I have been on the monitor for 2 weeks. I am an 84 year old male with kidney disease( inherited) My dr is just not available. He says the questions I have are best shared by existing users of the freestyle sensor. He directed me here. I Want to know if I am on track. I take 18 units of ingulid in my stomach. Not sure what the most important numbers are on the scanner. I am now at 68% ‘on target’ (between 7- 4) and my peaks after meals are 9. And occasionally 10. Are these the best most important nu bets to watch? If I keep these numbers from now on can I assume my diabetes is not doing any damage .
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Type 2 Freestyle libre quidance
- Thread starter Jyd
- Start Date
- Messages
- 5,227
- Location
- Worthing, UK.
- Type of diabetes
- Type 1
- Treatment type
- Insulin
- Dislikes
- Not being able to eat as many chocolate digestives as I used to.
Hi @Jyd
Welcome to the forums.
In an ideal world it would be good to get a little lower. This information page will give you some guidance.
https://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html
You can see that your numbers aren't too bad, we've seen a lot worse here.
What's your diet like?:What do you normally eat and have you been given any special dietary advice?
Thanks but I am still anxious about a few points. The occasional aberration eg:
1. How serious it if I hit 11 after a meal every 7 or 8 days
2. Is there at peak say 12or 13 or 14 that requires immediate action. Such ?
3. Is there any guidance on when I should raise my 18 units daily to 20?
1. How serious it if I hit 11 after a meal every 7 or 8 days
2. Is there at peak say 12or 13 or 14 that requires immediate action. Such ?
3. Is there any guidance on when I should raise my 18 units daily to 20?
Just my opinion. I have been using the libre for about 16 months and my main target has always been to do better than I did last week/month and to do that, I think you have to pick your battles.
The two figures that I check most regularly are my current blood sugar levels and my Time in range. Quite a lot of doctors seem to go by the A1c figure, but as this is a 90-day average, it only changes slowly and hence I ignore it and assume that as long as my Time In Range is not dropping then my A1c won't be getting worse. I don't pay too much attention to the average because I know this can give an incorrect impression because lows can cancel out highs. If you don't get lows then obviously the average will be more useful.
That sounds like you are saying you don't need to try to do better and that is certainly not how I look on the situation. Nothing is certain. For example, glaucoma apparently runs in my family,so if I develop problems with my eyes, I can not be sure that it was caused by my diabetes or by the glaucoma. All I can do is try my best to minimise the risk. The Libreview site contains the wonderfully vague statement. Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial. I assume this means that the longer I am out of range, the bigger the risk of problems.
This is where I talk about battles. At the moment I am concentrating on increasing my TIR and reducing my lows, so I don't really worry about an occasional 11 or 12 as long as I don't stay at that level for too long. If my figures go much above that, then I know that they are quite likely to stay out of range for some time, so I usually take some action. I do have the advantage that I can take a small correction dose of fast-acting insulin if things get too bad, but I prefer going for a walk, even if it is just walking around the house.
If I ever get to the stage where I am usually 100% in range (if that is even possible), then I think I would start to look to see if I can reduce the peaks.
Not really in a position to offer advice about changing your dosage. Some endos/doctors don't like their patients to change their dosage without consulting them, but all I would say is that when I was first put on insulin, by endo gave me permission to change my dosage if my figures did not start to come down, but told me to only do it very slowly and in small increments.
The two figures that I check most regularly are my current blood sugar levels and my Time in range. Quite a lot of doctors seem to go by the A1c figure, but as this is a 90-day average, it only changes slowly and hence I ignore it and assume that as long as my Time In Range is not dropping then my A1c won't be getting worse. I don't pay too much attention to the average because I know this can give an incorrect impression because lows can cancel out highs. If you don't get lows then obviously the average will be more useful.
That sounds like you are saying you don't need to try to do better and that is certainly not how I look on the situation. Nothing is certain. For example, glaucoma apparently runs in my family,so if I develop problems with my eyes, I can not be sure that it was caused by my diabetes or by the glaucoma. All I can do is try my best to minimise the risk. The Libreview site contains the wonderfully vague statement. Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial. I assume this means that the longer I am out of range, the bigger the risk of problems.
This is where I talk about battles. At the moment I am concentrating on increasing my TIR and reducing my lows, so I don't really worry about an occasional 11 or 12 as long as I don't stay at that level for too long. If my figures go much above that, then I know that they are quite likely to stay out of range for some time, so I usually take some action. I do have the advantage that I can take a small correction dose of fast-acting insulin if things get too bad, but I prefer going for a walk, even if it is just walking around the house.
If I ever get to the stage where I am usually 100% in range (if that is even possible), then I think I would start to look to see if I can reduce the peaks.
Not really in a position to offer advice about changing your dosage. Some endos/doctors don't like their patients to change their dosage without consulting them, but all I would say is that when I was first put on insulin, by endo gave me permission to change my dosage if my figures did not start to come down, but told me to only do it very slowly and in small increments.
Fine answers. Thank you so much.
You mention "The Libreview site contains the wonderfully vague statement. Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial. I assume this means that the longer I am out of range, the bigger the risk of problems."
This libreview site "3.9-10.0 time in range". confuses me. My time in range is 4.1-7.1. And time in range is about 62%. If I used 3.9-10.0, I would’ve 95% time in range.
You mention "The Libreview site contains the wonderfully vague statement. Each 5% increase in time in range (3.9-10.0 mmol/L) is clinically beneficial. I assume this means that the longer I am out of range, the bigger the risk of problems."
This libreview site "3.9-10.0 time in range". confuses me. My time in range is 4.1-7.1. And time in range is about 62%. If I used 3.9-10.0, I would’ve 95% time in range.
That was what I took it to mean.
It confused me at the start. The freestyle libre app allows me to set my own targets, (to the levels suggested by my diabetic team) and that has its own Time in range stats, but this AGP report on the libreview website did not give the same figures because it does not use the same range and does not allow any customisations Then I read someone involved with a free app say that the reason their software did not provide an AGP report was because it had to be licenced and cost tens of thousands of dollars to licence it. But the AGP report appears to be a rigid standard and defines the target ranges, percentages, periods etc etc and is an attempt to provide a simple consistent overview that doesn't change depending on your medication or type of diabetes or individually customised targets.
When I was put on insulin, I was told to keep my blood sugar levels above 5 (to minimise the chances of going low), so if I was spending a lot of time between 4 and 5, then my customised time in range would be at lot lower than the AGP report, but that doesn't mean it would be causing me any harm.
That's pretty good - only another 5% to go !
My first AGP was 76% in range and it took about a year to get to 90%. Currently about 95%.
But which range are you using. 4-7 or 4-10? Not even sure which one I should be shooting for.
If you were told to target 4-7 then use that.
Always take the advice of your diabetic team over the advice of some random bloke on the internet !
I view the AGP, not as a report saying what you should be aiming for, but as a report that will access how high the risk of damage is (and in your cause it is extremely low), but my own personal view is that there is probably some benefit to trying to match what a healthy pancreas would do, so the smaller the target range the better. But 4-7 is, at least for me, at the moment, not possible, so I am still using the range I was told which is 5-10. If I ever find that hitting those targets because easier (without causing other problems), then I will probably tighten the range.
The AGP (and other libreview graphs and summaries) can provide some really interesting data and make you realise trends which you perhaps wouldn't otherwise have realised. It is easy to have an information overload with them though, and easy to focus on just one aspect, when they all feed into each other and show aspects of your glucose management which you otherwise might not have noticed. I found the AGP provided a more accurat HbA1c prediction than the LibreLink app one did (now compaerd to two different lab blood test HbA1c results).
From what I understand, HCPs use the AGP as an overall measure to predict possible future complications. As a type 1, the advice I was given will be different from type 2 advice. I was told to aim for blood glucose levels between 5.5-6.5mmol/l, but only correct if they were below 4 and above 10mmol/l. Having said that, my targets are different when I want to drive, especially if it is a long distance, or if I am going to exercise, or before bed (so I basically have different aims for my ideal glucose levels every day!). Again, this is because I don't produce any of my own insulin (have been tested to confirm this) so my targets alter. The general advice to mimic a 'non-diabetic's' blood glucose seems to always be a sensible approach, but don't forget that 'non-dibetics' also get spikes after eating. The key is that they aren't too regular or sustained.
Are you able to get advice from a diabetes specialist nurse at a diabetes centre? I found my GP didn't know anything much about the Libre, and my consultant was understanably busy in the past year, but the DSNs were kappy to answer email queries. The longer you have the Libre the more useful the stats are - they need 90 days before accurately predicting HbA1c for example.
From what I understand, HCPs use the AGP as an overall measure to predict possible future complications. As a type 1, the advice I was given will be different from type 2 advice. I was told to aim for blood glucose levels between 5.5-6.5mmol/l, but only correct if they were below 4 and above 10mmol/l. Having said that, my targets are different when I want to drive, especially if it is a long distance, or if I am going to exercise, or before bed (so I basically have different aims for my ideal glucose levels every day!). Again, this is because I don't produce any of my own insulin (have been tested to confirm this) so my targets alter. The general advice to mimic a 'non-diabetic's' blood glucose seems to always be a sensible approach, but don't forget that 'non-dibetics' also get spikes after eating. The key is that they aren't too regular or sustained.
Are you able to get advice from a diabetes specialist nurse at a diabetes centre? I found my GP didn't know anything much about the Libre, and my consultant was understanably busy in the past year, but the DSNs were kappy to answer email queries. The longer you have the Libre the more useful the stats are - they need 90 days before accurately predicting HbA1c for example.
