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

[LittleGreyCat]

I received a polite request to start a separate thread about self monitoring with the Freestyle Libre, to avoid information being lost in another thread.

I've started it here because it covers so many areas; LCHF/keto diet, exercise, BG monitoring to name but three.

My normal regime (when I follow it) is coffee with butter and cream first thing, and usually one meal late afternoon. Minimal carbohydrates and nothing during the day is almost fasting, right? I checked when I started this, and occasionally afterwards, and I am making ketones so I should be in nutritional ketosis.

Weaknesses - many, but includes beer and a single malt before bedtime. Also a belief (disproved) that my body can handle the occasional hit of carbohydrates such as bread.

So here goes:

I am a long term T2 and have managed for about 11 years on diet, exercise and Metformin.
I went off the rails diet wise around December 2018 and my following HbA1c was over 7 which is not good news.

I set about being much more strict with my diet, but was getting inconsistent test results from finger prick tests, so I eventually decided to self fund Freestyle Libre for long enough to try and establish what was going on in trends, and where I wasn't finger pricking.

For example, what does my BG do overnight when I am sleeping? Last thing at night and first thing in the morning only give you spot checks; there is no real indication what is happening the rest of the time.

Testing before and two hours after eating; so what happens in the meanwhile? Do I peak early, late, not at all? One thing continuous monitoring might show is exactly when I should be testing to measure the impact of meals.

I go on long(ish) cycle rides; around 25-30 miles just fuelled by the butter and cream in the morning coffee. Sometimes I have low BG readings at the end, but sometimes quite high. Is my BG dropping and my liver dumping? Or what? I should be fuelled by ketones and need very little glucose so why isn't my BG always in the 4s and 5s after a 3+ hour ride.

With such a broad ranging topic I will post individual bits just looking at one particular aspect so as not to lose stuff in a single massive post.

 

[Rachox]

I shall watch with interest, as I too have only ever tested with finger pricks, fasting, before and 2 hours after meals then bedtime. Less finger pricks now as I’m 2 years from diagnosis. I do wonder what happens overnight but have never fancied waking up just to find out!
My HbA1cs have been consistently non diabetic but know there could be highs and lows within that. I have thought about trying a Libre once or twice to find out for sure, it’s just they are so expensive

 

[bulkbiker]

This will I'm sure turn out to be a very interesting thread.. please keep it going and let us know what your findings are.

 

[LittleGreyCat]

First couple of points, purely on the Libre.

(1) The changes in BG levels in the interstitial fluid lag behind the changes in the blood. So you end up looking backwards to what you did 20 minutes or so ago to try and explain what the reading means. Going up may mean you are now going down and vice versa. Steady state for over an hour does tell you something, though.

(2) My first Libre sensor seems to be reading about 1.5 mmol/L lower than my Freestyle Freedom Lite finger prick BG meter. I am (reasonably) confident that the BG meter is accurate because I have been using it for over 10 years now and I have seen both high and low readings. The Interstitial Fluid Glucose meter (IFG?) is at least consistent. The depressing bit is that I would be reasonably happy with the IFG readings. Adding 1.5 does not make for happy reading.

 

[LittleGreyCat]

Depressing but informative day yesterday.

My BG readings have been all over the place in unexpected ways so I did the nearest I could to a baseline day yesterday. [Look into the future down thread for explanations of that.]

No Bullet Resistant Coffee in the morning.
Drinking only spritzers ( a small amount of white wine topped up with fizzy water) and a cup of green tea.
Ham and eggs at around mid-day.
BBQ of two Tesco burgers, tomato and onion topped with wilted spinach.
No, ah say no, booze not even a small snifter before bed.

In relative terms the line was as flat as a pancake.
No peaks, no troughs.
[I was going to post an average but I can't see how to find this at the moment, apart from in the LibreLink App for the current day.]

Today I added back the morning coffee with butter and cream and I can see a minor peak which seems to be dropping back again.

Started at 6.4 on the IFG meter at 09:00, went up to 8.8 two hours later, now back down to 5.9 after nearly another two hours.
This peak is higher than I went all day yesterday including after the evening meal.
So the BRC is raising my BG when I expected it to keep it flat or lower it.
This may be the end of BRC for me.
Possibly substitute a cooked breakfast?

 

[bulkbiker]

So the BRC is raising my BG when I expected it to keep it flat or lower it.

How much cream? And maybe try it at another time of day? It might be the caffeine hit early in the morning?

 

[LittleGreyCat]

How much cream? And maybe try it at another time of day? It might be the caffeine hit early in the morning?

100-150 ml (which is quite a lot). Less if my partner makes it.
Caffeine is also a consideration, although I might struggle to drink cream and butter without the coffee.

This illustrates what I was coming back to post.

As a Scientist by early training (looking back about 50 years now) and a subsequent tester of IT systems from time to time I learned to only change one variable at a time.

This does put me under major time constraints to be able to get meaningful data.

For example, if I want to test the effect of a single apricot on my BG I need to wait for a steady state, eat the apricot, and then avoid anything else apart from a drink for about the next 3 hours (which seems to be my spike duration according to the IFG meter) to see what happens. If I eat or drink anything but my spritzer then I can't tell what is affecting the result.

To investigate the BRC issue further I need to:
(1) Wait until later (afternoon?) to try it
(2) Start the day with just black coffee
(3) Perhaps have two coffees instead of my usual one spread out through the day.

This is at least a couple of days testing, possibly more if I get anomalous results.
Possibly I could do it all in one day; coffee, BRC later in the day, but then I am mixing more than one variable.

Depending on how many different combinations I need to test (BRC followed by a carbohydrate snack an hour later, perhaps?) I could have a month or more of testing just to sort out what does what to me and if it is consistent. This includes things like beer, wine, whisky, baked beans, soft fruit (with and without cream), cheese (with and without biscuits).

I expect that most of my guilty pleasures will be ruled out.

 

[shelley262]

Interesting thread - especially as I’m in same position as using a libre forfirst time. My first 14 days finishes at end of this week but planning to put a second one on after this to get a full months worth of data. It’s fascinating to see just how my body reacts to different things eg fasting, stress, exercise and sleeping plus of course what I eat - for example learnt what I kind of guessed that any ‘peaks’ for meare often almost 3 hoursafter first bite and so if finger pricking after a meal should be doing after a longer period. So although my monitoring line dosent shift much it’s interesting to see what lowers and highers it.
For me luckily my finger pricks correlate quite closely to the libre in readings so now not doing finger pricks to check as I am now diet controlled only no meds so can rely on it. Overtime I may well ditch finger pricking and just use one sensor per month for a while to give me detailed info. Each sensor minus vat is 48 fromAbbott so more than a months strips but for lack of pain and amount of info for me worth it certainly based on what I’ve learnt so far.
I was very concerned that it would restrict my swimming as go regularly but had advice from forum and bought a waterproof covering which seems to be doing the job. I dokeep belowthe 30 mins recommended maximum though.
Like you @LittleGreyCat im enjoying trying things out. I had reduced my finger pricking anyway after now nearly two years of keto eating and similar readings and low hbaca1s but hadn’t quite realised how much my bg goes upand down albeit- for me - within quite a narrow range.
Look forward to reading your findings and hope it’s a useful tool for you.

 

[LittleGreyCat]

Well, the coffee experiment is going well.
A small blip but down low and steady at 4.8 (probably 6.3) which is more what I expected from OMAD and fasting.

I've just started my first "beer experiment" by having one of my favourite beers before we get to the BBQ which is cooking.
Slow start to any ramp up, but we shall see what the next half hour brings.
I must remember the time lag when looking at the readings.
25 minutes ago from starting the beer but the IFG meter may only be 5 minutes in.

 

[LittleGreyCat]

Updated to add that I'm trying to use Glimp as well ass LibreLink.

I do seem to have both reading the sensor but Glimp appears to be reading lower than LibreLink which (up to now) has been reading lower than a finger prick.

 

[CondorX]

Also watching with interest as my situation is similar........fortunately I have no interest in beer or other alcoholic drinks! I have had two sensors now and am currently trying to get Spike installed so I can "upgrade" my next sensor to a CGM instead of just a Flash monitor......I managed to get a Miaomiao. Will post up a thread once it is up and running. I found my first sensor seemed to consistently under read compared to glucometer, the second one seemed to be very sensitive to stress levels and would go up very quickly if I was stressed......

 

[Seacrow]

Me Three! First sensor still in the arm, haven't downloaded LibreView yet, but saw DSN this morning. She downloaded my data, we looked at it... OMG. It looks like a mountain range. There are no flatish plateaus, very few gradually changing regions, and the rest is steeply up or steeply down. Range 4 - 21mmol/ml. Testing 2hrs after meals was giving me results in a reasonable range, but giving me absolutely no idea that the past hour my bg had been free-falling from a height of 21, and the drop wasn't stopping until I hit 5 or 6.

So, one basal adjustment, one bolus/carb sensitivity adjustment, and we shall see...

Are you all using a mobile phone with the Libre? I don't have a mobile, so I'll be sensor-to-computer uploading. I _think_ it's just a matter of downloading something from the webpage, but, again, I'll see what happens.

 

[Bluetit1802]

I don't use a phone. I have the reader, and I don't use any fancy apps. I just use Libre View. I can look at the graphs on there whenever I want, and I can download the full data of all the 15 minute readings, which speak for themselves. This is my 16th sensor and apart from a faulty one that Abbott replaced, this is the first one to read higher than my Accu Chek, but not substantially. This last sensor finished this morning, and despite it reading higher than my meter it is giving me an estimated HbA1c of 32. Laughing out loud about that. I should get my lab results tomorrow and I will lay my life on the HbA1c being in pre-diabetic levels. We shall see.

 

[LittleGreyCat]

<snip>

Are you all using a mobile phone with the Libre? I don't have a mobile, so I'll be sensor-to-computer uploading. I _think_ it's just a matter of downloading something from the webpage, but, again, I'll see what happens.

As far as I know you can't "sensor to computer" upload.

You have to read the sensor at regular intervals (8 hours or less) using a dedicated reader from Abbott or a mobile phone.

With the reader from Abbott you will need a special USB lead, and you will need to download USB drivers but the LibreView web page takes care of that for you the first time you try and upload the information.

With a mobile phone the data is automatically uploaded to Abbott and then you can see it on the LibreView website.

If you had to go to your nurse to read the sensor data and look at it, it sounds as though you may not have the Abbott reader.

 

[Deleted Account]

Updated to add that I'm trying to use Glimp as well ass LibreLink.

I do seem to have both reading the sensor but Glimp appears to be reading lower than LibreLink which (up to now) has been reading lower than a finger prick.

Have you entered any finger prick readings into Glimp?
Once it has finger prick readings to calibrate against (I think it needs 3), I find it is much more accurate than LibreLink for me.
If I was not entering any values for calibration, I would not see any value in Glimp.

 

[bulkbiker]

@LittleGreyCat
Were you an existing customer with the Libre?
The website still says they will only supply existing customers...

 

[LittleGreyCat]

@LittleGreyCat
Were you an existing customer with the Libre?
The website still says they will only supply existing customers...

I'm on the mailing list for when they open up sales again.

Meanwhile I can buy them over the counter in our nearest (about 15 miles) Asda pharmacy.

 

[LittleGreyCat]

Interesting coffee thing.
This morning I had a weaker cup of coffee with a tiny drip of cream to take away the acidity.
My BG has still climbed above normal range although it seems to have topped out now.
This suggests that it may be caffeine which is triggering my liver to produce glucose in the morning.
We shall see if I get the drop I did yesterday.
However I need to eat as the sustenance from the butter and cream is missing.

 

[Goonergal]

Very interesting thread @LittleGreyCat am currently experimenting with the Libre myself. Look forward to further updates and will share some of my own insights.

 

[bulkbiker]

However I need to eat as the sustenance from the butter and cream is missing.

Cheese with butter spread on it?