Freestyle Libre teaching me sooo much about my T2 and RH

[Brunneria]

Hi All,

I have posted this in the RH (Reactive Hypoglycaemia) forum, because i think it might be interesting to fellow RHers. No idea if it will be of any interest to anyone else!

I got the Libre on Monday (early xmas pressie to self). I am thinking that the wee graphs are going to be fantastically motivating over xmas.

In case anyone doesn't know, the Libre is a widget that sticks to your arm and reads the glucose level in the interstitial fluid under the skin. For me, as an unmedicated T2, it is less about the numbers and more about the peaks, troughs and the speed of the highs and lows, allowing me to understand the effect my current eating has, and how to tweak it in future.

I consider myself well controlled (by very low carb/usually ketogenic diet) and until i saw these graphs, i thought my RH was virtually a thing of the past. Turns out, even as a T2, it is still going strong.

Screenshots and comments to follow.

Day 1



The blue zone is my self-selected target range. I have chosen 4.5-7.5 for my range.
Note the low point at 2am? And the subsequent rise?
That is a 'low' of around 4mmol/l it isn't a hypo, but it did trigger a liver dump (the rise) that takes me up to over 6mmol/l and jiggles around, up and down for the rest of the night.

As you will see, a variation of this happens nearly every night.

The gentler curves between 6am and midday are due to a coffeencream for breakfast followed by a 9bar

The hump at 1pm is from hummus, eaten as lunch, with a teasp.

The lower carb supper 7pm onwards, had protein and green veg. So v slow release carbs

Lesson for the day:
All readings were in my target zone
But the carbs in the 9bar and the hummus definitely resulted in lower bg at the end than at the start.
= Very mild RH reaction.
If i had eaten more carbs, the RH reaction would have been bigger.

 

[Brunneria]

Day 2.

The gentle drop at midnight-2am is after 2 tsp peanut butter at 11pm.
The minihump at 4am was an emergency trip into the garden with a dog with diarrhoea. Mini liverdump quite understandable, in the circs!
The high at midday was the effect of 2 (yes, just 2!) milk choc digestives. All in the interest of science, you understand.
Lunch and dinner were both VERY low carb, but that biscuit high left me unstable for the rest of the day = knock on effect, in action!

Lesson for the day:
Biccies are bad news and have a knock on effect!

 

[MellitusTrap]

It's a great tool for someone with RH!
The best bits probably are
- being able to know if you are having nighttime hypos - actually just knowing what is happening to you at night
- knowing if your number now (say 4mmol/L) is trending up or down
- being able to test as many times as you want

Con
- shame one can't alter the Y axis gradient (so the top was 12 or 15 and not 21)
- £50 a sensor (about £100 a month)

 

[Brunneria]

Day 3

A much steadier day. Managed to resist any scientific experiments today
Until i got too hungry before evening meal, and ate 1 biscuit (10g carbs approx, i think) while preparing the food. The meal was vlc, but that 1 biscuit bounced me right up to top of my range. Should have had a slice of cheese, instead.

Lesson for the day:
No signs of RH at all. Presumably because of staying vlc, and burying the biscuit under my evening meal.

 

[Brunneria]

It's a great tool for someone with RH!
The best bits probably are
- being able to know if you are having nighttime hypos
- knowing if your number now (say 4mmol/L is trending up or down
- being able to test as many times as you want

Con
- shame one can't alter the Y axis gradient (so the top was 12 or 15 and not 21)
- £50 a sensor (about £100 a month)

Absolutely. The cost is prohibitive. I can't possibly fund it the whole time.

At the moment, i intent to use a sensor (£50) maybe 4 times a year.
It should highlight any carb creep, and help keep me on track during holidays.

 

[MellitusTrap]

The high at midday was the effect of 2 (yes, just 2!) milk choc digestives. All in the interest of science, you understand.

LOL

 

[MellitusTrap]

It also struggles to give accurate blood sugar levels once you have gone into hypo - preventing you from knowing how hypo you are

 

[Kaz261]

That looks like a brilliant tool for RHers. I'm sure we would all be very surprised by some of the results. I'm not sure I would want to know what's happening while I'm asleep. Just working on the basis of what you don't know, you can't worry about! I'm sure that's just me though!

I've just had a quick look online and it is a bit on the pricey side, but for some intermittent testing and ensuring you stay on track during holidays etc, it's brill. I may have to speak to my husband very nicely

 

[Brunneria]

I will post 1 more day, then leave you in peace - i just thought you might be interested to see my bg 'in action' as it were, over several days.



Day 4

Note the usual low and liver dumps during the night.
The 6am surge was another emergency dash to the garden with a dog.
The 3pm spike and drop was a small (very small) portion of homemade pork and cider stew, with homemade cauli cheese.
See the RH reaction?
No idea how many carbs were in it, but i wouldn't have expected such a spike.
The evening meal was vlc again.

As @nosher8355 always says, we are better off fasting, than eating the wrong things - as soon as we go 'off piste' it is downhill from there!

Lesson for the day:
Don't assume that your spikes will be predictable!
And
Don't even start with the carbs!

 

[Brunneria]

Overall lessons (so far):

- basic diet is fine
- its the discrepencies that are causing the spikes
- even these spikes are OK. They don't trigger bad hypo RH reaction, they last less than an hour, and are back in target before 2 hrs. But bear in mind, these are SMALL carb doses. I rarely go above 50g carbs a day, because the moment I do, RH comes back in all its horrible hypo hell glory.
- the nightly lows, liver dumps and dog poo trips are kind of surprising. Dawn phen and stress hormones are throwing a party.
And
Apart from switching to a very low carb diet, i think this may be the best thing i have ever done, to inform my T2 and RH

 

[Kaz261]

Thanks for sharing your results. It's very interesting to see the results of a person who is on the whole, very well controlled. I shudder to think what mine would look like

 

[Brunneria]

Lol.
Actually, i have just had a look at these graphs again, and decided that i look rather like a goody-two-shoes with my 'in range' numbers.

- no proof at all that i would spike with high carbs, is there?

Tell you what, one day, over xmas, i will eat a couple of mince pies and post the results.
Just to prove how bad it can get.

 

[Kaz261]

I think that's called "taking one for the team"! All in the name of science though. Would definitely be interesting to see those results, but not worth risking a hypo for!

 

[AndBreathe]

It also struggles to give accurate blood sugar levels once you have gone into hypo - preventing you from knowing how hypo you are

Do you mean the graphs don't help you identify the extend of a hypo using the Libre, or something else?

The Libre allows the download of the background data, which gives a summary sensor reading every c15 minutes. It also has a built in meter, for strips, if you choose to use it in preference to a standalone meter.

I routinely go low overnight,msometimes to levels that might alarm some. I have, once or twice, done a finger prick test on the back of a sensor scan revealing a very low number and (provided it's a decent scanner) the score has been pretty close. Due to the differences of blood v interstitial fluid, and timings, there can be variance. I'm guessing that would be so where bloods were either screaming upwardly or downwardly.

It doesn't replace finger prick testing for anyone who needs to comply with DVLA rules, but for some of,us it certainly has helped fill in some blanks in our personal knowledge.

 

[AndBreathe]

I would also love to be able to calibrates both axis more tightly.

 

[Linagirl]

This is really interesting Brun thanks for sharing. I will definitely look into this x

 

[Lamont D]

Wow Brun, what a bit of kit!
I'm writing to Santa and asking him to change my pressie for chrimbo!
I want one, can't afford one!
Gonna have a word with my GP or endocrinologist to sponsor a test!
Do you think they will go for it?

Brun, never mind the experimentation, the results show that the importance of doing low carb and the good effect it has on blood glucose levels. Also on how control is so important!
Would love to do a fast with one of them on!
Would like to be a guinea pig for testing for my gliptin as well, even do a glucose test, just to see!
Definitely piqued my interest!

Thanks for sharing, really interesting study!

 

[Lamont D]

Wow Brun, what a bit of kit!
I'm writing to Santa and asking him to change my pressie for chrimbo!
I want one, can't afford one!
Gonna have a word with my GP or endocrinologist to sponsor a test!
Do you think they will go for it?

Brun, never mind the experimentation, the results show that the importance of doing low carb and the good effect it has on blood glucose levels. Also on how control is so important!
Would love to do a fast with one of them on!
Would like to be a guinea pig for testing for my gliptin as well, even do a glucose test, just to see!
Definitely piqued my interest!

Thanks for sharing, really interesting study!

 

[Brunneria]

you know, @nosher8355

It occurred to me, this evening, how amazingly simple it would be to use this as a diagnostic tool for RH.

Stick a sensor on someone.
Send them off for a fortnight, with instructions to download their readings every 8 hours, and keep a food diary, with instructions to eat carbs.

One glance at their daily graphs, and you would instantly see whether their readings were consistently lower after food.

Simples.

So much cheaper than taking up a hospital bed for 72 hrs for an OGTT.

 

[Lamont D]

Totally agree!
The data storage could be invaluable and I'm certain, a lot of good information and knowledge could be got from something so simple.
The cost of someone staying in hospital for glucose or fasting tests is enormous, never mind the disruption and actually being in hospital. From my stay, I definitely wouldn't recommend it!
I think I might phone my specialist, as if he wants more data for his paper!

It would have been so much easier to use the sensor when first diagnosed. To show what certain foods do to you!