Feeling frustrated

1) did she wait for the correction to work before eating, or did she stay eating at 13? Because a raise of 2mmol with a 40g carb lunch doesn't suggest insulin isn't working. It suggests it's working just fine, you just started out too high. The correction is going to be slightly stymied by food - a correction won't stop food raising you, and that isn't the purpose of a food bolus either. Everyone rises after eating. 2 mol is a mininimal rise, it just looks bad when it's 13 to 15, but the insulin is working perfectly.

2) yes, the menstual cycle can an does impact on insulin sensitivity. You might need different basal rates and different ratios depending on where you are in the cycle. But if effects everyone differently, just keep a close eye on what it's doing to you. It might be different next month.

sadsocks said:

We have been told by our dietician that as she's having Humulog, she doesn't need to take it 15 mins before food .

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That advice is ridiculous. The makers of humalog say that the onset of action takes 15 minutes, see graph below. Pre-bolusing makes a huge difference - I'm not a low carber, regularly eat relatively high carb meals, and my cgm trace barely shifts when I get the timing right.

If you inject at the same time as a meal, the food will be glucose in the bloodstream long before the insulin gets anywhere near it, so it will be fighting an uphill battle.



The medical profession is inately conservative: they don't want to be sued over causing hypos. It's up to you and your kid to decide whether you want to experiment with pre-bolusing.

Ask the dietician whether or not he/she is T1. If the answer is no, nod politely, and feel free to ignore advice. Non-T1 advisers are "book" diabetics. Although they mean well, they really don't have a clue about the 24/7 realities of it, so you've got free rein to experiment.

sadsocks said:

Hi, thanks for your reply. We have been told by our dietician that as she's having Humulog, she doesn't need to take it 15 mins before food .. I had asked about that one previously. The problem about waiting for the adjustment to work ( and I see your point) is that she worked and has v little time to eat during the day.
I'm probably getting a bit stressy about this, but it's v hard to see your child getting upset when she feels that she's following the rules

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I used to use Humalog and it's not as fast as they'd have you believe. In fact, for breakfast (my most insulin resistant time) I had to inject it 30 mins before eating. That stopped my spike.

So she could try carefully moving her bolus a little,earlier 5 mins at a time. 15 - 20 mins is a common time. But, as others have said here, her BS result wasn't bad - she just started with a high sugar.

Tell her she's doing ok. Don't let her think she's failing. She's not. Anyone coping with Type 1 is a success in my book.

Hi, it's very frustrating isn't it. Agree with the other comments, we always bolus my 6 year old daughter 15 minutes before eating. We're lucky that we have a cgm as well, so we watch and make sure that she's on a gentle downward trend before eating. We never eat when she's out of range (over 7mmol). It sounds a pain, but has just become part of normal routine now. Could she test and inject before her lunch break, so she doesn't have to waste 15 minutes of her break on her prebolus?

CathP said:

on a gentle downward trend before eating

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Stephen Ponder calls that "waiting for the bend" in his book Sugar Surfing, which is about cgm. He's a T1 endo and seems to know his stuff. Got the book shortly after I got libre. It makes a lot of sense, although some of his analogies with real life surfing are painfully cheesy in a West Coast, Californian way!

https://www.amazon.co.uk/Sugar-Surfing-manage-diabetes-modern-ebook/dp/B017EIX9HG

Scott-C said:

Stephen Ponder calls that "waiting for the bend" in his book Sugar Surfing, which is about cgm.

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I've not read 'Sugar Surfing' but I've heard of it. I always imagined much of it would be common sense once you've had cgm for a while. Is it worth getting?

CathP said:

I've not read 'Sugar Surfing' but I've heard of it. I always imagined much of it would be common sense once you've had cgm for a while. Is it worth getting?

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Sure, I found it worthwhile, subject to the caveat that I got it very shortly after getting the libre when I was mad keen on a new toy, so I might re-read it again having been using libre now for about 8 or 9 months and see how it stands up now I've got more experience with libre.

One of the things I found interesting was his comment that because bg and ifg (interstitial fluid glucose, which is what all cgms measure, and then make an educated guess about what bg is) are different things (even though libre is meant to adjust for it), the chances of a meter and a cgm reading the same are nil; if you get the same reading, it's a fluke.

It puts a lot of the whining I've seen on this site about, "oh, it's not the same as my meter" into context. Not going to beat about the bush on this point: cgm is incredibly useful, and if people can't recognise why they're different, they're weakening the gene pool.

Reading the book, and using the libre over several months has got me to the stage where I've been able to understand the reasons for the differences, adjust for them in my head, and realise in some instances, differences are actually quite useful.

For example, mine tend to run below my meter, so, if I'm out for a meal and a few beers at the weekend, when I might be tempted to insulin-stack, if the libre ends up higher than the meter, that's a strong clue that the IOB is doing it's job and no more bolus is needed.

And if they're both fairly close, good indicator I'm generally stable because the bg/ifg gradient is close which tends to occur when stable.

If they're far apart, good indicator I'm unstable, so will need to keep an eye on things.

A lot of people expect absolute, definite answers from meters and cgm. They don't do that. They provide clues, circumstantial evidence. I can figure out the puzzle a lot more with cgm on top of meters compared to meters alone, so I'm not that fussed that they're different.