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

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.

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.

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 said:

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

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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.

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.

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.

Seacrow said:

<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.

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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.

bulkbiker said:

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

Click to expand...

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.

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.