A T2, Libre self funding, "What is going on?" thread with keto

[LittleGreyCat]

My latest Libre has expired and I haven't started a new one yet (last of existing stock).

I am going to start this one soon because I have a review with my DSN next Monday, but I am seriously considering how frequently I should use a Libre.

When I am wearing one there is an almost obsessive need to scan at regular intervals, and also to fret over the irrational things that my body does.
However I do get a clear picture of what is going on, and a continuing reminder of the impact of impulse eating/drinking.

On the other hand I have probably got a lot of information to digest, and perhaps I don't need to constantly monitor.
Also, this is a £100 a month habit which is non-trivial and I wonder if this will continue to give value for money.

One Libre a month?

Once every 6 weeks?

Noting in passing that (having finally got round to trying to analyse the downloaded data in a spreadsheet) it is important to note in the log the start and end times of each sensor.

 

[Bluetit1802]

I have just finished my 17th sensor. I find I don't need them anywhere near as much these days because very little changes. Same old, same old. I like one leading up to my HbA1c tests, and I like one on holiday, so I tend to stick to those times now, although we go away 6 times a year, so that adds up.

 

[LittleGreyCat]

Well, this is disappointing.
My HbA1c came in at 6.6% when LibreView was predicting nearer 6%.

That is not a terrible result, as before my excursion to 7.2% my previous result was 6.4% but I expected to be down in the pre-diabetic range.

Beer is always my downfall, but I need to look at other aspects such as the extended Dawn Phenomenon as well.

Medication review here I come. :-(

 

[Bluetit1802]

So sorry you are disappointed, I understand your disappointment.

Methinks you need to start drinking red wine or find very low carb beer, sugar free. Says me, with a large glass of red at the side of me. When do you drink your beer? Is that affecting the DP?

 

[LittleGreyCat]

Mostly drink beer late afternoon early evening.

However it can cause a short spike then a deep dip so it may not (always) be the culprit.

This Libre is asking more questions than it is answering.

 

[Bluetit1802]

However it can cause a short spike then a deep dip so it may not (always) be the culprit.

But can it be a culprit if you have a tendency towards a fatty liver, depending on the level of actual alcohol in the drinks?
I'm thinking "beer belly" here. Fatty livers aid insulin resistance. Could be way off track, as usual, and just a thought.

 

[LittleGreyCat]

Well, not beer belly.
I'm 0.8 lbs off my very long term target of 11 stone 7 lbs which was my weight in my late teens.
I am also 1" off my target of a 32" waist (I think that was measured at the school medicals at the same time).
So I think I have more or less shifted any visceral fat by now.

However it may take some time to see any recovery in the pancreas.
I think I must still have insulin resistance but where it is coming from is a bit of a puzzle.
Not much fat left, and I have been doing enough cycling to build up new leg muscles which in theory should have reduced IR quite a bit.

 

[CL_in_NZ]

I check in here every once and a while but have a few libre thoughts/observations to pass on. Since my initial diagnosis a couple years ago all my hba1s have been back to normal. I wore a few libres over the first year but they quickly got boring as they were mostly straight lines (except for some things I will discuss below) I recently (this month) wore another as while I mostly eat low carb I wanted to see what my occasional lapses did. First libre in a year.

My observations about the libre are

• Heat raises BG readings, be it shower, a jacket or possibly exercise
• Going from a sitting/ laying down position to standing raises BG readings for me
• Above increases tend to disappear or get smoothed out if I wait to scan after the activity, 10 minutes for change of position or about an hour after a shower or exercise
• Sensors seem to vary day by day
• None of my sensors (5) have accurately predicted my hba1c, closest was still off by 5 points
• I don't pay any attention to the specific numbers now I just look at changes in relative position of the line by time and activity. e.g. where am I two hours after eating a burger vs before.

I have also found that when I eat something with more carbs then normal (~30sih of a refined carb like grain/sugar) for a meal my BG goes up slowly and tends to sit there for a while (say edge to 8-9 for an hour then down slowly over the next hour. If I eat a large amount of carbs say a burger, fries, craft beer my BG tends to shoot up to the 10s but then drops fast (4-5 points in 30 minutes) and stays on the low side for a while after that. This was an eye opener to me as I assumed more carbs would result in higher BG and that was not the case.

Just a few thoughts. Cheers

 

[Listlad]

Update:

I am coming to the end of my first sensor (Tuesday now, finishes on Thursday).

My main initial finding is that the Freestyle Libre has forced me to re-evaluate my diet.
"A little bit of what you fancy does you good." is patently untrue.
"Just a little bit won't hurt this once; I can cope with a few extra carbs." is also not accurate.
"A beer now and then is fine." also looks to be wrong.

Preconceptions (which seem supported by general discussions on this forum) seem to not always apply to me.

Some things I have identified:

• I seem to have a very extended dawn phenomenon some days which can carry on until about noon.
• My go to keto coffee+butter+cream also seems to spike me in the mornings, which goes against what I expected. Cream at 1.6 grams of carbohydrate per 100 ml shouldn't in theory do this.Butter at 1.8 grams per 100 gms likewise. I'm still trying to work out if it is the coffee. Decaf test soon.
• Prolonged exercise seems, under certain conditions, to raise and keep up my BG levels. This is a real puzzler.
• In general I can tolerate beans and pulses, even half a tin of Heinz Baked Beans (normal version)

My general graphs suggest that I may be over producing glucagon which stimulates the release of glucose into the blood and inhibits the release of insulin. Further study needed.

The most striking change is that the Libre is acting as the voice of my conscience.
I can't kid myself that a treat is OK because the graph shows me that it is not.

One interesting thing is that cutting out all beer (but not all alcohol) plus occasional days off the fat fest in the morning seems to be bringing my weight down.

I have now just reached my all time best of 11 stone 10 lbs without the major pain of water dieting or anything else extreme. I hope that the weight is mainly coming off my waist.
I have certainly dropped below a 36" waist and if I stand just right with the light behind me I can measure my waist at 34".

I haven't been vastly scientific about this during the first two weeks, like keeping a detailed food log, but have mainly concentrated on identifying trends.

My sensor readings are consistently low, but in the second week they aren't as different from the finger prick readings as they were initially. They now seem to be around 0.7 mmol/L low instead of about 1.5 mmol/L in the first week.
The main challenge is to wait for a period when the Libre readings are more or less constant (flat line on the graph) and then do some finger prick testing.

Summary: this is proving to be well worthwhile despite the expense.

Footnote: I just bought two more sensors from Asda which turn out to have a slightly earlier expiry date than the first batch of three. February 2020 as opposed to March 2020. Go figure.

Somehow I missed this thread.

I posted in a seperate thread some time back, with the idea of seeking to experiment in the way you have. The thread didn’t gain any traction. However your thread has so thanks for posting. A very interesting and informative account.

 

[Listlad]

My observations about the libre are

• Heat raises BG readings, be it shower, a jacket or possibly exercise
• Going from a sitting/ laying down position to standing raises BG readings for me
• Above increases tend to disappear or get smoothed out if I wait to scan after the activity, 10 minutes for change of position or about an hour after a shower or exercise
• Sensors seem to vary day by day
• None of my sensors (5) have accurately predicted my hba1c, closest was still off by 5 points
• I don't pay any attention to the specific numbers now I just look at changes in relative position of the line by time and activity. e.g. where am I two hours after eating a burger vs before.

I have also found that when I eat something with more carbs then normal (~30sih of a refined carb like grain/sugar) for a meal my BG goes up slowly and tends to sit there for a while (say edge to 8-9 for an hour then down slowly over the next hour. If I eat a large amount of carbs say a burger, fries, craft beer my BG tends to shoot up to the 10s but then drops fast (4-5 points in 30 minutes) and stays on the low side for a while after that. This was an eye opener to me as I assumed more carbs would result in higher BG and that was not the case.

Just a few thoughts. Cheers

Do you think it is possible that the temperature affects the sensor and therefore the reading, as opposed to your blood sugar levels? It could be that the output is not adjusted for any temperature changes.

 

[CL_in_NZ]

Do you think it is possible that the temperature affects the sensor and therefore the reading, as opposed to your blood sugar levels? It could be that the output is not adjusted for any temperature changes.

Yes I don't believe the temperature related readings. If I scan right after a shower I see the bump. If I wait an hour I can barely see it. I think the software on the scanner corrects it but suspect it works differently once in the reader as it clears from the sensor. I found a really informative blog post on this a year or so ago as it was really bugging me. I ignore it now and a scan less frequently.

 

[LittleGreyCat]

@Listlad @CL_in_NZ
On the temperature thing.
I see a short blip when I have a hot shower.
However the readings I get when exercising are different depending on the time of day. Big rise if it is the morning, drop if it is the afternoon. So probably not mainly temperature related.

Again time of day related, but in the afternoon a carby meal or drink has a sharp up and down, often ending up lower than the start, but a protein snack seems to have a long low slow hump.

There are outliers, of course, like the other evening when we had fish and chips with friends and I managed to eat a few chips without a spike.

One message to myself is that although my HbA1c at 6.6% is considered good by my HCPs I am seeing spikes up into the 12s at times.

 

[CL_in_NZ]

@Listlad @CL_in_NZ
On the temperature thing.
I see a short blip when I have a hot shower.
However the readings I get when exercising are different depending on the time of day. Big rise if it is the morning, drop if it is the afternoon. So probably not mainly temperature related.

Again time of day related, but in the afternoon a carby meal or drink has a sharp up and down, often ending up lower than the start, but a protein snack seems to have a long low slow hump.

There are outliers, of course, like the other evening when we had fish and chips with friends and I managed to eat a few chips without a spike.

One message to myself is that although my HbA1c at 6.6% is considered good by my HCPs I am seeing spikes up into the 12s at times.

I am much more inclined to believe the exercise bumps, I suspect some of the bump is heat related though and waiting for an hour to scan seems to reduce whatever I see.

Hope the libre helps you find some things you can change up. The one thing it did help me with initially was with really intense exercise, that was the only thing I was doing that really made my levels go up that I could control. I stopped pushing as hard and I could see the difference, later on it seemed to go away. I never could figure out if that was something with me or the sensor though.

 

[LittleGreyCat]

@Listlad @CL_in_NZ
On the temperature thing.
I see a short blip when I have a hot shower.
However the readings I get when exercising are different depending on the time of day. Big rise if it is the morning, drop if it is the afternoon. So probably not mainly temperature related.

Again time of day related, but in the afternoon a carby meal or drink has a sharp up and down, often ending up lower than the start, but a protein snack seems to have a long low slow hump.

There are outliers, of course, like the other evening when we had fish and chips with friends and I managed to eat a few chips without a spike.

One message to myself is that although my HbA1c at 6.6% is considered good by my HCPs I am seeing spikes up into the 12s at times.

I had a gentler start today - pootling about then stopping for about an hour - and didn't see the same steep rise.
After mid-day the ride picked up and I rode around 15 miles at a good pace but my BG level had already started to fall and kept on going down.

So as far as I can tell, if I have coffee, cream and butter in the morning (around 7-9) and then go for a vigorous bike ride before mid-day I get a large BG peak.

I must recheck if I still get the peak without the coffee. I think that I do.

 

[LittleGreyCat]

Puzzling results yesterday afternoon, overnight and this morning.

BG down in the 4s and 5s and staying there.
No DP or peak from the coffee, cream and butter.

Yesterday I ate one main meal early afternoon of cabbage, bacon, grated cheese and two eggs. Oh, and some garlic. However I have had this before so it isn't anything special.

I have now had three full days of 4 * 500 mg Metformin, up from 3 * 500 mg, and Metformin is supposed to reduce IR and also the release of glucose from the liver.

It can't be that simple, can it?

Very early days, but an atypical response in a good way is just as confusing as unexplained BG rises.

Next thing is some finger pricks to cross check the results.
Even so, I am looking at trends more than absolute values.

 

[LittleGreyCat]

Finger prick suggests that the sensor is accurate.

 

[becca59]

Puzzling results yesterday afternoon, overnight and this morning.

BG down in the 4s and 5s and staying there.
No DP or peak from the coffee, cream and butter.

Yesterday I ate one main meal early afternoon of cabbage, bacon, grated cheese and two eggs. Oh, and some garlic. However I have had this before so it isn't anything special.

I have now had three full days of 4 * 500 mg Metformin, up from 3 * 500 mg, and Metformin is supposed to reduce IR and also the release of glucose from the liver.

It can't be that simple, can it?

Very early days, but an atypical response in a good way is just as confusing as unexplained BG rises.

Next thing is some finger pricks to cross check the results.
Even so, I am looking at trends more than absolute values.

The results of your exercise the previous day. Your muscles continuing to call for glucose. On insulin you have to take this into consideration.

 

[LittleGreyCat]

The results of your exercise the previous day. Your muscles continuing to call for glucose. On insulin you have to take this into consideration.

Well, yeah but nah but.....

I do exercise regularly, and I have even recently ridden across the Netherlands to Germany over four days.
So I do have a reasonable baseline of what my body does with regards to BG and exercise.
If you look up thread you can see that exercise in the morning has caused my BG to spike very high.

Also, my muscles aren't calling for glucose because I am keto adapted and they are running on ketones.
My tentative explanation for BG rises in the morning during strenuous exercise was that my liver was releasing glucose but my muscles were ignoring it because they were running on ketones. So the BG had nowhere to go because the glucagon was inhibiting insulin production.

I am now wondering if the extra Metformin has inhibited glucagon production just enough to kick DP on the head.
We shall see.

 

[LittleGreyCat]

Someone just liked a post up thread which lead me back to this.
Worth reading again.
I may update in a while.