Here I go again!!

kelp84 said:

thanks Steve, that is very logical, so lower carbs will create lower spikes,
Thanks for taking the time to reply : ) much appreciated! (same to everyone who has offered me great advice!)

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Lower carbs and less insulin should avoid the big highs followed by steep drops

The other thing to look at is timing of insulin doses. You may need to bolus earlier to avoid the mealtime spikes.

My Libre graphs always looked very similar to yours @kelp84 but they're slowly starting to look better. @Type1Bri is right but I'm a real carb-addict so I'm resisting the sensible advice at the moment! I have found that as @tim2000s said bringing my bolus forward has made a real difference in flattening the curve out. Word of warning though - don't do what I did the other day - I took my bolus thinking I was going to get lunch shortly and then got engrossed by something and the next I knew I was hypo!

Keep going - you'll get there

BeccyB said:

I took my bolus thinking I was going to get lunch shortly and then got engrossed by something and the next I knew I was hypo!

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I think we've all done this!

Gee, those spikes are nasty! Here are some options for dealing with spikes:

• Reduce daytime basal; if you have less basal you should be able to take more fast-acting insulin which will help tackle the spike. Some options for reducing your daytime basal are:
  • Go back to Levemir. Since Levemir lasts ~12 hours it is easy to have higher basal at night and lower basal during the day, just take a lower dose in the morning than the evening.
    
  • Change your Lantus schedule. You may want to have different morning/evening doses or get rid of the morning dose altogether.
  • Get a pump
• Inject earlier for meals (if you are not sure what you will be eating you can inject SOME insulin in advance and then top up when you eat)
• Rub the injection site vigorously. Blood flow means the insulin will enter your bloodstream faster, and finish acting sooner. Make sure your injection site isn't cold. Doing some brief intensive exercise can help as well.
  
• Try different injection sites. Overused injection sites can release insulin more slowly; also some people find certain areas of their body work a lot better.
  
• Eat fewer carbs with a meal (increase meat and veg).
  
• Eat meals that are slower to digest (fats and fibre are great for this, as they are not digested until the small intestine).
  
• Take more rapid insulin and then eat a snack ~2 hours later while the insulin is still active.
  
• Try a different fast-acting insulin (such as Apidra); although they are not that different on average, certain people get much better results with particular insulins.

You'll get this under control!

I’m not a big fan of ultra low carb, but do try to keep things as low as possible. Also, I have found the best way to avoid a large rollercoaster is to inject a good time ahead, split my dose of bolus which seems to catch the quick acting and the slower acting carbs. I ditched the spuds, rice and pasta for veg alternatives. This helped. It is not to say that I don’t deviate from time to time, but on those occasions I am prepared for a high rise hit. However, I never eat cakes and other desserts.
Having said all that, some days, for reasons known only to diabetes, I cannot seem to avoid high rises no matter what I have done or eaten. Those days I have learnt to not stress about, accept them and move on.

@kelp84 one effective way to reduce your hba1c is to focus on the night time BG levels.

You are asleep for on average 33% of the day. You're not eating (hopefully) during that time, so if you can get your blood glucose down to a normal level before bed and keep it there overnight you will significantly improve your hba1c.

do this by A) making sure your overnight basal requirements are met correctly and B) eating no less than four hours before bed, then checking and correcting (either up or down) before you go to sleep. Some people are scared to take fast acting insulin before bed, but if you know your correction ratios you can safely make adjustments.

Chris Bowsher said:

@kelp84 one effective way to reduce your hba1c is to focus on the night time BG levels.

You are asleep for on average 33% of the day. You're not eating (hopefully) during that time, so if you can get your blood glucose down to a normal level before bed and keep it there overnight you will significantly improve your hba1c.

do this by A) making sure your overnight basal requirements are met correctly and B) eating no less than four hours before bed, then checking and correcting (either up or down) before you go to sleep. Some people are scared to take fast acting insulin before bed, but if you know your correction ratios you can safely make adjustments.

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edited to add throughout the day i like work within the cycles of my fast acting insulin. i allow five hours between injections, pre bolusing an hour before eating meals (in normal conditions) and checking BG 2 & 4 hours after meals. i take around 10 BG readings a day and up to 6 fast acting injections, including corrections,