like that with him. Personally I think having slightly more regular hypos can boost your confidence in dealing with them and make you less afraid of them.... as the fear can be far more debilitating that a hypo in my opinion.... but I know it is a fine line to walk and losing hypo awareness is a potential risk.

Anyway, off to do some research...


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## rebrascora (Apr 22, 2022)

Thanks so much for that suggestion..... 

Yes, "sugar surfing" is exactly what I do. It was really interesting to see it broken down and explained in such detail, as I was just doing it instinctively, but the thought processes I use and the things that I consider when I take action are exactly as he describes. It's good to know that this is a recognized strategy for managing Type 1 and that it works with a regular diet as well as low carb, although it was my low carbing which led me to develop it because the protein release is just too complex to try to calculate it. I think my change to Fiasp was also a catalyst in me altering my management to this strategy.


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## rayray119 (Apr 22, 2022)

phil90 said:


> @rebrascora
> Oh wow, I couldn't put up with another change like that. Its enough work changing doses and times with novarapid at the moment.
> 
> Yes I have noticed corrections don't work as well the higher up I am, as you say some exercise helps. I find I'll go for a walk first to bring levels down a bit and get the correction working better. That TIR is fantastic. Regarding corrections, do you make them between meals? I was told at the start not to do that but have found myself correcting if its been at least 3 hours since my last dose, just hope I'm not being careless there.
> ...


I'm now wording about the 4 hour rule myself I'm planing to speak to my team next time and i say thiers are points where i know i'm not going be down to normal in next 4 hours and speak to them about correcting before the 4 hours are up).   they always told me to be mindfull about correcting before bed but i do if I'm above ten because i know on day when i haven't been a work if i'm high at bed and don't do a correction i'm gernally not going to come back down(i've learnt this)


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## Benny G (Apr 22, 2022)

A few years ago I asked my diabetes consultant if I could try 'regular' insulin (as recommended by Dr Bernstein) to help investigate the full potential of the *high protein,* very low carb way of eating.
Long story short, consultant said 'No regular.'
The workaround using humalog, of course, is to stack.

Once you have learned the rules, you can break them as required.


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## Deleted member 33898 (Apr 25, 2022)

rebrascora said:


> Not heard of the term "sugar surfing".... Off to investigate that.... although I don't like the use of the word sugar in regards to diabetes as it is too misleading/blinkered in my opinion.
> 
> Congrats on going 4 days without a hypo! I have never thought to keep an eye on that sort of stat. I average almost one a day according to Libre but it exaggerates   and the ones I have are generally very mild and only involve one or 2 JBs at most and I can usually carry on with what I am doing, so they are more of an inconvenience (and a red blot on my stats ) than anything worse. I try to keep my TIR hypo % to less than 4. I got it down to 1% once but it was hard work and not something I could maintain.
> I bounced my attitude to hypos and the frequency of them off my consultant at my last appointment and he is fine with it at the moment. I think it is important to seek external input to assess whether you may be becoming complacent so I find it useful to discuss things like that with him. Personally I think having slightly more regular hypos can boost your confidence in dealing with them and make you less afraid of them.... as the fear can be far more debilitating that a hypo in my opinion.... but I know it is a fine line to walk and losing hypo awareness is a potential risk.
> ...



I generally hypo one or two times  day and the TIR at me at 4% and sometimes 5%. Its frustrating because it takes me a while to come back round after them, I can't concentrate at all for a few hours which makes work difficult. Of course after that run without them they are back again today, clearly missing something. I actually fear highs more than lows. I know I should be just as concerned with the lows because as you say losing hypo awareness isn't great but I still can't get the thought of complications out of my head even if they are years down the line. Its all I think about everyday. 



> Thanks so much for that suggestion.....
> 
> Yes, "sugar surfing" is exactly what I do. It was really interesting to see it broken down and explained in such detail, as I was just doing it instinctively, but the thought processes I use and the things that I consider when I take action are exactly as he describes. It's good to know that this is a recognized strategy for managing Type 1 and that it works with a regular diet as well as low carb, although it was my low carbing which led me to develop it because the protein release is just too complex to try to calculate it. I think my change to Fiasp was also a catalyst in me altering my management to this strategy.



After all the diets and methods I've read its the one that seems to make sense to me. I just need to create a good foundation before trying it by sorting my basal out and knowing my correction factor for bolus etc. That's good you found a strategy that works for you.


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## Deleted member 33898 (Apr 25, 2022)

rayray119 said:


> I'm now wording about the 4 hour rule myself I'm planing to speak to my team next time and i say thiers are points where i know i'm not going be down to normal in next 4 hours and speak to them about correcting before the 4 hours are up).   they always told me to be mindfull about correcting before bed but i do if I'm above ten because i know on day when i haven't been a work if i'm high at bed and don't do a correction i'm gernally not going to come back down(i've learnt this)



I've corrected before bed a few times as well. It just makes sense to not be sitting high all night. I guess it is risky but I think if you see it working and its safe then why not


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## rebrascora (Apr 25, 2022)

For me, getting my basal dose right is key and it needs tweaking quite often to keep it right as my needs change frequently due to not having a regular routine. Some days I can be very active and doing manual physical work and other days more sedentary although still a basic level of activity mucking out four horses.
I don't have a set routine with meals either. Some days I graze on low carb snacks all day and that gives me a great opportunity to assess my basal dose. Other days I might have 3 meals a day, or two or just one.... again, useful for seeing how level my basal is keeping me in the absence of food and bolus insulin. I guess that is another reason why the Sugar Surfing works so well for me. 

Learning to eat low carb is difficult to begin with because we have bulked out our plates with carbs pretty well all our lives and indeed there was an element of guilt in eating just the tasty bits like curry with no rice, when I first started. And "how do you eat without bread?" was an impossible question in those early days, as it is a carrier for so many foods either as a sandwich or on toast, but I have now developed a whole range of interesting recipes and snacks and treats which are low carb that I really enjoy and despite being a bread and tatties lover, I don't miss or crave them now. I might occasionally eat a small portion to be sociable when eating out but they are often not as good as I remember and not worth the BG upheaval. Eating more fat (cheese, cream in my morning coffee, full fat coleslaw and creamy Greek natural yoghurt and full fat mayonnaise and fatty cuts of meat) and discovering lots of different low carb veggies has been the key to making it enjoyable and sustainable. Last night I had a plate of ratatouille cooked in plenty of olive oil and balsamic and a splash of port and herbs with a couple of slices of smoked bacon as my evening meal. It wasn't a huge plateful but it was incredibly tasty and filling. I had a couple of boiled eggs and a packet of pork scratchings and some olives and a bottle of water at lunchtime as a snack type lunch as we were out with the horses. These things might not appeal to you, but there are other things to try which might suit you better.


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## trophywench (Apr 25, 2022)

I find having several hypos a day as utterly unacceptable to any Type 1.

Consider your brain cells.

You may well consider you have more than enough of them at the moment but perhaps when you get early onset Alzheimer's by killing too many of them, you may change your mind.

Anyone who considers a BG of 7 is too high is clearly already stark raving bonkers.


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## rebrascora (Apr 25, 2022)

trophywench said:


> I find having several hypos a day as utterly unacceptable to any Type 1.
> 
> Consider your brain cells.
> 
> ...



According to Libre I had 4 hypos yesterday but Libre exaggerates and they were all very minor ones that were extremely short lived. Didn't test them all but 1 JB was easily enough to do the trick. Some days I might have non, somedays 1. I average just under one a day over 90 days and my consultant is happy with that as I am still meeting the < 4% below range which is the target for Libre and they are all very minor ones.  

You have to remember that many of us are not on a pump and have lifestyles where our activity levels can vary quite a lot, so whatever basal insulin goes in, is there for the duration. I don't consider those "hypos" a problem as they are not below a level where a normal person might naturally drop to. I am quite sure some of them will not even be below 4, but I see no point in wasting a test strip to check most of the time, I just treat and get on with life. I also reduce my basal dose the next day if that happens, so this morning I knocked 2 units off my Levemir dose. I have still had a couple today so I might need to do a further reduction tonight of 1 unit but I have had a less active day today, so may be fine on my current dose. The important things is to recognize what the problem is and address it.

Personally I don't worry too much about the long term implications of being high but I find it very difficult to bring my levels down once they are high and I can be in double figures for hours and inject correction after correction trying to get them down and it is a lot of effort and frustration, so it is easier to keep them lower. If I go a bit too low, a jelly baby brings me up in 10 mins as easy as can be, so that is one of the reasons I would rather be towards the lower end of the range in the 4s and 5s rather than 7-8s. I also often start to feel sluggish once I get above 8 and it can be harder to yomp up the hill and muck out the horses at that level.


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## trophywench (Apr 26, 2022)

Ah - it was not stated that these were Libre hypos, just that they were hypos - and of course it's only when you actually get to 3.3 measured properly by a fingerstick test, or lower that our brain cells die.  The really annoying thing about Libre  is that every time you retest after discovering and treating the low, which you obviously do to make sure the remedy worked - it's reported as another hypo.  Bollards, cos it's the same one.


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## Deleted member 33898 (Apr 28, 2022)

rebrascora said:


> For me, getting my basal dose right is key and it needs tweaking quite often to keep it right as my needs change frequently due to not having a regular routine. Some days I can be very active and doing manual physical work and other days more sedentary although still a basic level of activity mucking out four horses.
> I don't have a set routine with meals either. Some days I graze on low carb snacks all day and that gives me a great opportunity to assess my basal dose. Other days I might have 3 meals a day, or two or just one.... again, useful for seeing how level my basal is keeping me in the absence of food and bolus insulin. I guess that is another reason why the Sugar Surfing works so well for me.
> 
> Learning to eat low carb is difficult to begin with because we have bulked out our plates with carbs pretty well all our lives and indeed there was an element of guilt in eating just the tasty bits like curry with no rice, when I first started. And "how do you eat without bread?" was an impossible question in those early days, as it is a carrier for so many foods either as a sandwich or on toast, but I have now developed a whole range of interesting recipes and snacks and treats which are low carb that I really enjoy and despite being a bread and tatties lover, I don't miss or crave them now. I might occasionally eat a small portion to be sociable when eating out but they are often not as good as I remember and not worth the BG upheaval. Eating more fat (cheese, cream in my morning coffee, full fat coleslaw and creamy Greek natural yoghurt and full fat mayonnaise and fatty cuts of meat) and discovering lots of different low carb veggies has been the key to making it enjoyable and sustainable. Last night I had a plate of ratatouille cooked in plenty of olive oil and balsamic and a splash of port and herbs with a couple of slices of smoked bacon as my evening meal. It wasn't a huge plateful but it was incredibly tasty and filling. I had a couple of boiled eggs and a packet of pork scratchings and some olives and a bottle of water at lunchtime as a snack type lunch as we were out with the horses. These things might not appeal to you, but there are other things to try which might suit you better.


I've been very hesitant about changing my basal. I've been afraid to make a change. It's pretty much always the same dose at the same time every night. Some nights my glucose rises as soon as i fall asleep, some nights it stays steady and rises rapidly in the middle of the night and sometimes it starts falling gradually as soon as I go to sleep but generally waking up with an in range level. Been going through all my food logs and libre data and not a clue. Makes me want to give up recording info all together, it just feels like a big waste of time. I've got to a point were I wanna rip off the sensor and chuck everything in the bin. I went for a walk last night after dinner because I was higher than usual, plummeted to 2.8 , treated with what usually works and flew back up higher than when I started, had to correct it. The enjoyment of life has been sucked out of it. I've read 3 books on diabetes, constantly checking info online, checking my levels and logging everything, its exhausting when I'm getting no where. The low carb diet seems to be the solution pushed more than anything but I hate most low carb foods. At this rate what is the point anymore. Burn out quickly with the life I lived before or suffer slowly until the complications arrive.


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## trophywench (Apr 28, 2022)

Stop exaggerating!  Nobody wants or needs to starve.  Low carb food is merely smaller portions of the same ruddy food!!


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## rebrascora (Apr 28, 2022)

So sorry to read that you are struggling with the randomness of it all.
Low carb is very much a minority approach when it comes to Type 1 so don't feel pressured to go for that option. The vast majority of people manage fine with a normal diet, but you have to understand that there are a lot of factors which affect BG levels. Food, exercise and medication are the 3 main players but lots of other things can mean different outcomes from very similar circumstances and you always have to remember that everyone struggles to manage their levels at different times. If it helps you to know this, I have had nocturnal hypos the last 2 nights (2.9 and 3.5 last night) despite a basal reduction and no evening bolus or lunchtime bolus for that matter yesterday..... so just 4 units of Fiasp yesterday morning plus my basal doses. I will be doing another basal reduction tonight to 0 units (down from 2 units last night and 5units last week) Levemir and just run on my reduced morning dose of 22 (down from 24) units and see how that goes. I need to constantly adjust my basal to keep me right. I am not losing sleep over those hypos other than waking up, munching JBs and going back to sleep (usually within minutes), but obviously I need to take steps to address them hence a further basal reduction as basal is the only possible cause.

Your incident with a high and then a low and then a high may be down to timing of your bolus, the exercise and the food you ate and maybe even the order that you ate that food in. What was your premeal reading and how long did you prebolus?
Foods like pizza and creamy pasta meals and maybe fish and chips etc can be tricky and need a split bolus to deal with them, so maybe half the dose up front prebolused depending upon your premeal reading and then the other half an hour or two later. Sometimes I need to split it into 3 or 4 doses for a low carb higher protein meal. It took me a record 5 bolus injections to cope with a Chinese buffet the other week! Then yesterday eating very little and all low carb I just needed 1 bolus injection at breakfast and still hypoed through the night TWICE!! The only thing that really bothers me about it is that it is ruining my Libre stats. The important thing is that I am doing my best to understand which insulin is causing the problem and make appropriate adjustments to try to prevent it happening again.... it can only be my basal in my case since I hadn't had any bolus insulin since breakfast, so it is pretty easy to see what I need to do and as long as I address that tonight again then I have managed my diabetes well, even if the results look shoddy! 

I think what reassures me about my diabetes management longer term is that I have far better tools (modern basal/bolus insulins and testing equipment) to manage my diabetes now than my uncle ever did. He was occasionally found in a DKA coma and admitted to hospital at various times throughout his lifetime (diagnosed in his 20s) as well as having had fits from very low hypos at times and he still made it to 84 with all his limbs and eyesight and kidneys which I don't think is a bad innings although he did suffer with dementia the last couple of years. He did exercise regularly and I think that may be an important factor. He was still cycling regularly at 80. 
I am pretty certain that your BG management will be far better than my uncle's could ever have been so cut yourself some slack and try not to worry about long term impact.... just do your best in the "here and now". When things go wrong, try to figure out how you could have done better, ie did you make any silly obvious mistakes.... I know I certainly do sometimes .... but otherwise you have to learn to shrug and just move on. Being more relaxed about it may well give you better results just purely from reducing stress. 

One thing I would recommend if you haven't done it is an intensive insulin management course like DAFNE or whatever your local equivalent is. I benefitted both in confidence and practical skills and particularly in adjusting my basal doses, even if much of the carb counting (DAFNE stands for Dose Adjustment For Normal Eating) didn't apply to me because I low carb. Just spending a week with other Type 1 diabetics was incredibly beneficial as well as having my stats overseen by a highly qualified and specifically non-judgemental DSN (DAFNE educator DSNs have to pass specific assessment for that characteristic because any negativity is recognized as hindering improvement in patients) 

Anyway, I hope that helps you to realise that you are not alone in being frustrated with your management. A month ago I was doing brilliant and now my levels are misbehaving which almost certainly means for me that my basal needs are changing. It ebbs and flows like this all the time and I have learned to just roll with it, try the usual tactics and after that, just wait for it to settle down into stability again. If you keep chasing the dragon's tail, it just wears you down.


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## Leadinglights (Apr 28, 2022)

phil90 said:


> I've been very hesitant about changing my basal. I've been afraid to make a change. It's pretty much always the same dose at the same time every night. Some nights my glucose rises as soon as i fall asleep, some nights it stays steady and rises rapidly in the middle of the night and sometimes it starts falling gradually as soon as I go to sleep but generally waking up with an in range level. Been going through all my food logs and libre data and not a clue. Makes me want to give up recording info all together, it just feels like a big waste of time. I've got to a point were I wanna rip off the sensor and chuck everything in the bin. I went for a walk last night after dinner because I was higher than usual, plummeted to 2.8 , treated with what usually works and flew back up higher than when I started, had to correct it. The enjoyment of life has been sucked out of it. I've read 3 books on diabetes, constantly checking info online, checking my levels and logging everything, its exhausting when I'm getting no where. The low carb diet seems to be the solution pushed more than anything but I hate most low carb foods. At this rate what is the point anymore. Burn out quickly with the life I lived before or suffer slowly until the complications arrive.


You mean you hate meat, fish, eggs, cheese, vegetables, salad berries, nuts, avocados, yoghurt, cream to name but a few.
Surely you can eat normal foods and adjust your insulin accordingly.


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## rebrascora (Apr 28, 2022)

Leadinglights said:


> Surely you can eat normal foods and adjust your insulin accordingly.


I know you mean well, but that sentence really belittles the complexity of matching insulin to what you eat, be it low carb or otherwise, especially when you are also trying to balance liver output with basal insulin and it is hard to tell what is what, particularly for someone relatively newly diagnosed, who is struggling. 

I think in some respects Libre is a blessing and a curse, particularly in the early days when it is so easy to be overly critical of yourself.... and expect perfection.... when you simply don't yet have the skills and experience to balance everything. It takes time and practice and even then you still get spells where if doesn't work as you expect and it is frustrating.


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## Deleted member 33898 (Apr 28, 2022)

Leadinglights said:


> You mean you hate meat, fish, eggs, cheese, vegetables, salad berries, nuts, avocados, yoghurt, cream to name but a few.
> Surely you can eat normal foods and adjust your insulin accordingly.


with the exception of vegetables, salad and berries, I only use those others to bulk up my meals because I shrunk my carb intake. That became a problem for me because I still haven't gained back any weight I lost due to the diabetes. The more I reduce the carbs, the more I'll have to up all those low carb foods. Yet I'm told by the dietician to increase all my carbs. There is no enjoyment for me with these low carb foods by themselves. I never bothered with eggs and nuts before but now I eat them just to keep me from losing more weight. I think its great many have found this way work for them but I don't think it will ever be for me which leaves me stuck until some miracle.


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## rebrascora (Apr 28, 2022)

If you don't enjoy eating low carb, then you absolutely don't have to as a Type 1, so don't be waiting for some miracle, but you will need to experiment to find a good balance of food and insulin and it will take time and patience and getting it wrong quite a bit before you start to get it right. Don't be frightened of getting it wrong because those are the times when you learn more. 
There is absolutely no need to starve yourself. What sort of things do you want to eat? Start with your favourite meal and practice it once a week for a couple of months if necessary until you figure out the best strategy for it. Keep good notes of pre meal BG levels and insulin doses. Post on here with the meal and what happened afterwards and we should be able to help you. Gradually work your way through different meals one at a time until you work out strategies that work for them most of the time..... there will always be occasions when it doesn't work but most of the time is good enough.


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## Leadinglights (Apr 28, 2022)

rebrascora said:


> I know you mean well, but that sentence really belittles the complexity of matching insulin to what you eat, be it low carb or otherwise, especially when you are also trying to balance liver output with basal insulin and it is hard to tell what is what, particularly for someone relatively newly diagnosed, who is struggling.
> 
> I think in some respects Libre is a blessing and a curse, particularly in the early days when it is so easy to be overly critical of yourself.... and expect perfection.... when you simply don't yet have the skills and experience to balance everything. It takes time and practice and even then you still get spells where if doesn't work as you expect and it is frustrating.


Apologies I didn't mean to imply that it was a simple thing to cope with all the adjustments needed to achieve a healthy balance, I know full well what struggles people have when trying to get to grips with all the implications of a diagnosis.
It perhaps highlights the lack of support people are getting from their diabetic team that they feel they cannot have the varied diet they enjoy. No offence intended in my comment.


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## Deleted member 33898 (Apr 28, 2022)

rebrascora said:


> So sorry to read that you are struggling with the randomness of it all.
> Low carb is very much a minority approach when it comes to Type 1 so don't feel pressured to go for that option. The vast majority of people manage fine with a normal diet, but you have to understand that there are a lot of factors which affect BG levels. Food, exercise and medication are the 3 main players but lots of other things can mean different outcomes from very similar circumstances and you always have to remember that everyone struggles to manage their levels at different times. If it helps you to know this, I have had nocturnal hypos the last 2 nights (2.9 and 3.5 last night) despite a basal reduction and no evening bolus or lunchtime bolus for that matter yesterday..... so just 4 units of Fiasp yesterday morning plus my basal doses. I will be doing another basal reduction tonight to 0 units (down from 2 units last night and 5units last week) Levemir and just run on my reduced morning dose of 22 (down from 24) units and see how that goes. I need to constantly adjust my basal to keep me right. I am not losing sleep over those hypos other than waking up, munching JBs and going back to sleep (usually within minutes), but obviously I need to take steps to address them hence a further basal reduction as basal is the only possible cause.
> 
> Your incident with a high and then a low and then a high may be down to timing of your bolus, the exercise and the food you ate and maybe even the order that you ate that food in. What was your premeal reading and how long did you prebolus?
> ...



Honestly I feel like an idiot for that outburst, I apologise. You have been very helpful with this post and previous ones.

I know about all the different factors which affect BG levels, its quite a long list =/ So you just get on with these mishaps really? I think when its a constant flow of issues I get down about it. The alarms on libre going off just ruins my day. Interesting with the basal amounts, so you take a small amount over night and a large dose in the morning? I find it difficult to figure out how much and when to take its driving me insane making a change. I keep thinking i'll just make matters worse. Been thinking if I take my evening dose earlier and top it up in the morning but then exercise is too close to taking the basal if I take it earlier.

I base my bolus timing off previous similar meals. Also I watch to see when levels start to drop meaning the insulin is working. So I started at 5.5 and dropped to 4.5 and then up to 9 just after an hour. I would let it go if the libre said it was steady or the line on the graph is starting to settle and go down but decided I had to walk cause I know it will keep climbing. I've tried all the tricks like eating in a certain order and having fat and protein to slow things down but it seems a working method only lasts soo long then stops having an effect. The 3 glucose tablets bringing me up soo fast and high shocked me, maybe because I hadn't tried them as a hypo treatment in a while I dont know. I have had some success with pizza but tend not to have it very often anyway. Anything with chips and potato usually isnt too bad but I thought chips were a no no. I have noticed pasta and rice always seem to cause some delayed spike in the middle of the night but do I just replace them completely. I know what you are saying, trying to learn to make adjustments for the future but it seems I keep making the same mistakes over and over again. I've tried soo many ways of looking at and recording what I'm seeing. It ends up being a waste of time. Everytime I have a meal I spend about 15 minutes looking back through logs on libre and lifesum to see what I did last time with the meal. End up not getting anywhere. 

Wow that is quite a success story. Obviously sorry to hear of his dementia and passing. That's amazing he was cycling still, fantastic ! I guess just knowing all the complications is enough to freak me out everyday. You are probably right, the stress may be a factor. I think the mental turmoil is actually worse than the physical side at the moment for me. 2 year waiting list for therapy for those living with diabetes. They always bring it up and I say well isn't there a 2 year waiting list, which thats still the case.

It's DAFNE here too but I doesn't look to be starting up again anytime soon, they'll be a huge back log of those who missed out during the pandemic.  I have a feeling I already know most of what they would teach but as you say being there with other diabetics would be a real boost. 



> If you don't enjoy eating low carb, then you absolutely don't have to as a Type 1, so don't be waiting for some miracle, but you will need to experiment to find a good balance of food and insulin and it will take time and patience and getting it wrong quite a bit before you start to get it right. Don't be frightened of getting it wrong because those are the times when you learn more.
> There is absolutely no need to starve yourself. What sort of things do you want to eat? Start with your favourite meal and practice it once a week for a couple of months if necessary until you figure out the best strategy for it. Keep good notes of pre meal BG levels and insulin doses. Post on here with the meal and what happened afterwards and we should be able to help you. Gradually work your way through different meals one at a time until you work out strategies that work for them most of the time..... there will always be occasions when it doesn't work but most of the time is good enough.



See I have done all this. If you saw the notes I've kept in the last, it's quite detailed. Maybe too much detail is my problem or not being able to analyse it all properly. I might try even making some sort of meal plan and stick to the same set meals for a while. Something I regularly eat would be fish (no batter or anything like that ) rice , plenty of veg, hot sauce(less than 0.5g carbs) and cheese . I don't know if that sounds strange or not. It's one of those ones though that I reckon is giving me a high in the middle of the night for whatever reason. Only way to fix that is getting up and bolusing everytime which isn't ideal. Maybe something I need to reduce in that meal but I'm still not sure. 

Yes much appreciated, all that info. I just have to stop comparing myself to those showing all these great levels. Thanks for taking the time.


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## Benny G (Apr 29, 2022)

@phil90 Success is a funny thing, and managing diabetes requires both knowledge, skills and an awareness of your immediate situation.

It sounds like you have done some reading up, and think perhaps your control should be better than it is. You can ease up, widen your goal posts to score some points. Skills require practice: Practice is messy. Give yourself time and space, set smaller achievable goals, then gradually aim  up. Set your high and low glucose values further apart; play with the timing of prebolus, corrections, and learn to manage and (stack) small doses. 
Learn to use your libre to guide your decision-making. 

If you are looking at your libre graph and scratching your head, you can post a screen shot (either as a private message or on open furum) and compare notes with seasoned veterans.

Be kind to yourself.


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## nonethewiser (Apr 29, 2022)

phil90 said:


> with the exception of vegetables, salad and berries, I only use those others to bulk up my meals because I shrunk my carb intake. That became a problem for me because I still haven't gained back any weight I lost due to the diabetes. The more I reduce the carbs, the more I'll have to up all those low carb foods. Yet I'm told by the dietician to increase all my carbs. There is no enjoyment for me with these low carb foods by themselves. I never bothered with eggs and nuts before but now I eat them just to keep me from losing more weight. I think its great many have found this way work for them but I don't think it will ever be for me which leaves me stuck until some miracle.



There has to be a middle ground Phil, diet like low carb isn't going to resolve all your problems just same as any other diet going knocking around, found that out myself all those years ago.

Middle ground for me was learning more about condition & working more with diabetes clinic, with small changes it eventually falls into place where you can get decent results & not have to restrict diet to much or be constantly think about condition all of the time. Think insulin  pump woul be ideal for yourself so would press your clinic team to get one, won't resolve all problems but it should solve your basal issues out by having numerous basal rates & ability to reduce basal for when you exercise.
.


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## Proud to be erratic (Apr 29, 2022)

Hello @phil90 ,
There are so many aspects about this thread it is difficult to know where to start a response.

Firstly, good on you for wrestling with your diagnosis, for exploring the boundaries, for your curiosity leading to research in books and on line, for tapping in to this forum's accumulative knowledge - and for wanting to improve your management of your DM. Of course there is a high level of self interest in doing this; you want longevity as well as a decent quality of life and you certainly don't want true hypos interfering with your day. But well done.

I've picked up that you are on Novorapid, but couldn't spot what basal and whether you take that 1x daily or twice. I couldn't find what your latest HbA1c is. Nor did I find what TIR you are achieving; given that you started this thread in late April, it could be useful to know if things have improved in the last 30 days, as well as the last 90 days. I don't know if your weight is relevant to your diet. Is alcohol part of your daily life? I like a glass of wine or whisky, but Libre reveals that it definitely interferes with my digestion and BG.  So the goal posts aren't too clear.

Secondly you've been T1 for less than a year and you mention "so many factors" affecting BG. One factor for you will be the possibility of your ailing pancreas intermittently contributing and confusing your interpretations.

Thirdly, I particularly agree with @Benny G about measuring success at this stage and his list of things to try - but only one at a time! And you can't interpret anything from a single result, so each experiment needs a decent set of results to provide a platform to interpret from.

Much of your dialogue has been with @rebrascora who has an exceedingly low carb diet and who, from my perspective, pushes boundaries by stacking insulin - which I'm uncomfortable about doing myself. She also uses changing her basal to assist in her daily BM management. I eat around 200-250gms of carbs daily, not as a target, its just what I want, when I want and I start with a breakfast of either 104 or 96 gms; those nos are divisible by my breakfast ratio of 1:13. I have a very inflexible 1x daily basal, which is optimised to keep me away from hypoland while I sleep and which I rarely alter. I regulate by using my bosul, knowing that if I've misjudged the dose (or something else comes into play) I can correct by eating a snack if low or a correction after 4+hrs, (usually at my next meal if I'm hungry). I aspire to be close to 6, a recent change from 7, with my recent improved BG stability.

What @rebrascora both have in common is that we're both relatively new to this, that we've both found very different ways of accommodating our DM and, by complete coincidence, we're both sugar surfing. Or at least I think I am, in principle, even though I'm not yet near a pump.

It takes time to work this all out. I made stopping having hypos my first priority quickly followed by getting off the low, high, low roller coaster; I'd be happy to sharevhow I tackled that. I'm retired and have the luxury of no work schedule to adhere to; I fully appreciate that you don't have that luxury.

I hope some of this helps. You might find it helpful to read your first post again and update us on where you think you now are after 30+ days of this thread; writing that down here, might prove useful to you as well as us.


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## Proud to be erratic (Apr 29, 2022)

Sorry @phil90 , what I should also have said is that you, @rebrascora and myself have in common is the use of Libre to provide vastly superior visibility of what is happening to our BGs minute by minute. Hence our ability to respond artificially, which our panc'ys no longer do for us.


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## trophywench (Apr 29, 2022)

There are simple things you can easily do about some of what's bothering you.  eg. you say the Libre alarms drive you potty - so turn the alarms off.

The scans of the Libre are not sufficiently accurate to rely on wholly to base insulin calculations on - only to find out whether you're shooting upwards or downwards at an alarming rate of knots, in which case you do a fingerprick and base your calculations on the fingerprick results.

Bit like blood pressure readings - if they want you to monitor your BP yourself the instruction they give you is to take it twice a day - morning and evening - for 5 days in a row.  You are to measure it, 3 times in a row on both occasions.  Each time - sit down and relax for 15 minutes first.  Then take reading 1.   5 -10 mins later, take reading 2, ditto for 3.  Now - ignore reading 1.  For morning readings - now take average of readings 2 & 3.  For evening readings, having ignore reading 1, take the better of 2 & 3.  On morning 6, report the 5 days answers to the doc. for advice re any medication dose changes.

It is not at all whatsoever necessary to try and micro-manage either BG or BP.  (unless you are in intensive care at death's door in which case, you wouldn't be doing it yourself!)

Nobody dropped dead instantly nor had a foot drop off/kidney to fail/eye blinded by their BG spiking to 23.0 after eating a whole trifle on Boxing Day cos you'd gone to the trouble of making it then nobody wanted any so sod you I'll eat it then, or a whole packet of Jaffa cakes one other day when they felt depressed.

Oh yes - been there, done both - more than once I'm sure - but I'm still here !!


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## Deleted member 33898 (Apr 29, 2022)

nonethewiser said:


> There has to be a middle ground Phil, diet like low carb isn't going to resolve all your problems just same as any other diet going knocking around, found that out myself all those years ago.
> 
> Middle ground for me was learning more about condition & working more with diabetes clinic, with small changes it eventually falls into place where you can get decent results & not have to restrict diet to much or be constantly think about condition all of the time. Think insulin  pump woul be ideal for yourself so would press your clinic team to get one, won't resolve all problems but it should solve your basal issues out by having numerous basal rates & ability to reduce basal for when you exercise.
> .


i ended up at the clinic quite a few times and they keep telling me everything is grand but I need to work on the constant up and downs throughout the day. It's the variability in my glucose I hate at the minute. I did have a good few months until end of January when I caught covid. After that its been difficult to keep stable. There was a lot of work put into to getting them good and now I feel like I have to find another answer. A pump was mentioned but they said I wouldn't be eligible for that for a while. They said it would take away some of the burden but obviously it still requires plenty of work. The only option available to me from them is to switch over to  different insulin, both basal and bolus.


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## Proud to be erratic (Apr 29, 2022)

phil90 said:


> i ended up at the clinic quite a few times and they keep telling me everything is grand but I need to work on the constant up and downs throughout the day. It's the variability in my glucose I hate at the minute. I did have a good few months until end of January when I caught covid. After that its been difficult to keep stable. There was a lot of work put into to getting them good and now I feel like I have to find another answer. A pump was mentioned but they said I wouldn't be eligible for that for a while. They said it would take away some of the burden but obviously it still requires plenty of work. The only option available to me from them is to switch over to  different insulin, both basal and bolus.


Phil, what basal are you currently on and did they indicate what options they could switch you onto?


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## rebrascora (Apr 29, 2022)

Can you post a photo of a typical Libre trace which concerns you so that we can see if you are expecting too much or we can spot things that might be fixable and make suggestions. BG levels are rarely stable, so you may be trying too hard to fix something that isn't actually a problem. I say this because you mention worrying about Libre showing a 9 with an upward pointing arrow after your evening meal. Libre has an algorithm which tries to predict ahead to reduce lag between interstitial fluid and blood glucose. Sometimes I can get a 9 with a vertical upward arrow but it suddenly levels out at 9.5 and then starts to drop and sometimes the graph suggests it didn't actually go as high as 9. It is easy to respond too quickly to Libre. I think one of the key characteristics with Sugar Surfing is patience. It takes quite a bit of discipline for me to ride it out but usually it levels out and starts to drop if I have calculated things right. At your stage I am pretty sure I was still hitting low to mid teens quite frequently. 

It may be that before Covid your own pancreas was smoothing off the edges and peaks for you and now after Covid you have perhaps lost some of that already limited insulin production which is making things more erratic. It may also be that your basal dose(s) are no longer correct.
Can you remind us which basal insulin you use and when you take it?


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## Deleted member 33898 (Apr 29, 2022)

Proud to be erratic said:


> Hello @phil90 ,
> There are so many aspects about this thread it is difficult to know where to start a response.
> 
> Firstly, good on you for wrestling with your diagnosis, for exploring the boundaries, for your curiosity leading to research in books and on line, for tapping in to this forum's accumulative knowledge - and for wanting to improve your management of your DM. Of course there is a high level of self interest in doing this; you want longevity as well as a decent quality of life and you certainly don't want true hypos interfering with your day. But well done.
> ...


I appreciate the support. Yes I'm on novarapid, usually 3 times a day for meals and a few more times for corrections. Generally taking about 4,6,6 doses for meals with ratios different throughout the day. I'm on levermir once a day before bed, 5 units. My first HbA1c was 99, then 56 a month later, 29 few months after that and back in March 30. TIR for 3.9 to 10 range generally 95% , the other 5% usually spent either in the low or high end, I have weeks were that 5% its all low then all high. Those blood results might look good but its mainly due to the amount of lows I've been having, for instance I've had a few 1.8s. Best way I can explain is probably through the graphs, can see the constant roller coaster. I realise it's not supposed to be nice and steady all the time but I feel sick and exhausted everyday from the jumps and falls. Is it normal to get the tingles in legs and feet and stinging eyes when bloods are high?  My weight is a big issue for me. I know I need more calories but I'm afraid to add more carbs or fat. 

I think as far as the pancreas still working, it definitely looks like things are changing. I think it was covering for quite a bit. For instance I never had regular highs whilst sleeping but now that is becoming increasingly common. 

I have a difficult time trying to concentrate on one thing at a time. I already tried tackling one issue at a time at the start of my diagnosis by building on strategies. For example not exercising initially and trying to figure out my bolus and basal. Then exercising and seeing how things need adapted. I think it could be difficult to start from scratch again but might have to.

You eat around the same amount of carbs as myself per day. Do you mind me asking what sort of carbs you eat? Do you pair them with plenty of fat and protein? It is crazy how much I ate before that I don't now(or very small amount the odd time). Just all the nice stuff like sausage rolls, sweets, chocolate, crisps etc Could I eat them , probably but takes planning. I find its the spontaneity that diabetes robs, I hate that the most. Being at someone's house and the biscuits or cake comes out, oh no thanks I'd have to dose for that.

Sugar surfing looks like a good way of managing diabetes but I think I need to go back to basics first before trying it.

I think for me I've been soo fixated on preventing highs that hypos haven't bothered me as much even though they should. I'd love to get off the low high rollercoaster. By all means any advice you can offer would be greatly appreciated. 

Yes I'll definitely come back to this thread and update.

Thank you

Phil


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## Deleted member 33898 (Apr 29, 2022)

rebrascora said:


> Can you post a photo of a typical Libre trace which concerns you so that we can see if you are expecting too much or we can spot things that might be fixable and make suggestions. BG levels are rarely stable, so you may be trying too hard to fix something that isn't actually a problem. I say this because you mention worrying about Libre showing a 9 with an upward pointing arrow after your evening meal. Libre has an algorithm which tries to predict ahead to reduce lag between interstitial fluid and blood glucose. Sometimes I can get a 9 with a vertical upward arrow but it suddenly levels out at 9.5 and then starts to drop and sometimes the graph suggests it didn't actually go as high as 9. It is easy to respond too quickly to Libre. I think one of the key characteristics with Sugar Surfing is patience. It takes quite a bit of discipline for me to ride it out but usually it levels out and starts to drop if I have calculated things right. At your stage I am pretty sure I was still hitting low to mid teens quite frequently.
> 
> It may be that before Covid your own pancreas was smoothing off the edges and peaks for you and now after Covid you have perhaps lost some of that already limited insulin production which is making things more erratic. It may also be that your basal dose(s) are no longer correct.
> Can you remind us which basal insulin you use and when you take it?



I have seen the libre do this with the lag. But I'll do random finger prick tests to confirm and it normally matches, sometimes higher than the libre reading. I do see the levelling out sometimes but normally I'll go for a walk to bring things down a bit, I dont like waiting for it to go too high. I'll only correct after 2 hours if a rise continues.

I definitely believe I've lost some of the ability to produce a bit of insulin. Yes Im taking 5 units before bed, so 11pm. I started on 12 when I was diagnosed. I've done plenty of basal tests but not 100% on next move everytime I test.


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## rebrascora (Apr 29, 2022)

Are you saying that you are achieving 95% TIR (3.9-10) now on a regular basis. If so that is exceptional and it is your perception which is the problem not your BG management. Getting 70% TIR is good enough, 80% is great, 90% is excellent. I am currently having what I consider a bad spell and I am down at 84% TIR. That is still perfectly acceptable/good although it is a bit low for me. It isn't bothering me too much as I know the change of seasons is messing with my basal needs and I will get the doses more or less right again soon and I know that BG management ebbs and flows and there will be times when I have better management and other times when it isn't so good. As long as it is above 70% I have to be happy (It would be difficult but you have to be ratiuonal about this stuff) even if I know I can achieve better. You do not have control of all the factors which affect BG so you cannot have perfect BG numbers. 
Apologies if I have gone off on one and misunderstood your post but it seems to be you are being much too hard on yourself and if you continue to impose such strict control, you may well burn yourself out. Diabetes is hard for perfectionists..... you have to learn to temper it.


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## Deleted member 33898 (Apr 29, 2022)

rebrascora said:


> Are you saying that you are achieving 95% TIR (3.9-10) now on a regular basis. If so that is exceptional and it is your perception which is the problem not your BG management. Getting 70% TIR is good enough, 80% is great, 90% is excellent. I am currently having what I consider a bad spell and I am down at 84% TIR. That is still perfectly acceptable/good although it is a bit low for me. It isn't bothering me too much as I know the change of seasons is messing with my basal needs and I will get the doses more or less right again soon and I know that BG management ebbs and flows and there will be times when I have better management and other times when it isn't so good. As long as it is above 70% I have to be happy (It would be difficult but you have to be ratiuonal about this stuff) even if I know I can achieve better. You do not have control of all the factors which affect BG so you cannot have perfect BG numbers.
> Apologies if I have gone off on one and misunderstood your post but it seems to be you are being much too hard on yourself and if you continue to impose such strict control, you may well burn yourself out. Diabetes is hard for perfectionists..... you have to learn to temper it.


I realise part of my problem is my personality. I've always been like this. They told me at the clinic I need to calm down. Easier said than done. What my issue has been is the variability in glcuose levels. The jumps from low to high and high to low. It doesn't feel good. And  what is bugging me is my levels have been getting worse and I have no answer for it except that my pancreas is saying bye bye.  I was able to manage on a high carb diet generally keeping peaks below 2mmol change overall after meals.what the consultant said to me has stuck with me and from what I've read. I have to aim for keeping the overall change in levels within 2 to 3 mmol as much as I can. As in I start at 5 and don't go up past 7 whilst eating and after. Or if I'm at 9 dont go up past 11.  Obviously this won't happen everytime. But now I'm back to the early months of 5 to 6 mmol changes and it's quick, this is every meal now , that and these spikes whilst sleeping which I don't understand. Look sorry if I'm coming across like a moan but this is how I feel about all this. Again I really appreciate all like yourself taking the time to read and respond. I hope I can be in a position to help others sometime down the line when I'm feeling more confident because diabetes aint easy.


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## nonethewiser (Apr 29, 2022)

phil90 said:


> i ended up at the clinic quite a few times and they keep telling me everything is grand but I need to work on the constant up and downs throughout the day. It's the variability in my glucose I hate at the minute. I did have a good few months until end of January when I caught covid. After that its been difficult to keep stable. There was a lot of work put into to getting them good and now I feel like I have to find another answer. A pump was mentioned but they said I wouldn't be eligible for that for a while. They said it would take away some of the burden but obviously it still requires plenty of work. The only option available to me from them is to switch over to  different insulin, both basal and bolus.



Can only say that I for one didn't find pumping hard work, on the contrary it was big relief from injections & far less hassle,

Surely if your injecting more to cover meals & having issues with basal insulin then that would be something your clinic should consider with regards to switching to pump, especially as it's all causing you great anxiety.


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## Benny G (Apr 29, 2022)

Interesting @phil90, achieving 95% TIR (3.9-10) and HbA1c 30 in March. (The _normal_ range for _HbA1c_ is 4 – 5.6% (20 – 38 mmol/mol) in healthy people.) Do you know your glucose control is better than 99% of type 1 diabetics, better in fact than a good percentage of people who don't even have diabetes.

Let that sink in for a moment.

You are new to diabetes, and still enjoying the honeymoon, use this time to gather information and practice your skills for the period after the honeymoon.


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## rebrascora (Apr 29, 2022)

I wonder if you are trying to apply Type 2 guidelines to your Type 1. Keeping your increase to just 2 or 3 mmols with exogenous insulin each meal is extremely unrealistic. You might have managed when your own pancreas was helping out but long term, even on a low carb diet you will really struggle to achieve that regularly and you are clearly not committed enough by the sound of it to find an enjoyable way to go low carb. 
What does your Libre Link say your variability is. I am usually about 23-28% variability. I think they like you to be under 50%. 
I am guessing yours might even be under 25%?
I know when I was first diagnosed I used to shoot up to mid teens after breakfast and then come crashing back down to 5 and that felt rough but dropping 5 or 6mmols shouldn't feel that bad and if it does, maybe you need to give your body time to get used to them because it is normal and even non diabetic people have those sort of increases and decreases sometimes. You are expecting too much of yourself.


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## Proud to be erratic (Apr 30, 2022)

phil90 said:


> I appreciate the support.


You are welcome. This thread is galloping along, with added nuances and insights. I'm struggling to keep up, it must be challenging for you also! I'll try and answer this post following your narrative here.


phil90 said:


> Yes I'm on novarapid, usually 3 times a day for meals and a few more times for corrections. Generally taking about 4,6,6 doses for meals with ratios different throughout the day.


4, 6, 6 units, total 14 per day (generally) for perhaps 200-250 gms carbs is not so dissimilar to myself.
I have 6.5 units for my big breakfast of 104 gms (this 13 units for my food ratio, reduced by 50% for my planned activity =6.5); I now rarely wake high so rarely need a correction before b'fast. But need 45mins pre-bolus.
For lunch 4, 5 or 6 units (@1:10, with no adjustment for activity - but a correction added if needed). 20-30 mins pre-bolus. My activity may or may not be what I envisaged when I woke up. So I'm now responding to what is happening not what I anticipated. Hence my sense of sugar surfing. I may have had a snack of latte and a biscuit if I've been low; I never correct (so don't stack) within the 4 hrs if a little high.
For dinner 6, 7 or 8 units, plus a correction if needed. Pre-bolus 15 mins; BUT if I'm high and need a correction I NEVER eat until I'm below 8 and have a downward trend. I have found that my resistance to insulin when above 8 is stubborn and if I eat too soon then I simply never get below 8, often not below 10. This is tiresome, a cause of friction, yet acceptance by by us both that it has to be so. We sometimes end up eating the same meal, but an hour apart!
Typically 18 units for food, plus corrections.

I only take 1 further correction around midnight if I've got it wrong and am still high. So normally only 3 or max 4 NovoRapid doses in any one day.

I wonder if your extra corrections are premature and part of the roller coaster problem.


phil90 said:


> I'm on levermir once a day before bed, 5 units.


I was on Levermir 2x daily, 9 or 10 units each time. I asked to go onto a single basal and was moved to Tresiba; this was my 2nd big step in taking ownership of my DM management. [The first was carb counting, moving from defined fixed doses and exploring meal ratios]. My c.20 units of Levermir became initially 16 units of Tresiba, steadily reduced and now 10 units 1x daily at 8am; probably one more tweak to 9.5 now I have a half-unit pen and disposable cartridges for Tresiba.
Tresiba is a long lasting basal, up to 40 hrs profile, so 10 units daily stack with each new daily dose. Hence it is described as inflexible and adjustments take up to 3 days to come into play. This suits my lifestyle and, broadly, fixes one variable. My basal is optimised for steady nights.


phil90 said:


> My first HbA1c was 99, then 56 a month later, 29 few months after that and back in March 30. TIR for 3.9 to 10 range generally 95%


As others have said - wow. You are miles better than myself. I think your DM management is questionable, not because it is bad (far, far from it) but it is not realistic. Your expectations are simply too demanding on yourself and this is (clearly demonstrated by this thread) dangerously stressful.
Stress is a major factor  causing BG elevation. That is a fact. What is not so clear is putting that into numerical terms; ie how much extra insulin is needed to manage this sort of stress.


phil90 said:


> , the other 5% usually spent either in the low or high end, I have weeks were that 5% its all low then all high. Those blood results might look good but its mainly due to the amount of lows I've been having, for instance I've had a few 1.8s.


Yes, understood. We all get Libre "statistics" that seem to mislead; and it's frustrating, eg when false compression lows during the night show as low glucose events which weren't actual hypos. But in the swings and roundabouts of this there is a general averaging out. That is also true of the HbA1c figure from periodic blood tests.
But, the trick here is to accept that the stats are not mathematically as perfect as you might wish. Libre and CGMs in general are bringing a level of BG visibility that would have been unthinkable a few years back. Unquestionably better than just getting snapshots from finger pricking; but still need better ways of removing the "outliers". OR is it that we want to cheat and ignore the unpalatable outliers.
The brilliance of CGM is getting visibility of the trends. The difficulty is judging when to react and when to be patient.


phil90 said:


> Best way I can explain is probably through the graphs, can see the constant roller coaster.


I have smoothed down my roller coasters, but not eradicated them; there are still undulations. Significantly mainly in range.
Interestingly, I had an app called Diabox which took the minute by minute Libre readings and gave me a true CGM. The daily graphs on Diabox looked so much better than on Libre, simply because of the pictorial scale! Same data, possibly slightly different interpretation from different algorithms, but different visual presentation. I have a tech issue on my phone with the Diabox app, so am temporarily (infuriatingly) without it and can't send you a photo.


phil90 said:


> I realise it's not supposed to be nice and steady all the time but I feel sick and exhausted everyday from the jumps and falls. Is it normal to get the tingles in legs and feet and stinging eyes when bloods are high?


I seem to have good hypo awareness, but less so for hyper awareness. I don't get much difference in how I feel when I'm high, particularly if I'm busy. Just sometimes if I'm sitting still I feel a bit strange, and then check BG to find I've crept above 15. But this is very infrequent now.


phil90 said:


> My weight is a big issue for me. I know I need more calories but I'm afraid to add more carbs or fat.


I weigh 11stone 3-4lbs, and been trying unsuccessfuly to get to 11 stone 7lbs since Xmas. I feel too skinny. Overall my BMI is respectable. 5 years ago I was 15 stone and none of those clothes fit.


phil90 said:


> I think as far as the pancreas still working, it definitely looks like things are changing. I think it was covering for quite a bit. For instance I never had regular highs whilst sleeping but now that is becoming increasingly common.


Noted. I have no experience with this.


phil90 said:


> I have a difficult time trying to concentrate on one thing at a time.


Understood. This is a very common outcome from stress, so there is a connection to your DM in that your varying concentration might be because of DM or might be because you are stressing yourself by not managing so well your expectations! Apologies - bit harsh, but .. 
I found myself short tempered (more than my normal grumpy self) and frustrated by "everything". In a determined effort to improve this aspect I've done some mindfulness training. If you asked me 12 months ago I would have said "mumbo-jumbo; lack of personal responsibility; an excuse. ..." or similar. But now, when I realise I'm getting tense I use the mindfulness techniques and can (or could) see the BG fall, as it happened on my smart watch. Now, temporarily, I have to flash scan (which is irritating and stressful!).


phil90 said:


> I already tried tackling one issue at a time at the start of my diagnosis by building on strategies. For example not exercising initially and trying to figure out my bolus and basal. Then exercising and seeing how things need adapted.


This is commendable, disciplined and frankly the only way anyone can manage up to 42 factors that can affect BG. But this needs years not months, so is inevitably work in progress. Remind yourself DM is a marathon not a sprint and you are still in training for that marathon.


phil90 said:


> I think it could be difficult to start from scratch again but might have to.


You will never start from scratch again. You can't "unlearn" what you now know. But you might find it helpful to try a different method.


phil90 said:


> You eat around the same amount of carbs as myself per day. Do you mind me asking what sort of carbs you eat?


I eat almost anything I want. Twice I've struggled to digest a great steak, so now don't do that and both Christmas lunches have proved to be too much. No panc'y means I'm missing all natural digestive enzymes, so have to take Creon capsules to replace my missing enzymes.



phil90 said:


> Do you pair them with plenty of fat and protein?


I have loads of oil and butter at every opportunity, good dollop of cream with my cereal and in my lattes. I try to consciously increase my protein in my lunches, eg tinned fish etc. I read in Gary Scheiner's Think Like a Pancreas (have you read this?) that if your diet is not deliberately low carb then one needs c. 30gms of carbs in any meal, or your metabolism will start to extract carbs from proteins and this confuses the carb ratios for bolusing. Above 30 gms this doesn't happen. I don't know what the medical explanation is for this; but I have an unwritten 30 gm carb rule! Doesn't apply to snacks; snacks are top-ups without a bolus when the BG trend is falling (when plummeting / crashed - higher GI, eg jelly babies, but still only around 15 gms as an emergency snack).


phil90 said:


> It is crazy how much I ate before that I don't now(or very small amount the odd time). Just all the nice stuff like sausage rolls, sweets, chocolate, crisps etc Could I eat them , probably but takes planning. I find its the spontaneity that diabetes robs, I hate that the most. Being at someone's house and the biscuits or cake comes out, oh no thanks I'd have to dose for that.


Absolutely understood and the loss of spontaneity is potentially stressful. I refuse to let that get to me. 

My circumstances are a little different to yourself: wrong side of 70, pancreatic cancer with dreadful survival stats, major surgery and grateful to be alive. I appreciate that your perspective is pretty different: just turned 30; why me; why isn't this easier/quicker/etc .

But, I eat crisps, along with kit-kats, sausage rolls, twiglets, nuts, dried fruits like figs and dates and generally almost all of the things I used to eat. But usually as snacks, in 10-20 gm portions; which means a good wareness of how many crisps (eg a 25gmwt small bag) or a 2 finger kit-kat rather than a whole chunky. Biscuits are generally between 6-15. Unfortunately a slice of cake does need pre-planning. But when I deliberately set out to get from 15 stone to 12 stone, that too meant change in my lifestyle.

Loss of spontaneity might be lessened if on a pump.


phil90 said:


> Sugar surfing looks like a good way of managing diabetes but I think I need to go back to basics first before trying it.


Try reading Dr Stephen Ponder's book, "Sugar Surfing". I'm 20% in to my recent purchase; not enough hours in the day. So far his premise seems to be we need to try and emulate what our body does (did) naturally, ie provide insulin whenever carbs are eaten and generate or replenish glucose whenever our BG is low. One needs to be on a pump to fully do this; but CGM allows a fair degree of sugar surfing. 

I don't agree with your assessment that you need to go back to basics first. You've already done that, demonstrated with your fabulous HbA1c and tir stats that you've learnt those basics. So now it's a matter of deciding how you intend to proceed .


phil90 said:


> I think for me I've been soo fixated on preventing highs that hypos haven't bothered me as much even though they should.


Agreed; in my opinion you understand where you have the balance wrong. Hypos are bad in all respects: now and for your future health. Hypers can be bad in the longer term, if left unchecked - but that means weeks and months, not 3 or 4 hours.


phil90 said:


> I'd love to get off the low high rollercoaster. By all means any advice you can offer would be greatly appreciated.


With your existing knowledge, no longer a Newbie: 
Use Libre to anticipate and head off hypos; intercept from low alarm near to the max of 5.6. Tiny snack of low GI, eg 1x Nairns oat biscuit at 6gms. 
If hypo check by finger prick before reacting; Libre is not reliable below 4. Treat with 5gms of high GI, eg JBs, if just low and 10 or 15 gms if v low. Be patient, resist the urge to panic and take more carbs; that only leads you onto the rollercoaster. Full 15 mins, retest actual BG, if already recovering wait, no more high GI; otherwise repeat first response.
Once hypo recovery is underway take a further low GI snack to consolidate that recovery; anything from 5-15gms; needs trial and error to find what works for you  
Monitor; once you reach 8 and if trend is still upwards, get moderately active and head off the hyper. For me, after 8 is almost too late. Activity must not be anaerobic, ie not very intense; anaerobic exercise elevates BG (its an innate fight or flight response  where you liver dumps extra glucose to help that fight or flight). Avoid getting stressed, which elevates BG.

The intent is to smooth the rollercoaster into undulations. It's all about control, resist panic; when hypo, you know you are there and that you won't go into a coma if you treat it - but your brain is saying do something, eat more, etc. As you trend towards hyper, intercept and don't ignore it.


phil90 said:


> Yes I'll definitely come back to this thread and update.


You know the theory and have proved you can apply it. But I think you should adjust your expectations. 
Good luck, keep asking if you need further help.


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## trophywench (Apr 30, 2022)

@Proud to be erratic - I haven't concurred 100% with some of the posts you have made previously during your membership here - but I do with this one!  Thank you so much for managing to put it all into written English without missing anything.  

It's so long since I read Gary Scheiner's gift to worldwide T1s that I'd forgotten he reckoned it was 30g carb per meal - I'm another one for whom that works - and as I'm happy with around that level, my motto for everything is if it ain't broke, I won't even bother trying to fix it - but we all have to make friends with our own diabetes and make it live with us comfortably (not sharing MY life with a ruddy enemy!!)

However @phil90 - it took me a good few years to feel really comfortable and that I actually had a decent degree of control.  That state of affairs has only really been the last 20+ years - but a lot of the previous 30 years, none of the current helpful things even existed, so you aren't lumbered by that, so shouldn't take you quite that long, but I can't estimate how long, is all.  

Rome wasn't built in a day - and neither will be your control of your BG!!


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## Deleted member 33898 (May 5, 2022)

nonethewiser said:


> Can only say that I for one didn't find pumping hard work, on the contrary it was big relief from injections & far less hassle,
> 
> Surely if your injecting more to cover meals & having issues with basal insulin then that would be something your clinic should consider with regards to switching to pump, especially as it's all causing you great anxiety.


I'm having to correct for at least one meal everyday and getting up in the middle of the night to correct highs. Does seem to be gradually getting worse. Giving myself until the end of the month before contacting the clinic.


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## Deleted member 33898 (May 5, 2022)

Benny G said:


> Interesting @phil90, achieving 95% TIR (3.9-10) and HbA1c 30 in March. (The _normal_ range for _HbA1c_ is 4 – 5.6% (20 – 38 mmol/mol) in healthy people.) Do you know your glucose control is better than 99% of type 1 diabetics, better in fact than a good percentage of people who don't even have diabetes.
> 
> Let that sink in for a moment.
> 
> You are new to diabetes, and still enjoying the honeymoon, use this time to gather information and practice your skills for the period after the honeymoon.


These ranges are slowly disappearing, which is why I'm getting a bit frustrated. The end of the honeymoon period scares me a bit to be honest. Last clinic visit they said my bloods are great, that was about 2 months ago, and that they want me to prolong the honeymoon period for as long as possible.


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## Deleted member 33898 (May 5, 2022)

rebrascora said:


> I wonder if you are trying to apply Type 2 guidelines to your Type 1. Keeping your increase to just 2 or 3 mmols with exogenous insulin each meal is extremely unrealistic. You might have managed when your own pancreas was helping out but long term, even on a low carb diet you will really struggle to achieve that regularly and you are clearly not committed enough by the sound of it to find an enjoyable way to go low carb.
> What does your Libre Link say your variability is. I am usually about 23-28% variability. I think they like you to be under 50%.
> I am guessing yours might even be under 25%?
> I know when I was first diagnosed I used to shoot up to mid teens after breakfast and then come crashing back down to 5 and that felt rough but dropping 5 or 6mmols shouldn't feel that bad and if it does, maybe you need to give your body time to get used to them because it is normal and even non diabetic people have those sort of increases and decreases sometimes. You are expecting too much of yourself.


Just going by guidelines set out by my consultant. 2 to 3 mmol is what they told me. Variability this week is 20% but average up to high 6s , low 7s. Finding the night time to be the main contributor. I tend to fly up as soon as I fall asleep to 9 or 10 and stay there unless I intervene. I tried increasing basal and instead found I'd go up for few hours and then fly down to hypo by morning. Basal test by skipping dinner revealed I was hypo before bed ( libre readings havent been great for this current sensor) So possibly what I eat.

I definitely get symptoms when my bloods go high, I feel burning sensation in my legs and feet and my eyes sting, then the crash later if it happens.


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## rebrascora (May 5, 2022)

phil90 said:


> Just going by guidelines set out by my consultant. 2 to 3 mmol is what they told me. Variability this week is 20% but average up to high 6s , low 7s. Finding the night time to be the main contributor. I tend to fly up as soon as I fall asleep to 9 or 10 and stay there unless I intervene. I tried increasing basal and instead found I'd go up for few hours and then fly down to hypo by morning. Basal test by skipping dinner revealed I was hypo before bed ( libre readings havent been great for this current sensor) So possibly what I eat.
> 
> I definitely get symptoms when my bloods go high, I feel burning sensation in my legs and feet and my eyes sting, then the crash later if it happens.


I think that either you are misunderstanding your consultant or he/she is setting unrealistic targets if they are expecting you to keep meal rises to 2-3mmols as a Type 1. I am pretty certain that 20% variability is exceptional but you don't really get any awards for being exceptional with diabetes (being good is enough) and maintaining it long term is so hard on you it is detrimental to your everyday life.... and there is no point in living forever if all you live for is exceptional diabetes results. You have to find a diabetes/life balance.
As regards your basal going high when you first go to sleep, I think it may be a timing issue. You are taking a small dose of Levemir once a day before bed so it is likely running out before the next dose kicks in and builds up to full strength. Splitting the Levemir should give you better coverage but may mean that you need to adjust your evening bolus ratio as it is possible that your NR is helping to keep your levels in check as the Levemir wears off. Levemir is probably running out after about 16 hours with that small a dose maybe even sooner. The other alternative would be to try a longer acting basal like Tresiba. I would ask about splitting the Levemir dose first and see if that solves the night time problem.


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## Proud to be erratic (May 5, 2022)

phil90 said:


> I'm having to correct for at least one meal everyday and getting up in the middle of the night to correct highs. Does seem to be gradually getting worse. Giving myself until the end of the month before contacting the clinic.


Phil,
Please clarify at what BG you are correcting in the middle of the night and at what sort of time?

I'd like to be sure you are not over-reacting to the normal nighttime BG changes that can occur. Personally, I would first reassure myself about when I last took a bolus; my NovoEcho pen shows when I last jabbed and how much.

A low Glycaemic Load (GL) meal could be very slow in digesting and its glucose could arrive after the bolus has dissipated. If I suspected that was the case I might then correct and would in future avoid that meal type in the evening.

Otherwise I will only react to a night high BG if at 12 and trending upwards (and even then I'd first check by finger pricking) and also wait 15 mins to confirm that the trend is still upwards; Libre is not reliable above 10 (Abbott acknowledge that and tell you to check by meter for below 4 and above 10) and the trend arrow can change every 5 mins if you are in a period of changing metabolism. Unfortunately we don't have meters for metabolic activity - or rather the nearest equivalent is Libre.

A mild digression: 
apparently your brain is at its busiest during the night;
that your brain only uses glucose to sustain itself and if there is none around it will get proteins converted into glucose to meet its needs; 
finally, that your brain doesn't need insulin to extract glucose from the blood - so BG changes during the night can be your brain doing overtime! Normally your brain sends a message to the pancreas, telling it to send a message to the liver (the hormone Glucagon) which encourages the liver to release glucose from the store. I have no panc'y, so no Glucagon hormone.

There is also the dawn phenomenon, a release of glucose by your liver. This can start much earlier than dawn and be triggered by waking needing the bathroom! When my Diabox CGM was playing I would frequently see this in action.

Our bodies sometimes behave inexplicably: last night c.11.30pm I went to sleep with Libre=8.2, actual BG of 7.4, a little higher than my target of 6, but I didn't correct. I was woken by Libre alarm showing 10.1; I knew Libre was reading high above actual, so ignored it. But now 2am, awake and needing the bathroom; as I got back into bed and a scan now showed 12. I ignored that; at 03.15 Libre showed 9.9; at 6.30am Libre= 9.4, at 8.45am down to 8.4, 9.35 Libre=8.1, actual BG=6.0. I'd done nothing other than shuffle 3 yards to the bathroom; and sleep. Where did all of that BG change come from? Inexplicable to me. But glad I didn't do do any correcting either as I went to sleep or during the night.

And to add to my confusion Libre is now repeatedly reading low in respect of actual BG. As I said in a previous post,  need to stay calm and trust my body as well as actual BGs from finger pricks.


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## Proud to be erratic (May 5, 2022)

rebrascora said:


> I think that either you are misunderstanding your consultant or he/she is setting unrealistic targets if they are expecting you to keep meal rises to 2-3mmols as a Type 1.


I agree, normally those meal targets are used for T2s not on insulin as a mechanism to regulate carbs in each meal. 
With insulin you can eat as many carbs as you wish and bolus accordingly. This can mean a surge into above 10 post meal and the only goal is to get back to the BG just before eating by the time one's bolus has dissipated.
I sometimes use mild activity to help nudge that process.  


rebrascora said:


> I am pretty certain that 20% variability is exceptional but you don't really get any awards for being exceptional with diabetes (being good is enough) and maintaining it long term is so hard on you it is detrimental to your everyday life.... and there is no point in living forever if all you live for is exceptional diabetes results. You have to find a diabetes/life balance.
> As regards your basal


basal ? did you mean BG ...


rebrascora said:


> going high when you first go to sleep, I think it may be a timing issue. You are taking a small dose of Levemir once a day before bed so it is likely running out before the next dose kicks in and builds up to full strength. Splitting the Levemir should give you better coverage


In principle yes, but since Phil is on small Levermir doses and taken in the evening it should be covering the night  and running out mid to late afternoon.


rebrascora said:


> but may mean that you need to adjust your evening bolus ratio as it is possible that your NR is helping to keep your levels in check as the Levemir wears off. Levemir is probably running out after about 16 hours with that small a dose maybe even sooner. The other alternative would be to try a longer acting basal like Tresiba.


Tresiba is where I am, by chance not because I understood then how the change of basal would prove so fortuitous.


rebrascora said:


> I would ask about splitting the Levemir dose first and see if that solves the night time problem.


As above, the small basal dose in the evening isn't covering the night anyway.


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## rebrascora (May 5, 2022)

Proud to be erratic said:


> In principle yes, but since Phil is on small Levermir doses and taken in the evening it should be covering the night and running out mid to late afternoon.


If Phil takes his 5 units of Levemir at say 11pm (bedtime) then his previous basal dose likely ran out mid afternoon but perhaps daytime activity followed by bolus insulin for evening meal are keeping things in check. It will take about an hour for that new Levemir dose to start building up and his evening bolus will have worn off in that period before bed, leaving perhaps a couple of hours where his liver output isn't covered, hence the rise, then if he is injecting a correction right at the point that his new Levemir dose is kicking in, that would cause a crash. That was the way I am interpreting it.

And yes, that should have read BG, not basal.


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## Deleted member 33898 (May 5, 2022)

rebrascora said:


> I think that either you are misunderstanding your consultant or he/she is setting unrealistic targets if they are expecting you to keep meal rises to 2-3mmols as a Type 1. I am pretty certain that 20% variability is exceptional but you don't really get any awards for being exceptional with diabetes (being good is enough) and maintaining it long term is so hard on you it is detrimental to your everyday life.... and there is no point in living forever if all you live for is exceptional diabetes results. You have to find a diabetes/life balance.
> As regards your basal going high when you first go to sleep, I think it may be a timing issue. You are taking a small dose of Levemir once a day before bed so it is likely running out before the next dose kicks in and builds up to full strength. Splitting the Levemir should give you better coverage but may mean that you need to adjust your evening bolus ratio as it is possible that your NR is helping to keep your levels in check as the Levemir wears off. Levemir is probably running out after about 16 hours with that small a dose maybe even sooner. The other alternative would be to try a longer acting basal like Tresiba. I would ask about splitting the Levemir dose first and see if that solves the night time problem.


I'll have to ask them again. I definitely remember asking them to clarify did they mean overall no change between 2 and 3 mmol and they said yes which confused me because before that I was told spiking is fine as long as I get down to reasonable fasting levels before the next meal. 

Yes I need to wise up but finding this very difficult. I've convinced myself if I let up the intensity I'll wind up with terrible levels but then that's where I should be adjusting my expectations anyway. Ahh. 

Yes the consultant thinks my evening bolus is acting like a bridge between my basal running out and the next dose starting. I eat between 8 and 9 every night. Not because I want to but because by the time I get home from work and exercise thats the time I eat. I used to eat first , adjust bolus and exercise but consultant said that wasn't a good idea. 

From numerous basal tests  I've discovered the following, and thats with making sure no bolus in the last 4 hours or eating:

630am to 1pm. Slight rise, sometimes as much as 2 mmol then steady but looks to be foot on the floor 

1pm to 7pm. Start to fall and usually hypo before dinner 

7pm to 11pm . Fall and have hypo before bed. (Though only ever carried this test out once ) 

This is without any major exercise . At most the odd movement whilst in the office all day. This is what I can't figure out. If I'm running out then why do I still go low even when bolus isn't present and basal should be way out of my system.  Makes me think a split dose could make matters even worse. I do think there is something happening with my basal requirement past 11pm though. I thought if I started to take a split dose , with an evening one earlier but problem is this would be close to any exercising.

Or it's my evening meal. Giving out 2 spikes possibly. Though surely I wouldn't get a first spike at all and instead go low. And then the delayed spike would make sense. But I'm finding it can start anytime between 12 and 3am. Example from today. I corrected eventually with 1 unit. You'll see the rest of the day is good as I've been working on bolus plus I find when I eat breakfast late which I don't get the opportunity to do during the work week often, I don't spike as high. 



@Proud to be erratic 
Thank you for your recent replies. Sorry to hear about your illness. All your info is helpful, alot of what I know already but hearing it in practice with a normal diet is reassuring. I've read both those books you mentioned, both helpful but alot of info to digest. The brain using protein in the middle of the night is interesting. Most of my meals are high protein, perhaps I have alot floating about and my body is converting it then ? And of course by that stage there isn't much insulin to take it from my blood ? I could be talking non sense here. I actually wake every night to pee, which is very annoying. And then I'll notice the high glucose aswell. It would be great to have a full night's rest, been a long time. I don't think I could ignore glucose levels sitting above 9 all night. With no meals it's the perfect time to get lower and steadier levels for as many hours as possible, almost like a cleanse. But that has been very difficult lately. I've also had trouble with sensors in the past, about 4 failed since using libre since July last year. I was linked instructions by a forum member to calibrate readings on a patched app but haven't bothered yet. I may check out the diabox app you mentioned.


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## Benny G (May 5, 2022)

phil90 said:


> (snip) Brain using protein in the middle of the night is interesting.





phil90 said:


> Most of my meals are high protein, perhaps I have alot floating about and my body is converting it then ? And of course by that stage there isn't much insulin to take it from my blood ? (snip)


The brain uses glucose or ketones at night, neither of which require any insulin to provide transport to the brain. 

Dietary protein is difficult to breakdown and digest, depending on your meal's ingredients, I would not expect protein conversion to raise glucose levels until at least 3 hours after eating, and could still be busy at the 6 hour mark. If your meal contained both high protein and high fat your digestion would take even longer with the glucose rise from conversion being noticeably delayed and extended for multiple hours. (The well known pizza effect) 

The body does not store dietary protein, it either gets used for a job in the body or it gets converted into glucose. 
If you are eating a high protein meal at 9 pm it could well be the conversion of that meal nudging your glucose levels up until 3 or 4 am. 
Do you usually bolus for the protein a couple of hours after your meal? That would be the bolus to nudge.


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## Deleted member 33898 (May 5, 2022)

Benny G said:


> The brain uses glucose or ketones at night, neither of which require any insulin to provide transport to the brain.
> 
> Dietary protein is difficult to breakdown and digest, depending on your meal's ingredients, I would not expect protein conversion to raise glucose levels until at least 3 hours after eating, and could still be busy at the 6 hour mark. If your meal contained both high protein and high fat your digestion would take even longer with the glucose rise from conversion being noticeably delayed and extended for multiple hours. (The well known pizza effect)
> 
> ...


I've thought about the problem being protein, though some nights when I have less protein I'll still see the rise. I tend to keep the fat content down below 30 and if it's not I'll split the dose. Maybe it's high protein paired with certain foods as you say depending on the ingredients. I have seen a pattern of higher levels overnight after eating rice or pasta. Just need to sit down and record all what's going on with those nights and see if there is a definite link between them. 

I don't consider bolus for any protein in the meal unless it was over 60g but I have had meals with 60g in the past without extra insulin and no problems over night. There are takeaways I dose a certain amount for and usually give additional insulin before bed and sometimes the middle of the night but that was through trial and error. 

I don't want to give up rice and pasta but results might bring me to stop. And the higher protein meals i have for definite on my two workout days, though I'm maybe just not working out enough to make use of the protein. Generally hit between 100 to 130g a day. I know that might seem excessive but the dietician didn't have an issue with it.


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