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Poor Sugar Control

Discussion in 'Type 1 Diabetes' started by dondo, Sep 11, 2018.

  1. dondo

    dondo Type 1 · Newbie

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    Hi my name is Nik, I am 21 years old and have been diabetic for 10 years.

    I use the freestyle libre glucose monitor - for those that do not know - the libre monitor gives you information about how much time you spend in your target. In my case, I have set my target to 4.8-8.8 mmol/mol. I average about 35-40% in the zone on average. What sort of range do you guys have? Any tips on increasing the time in range?
     
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  2. enzina

    enzina LADA · Well-Known Member

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    Hi Nik,
    I have set my target to 4.5-8.5 and was 77% in range within the last week, 73% the last 90 days.

    Good luck.
     
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  3. dondo

    dondo Type 1 · Newbie

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    Hi Enzina, are you a type 1 diabetic?
    Thanks for the reply. Are you a type 1 diabetic?
     
  4. Juicyj

    Juicyj Type 1 · Moderator
    Staff Member

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    Hello @dondo and welcome to the forum :)

    I changed mine recently to 4.4 - 9mmol/l and was in range 71% of the time in the last 7 days. I tend to eat low carb because I know my body can't handle carbs too well and I suffer big spikes when I do, I also run/cycle 3-4 times a week which helps keep my BG levels regulated, I snack on nuts/pork scratchings if hungry and just stay active, I also really monitor my carb/insulin ratios carefully adjusting where necessary, however it is easier to make adjustments as I use a medtronic 640g.
     
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  5. porl69

    porl69 Type 1 · Well-Known Member

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    Hi @dondo and welcome to the forum
    I have set mine to 4 - 10. I have been on the Libre since January. Had very few days in 100% (probably 5). Just had a check now and in 90 days I am 65% in target
     
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  6. Knikki

    Knikki · Guest

    Hi welcome to the forum

    I have mine set to 5 - 9.5 last 7 days 57% in target.

    Had the Libre since May this year.

    As for "getting more in target" that I think is a tricky one but some ideas:

    Aggressively monitor and mange your condition don't be afraid to correct weather up or down.
    Carb count.
    Could try low carb diet.
    Don't get hung up on numbers.
    Enjoy life.
     
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  7. enzina

    enzina LADA · Well-Known Member

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    Hi Dondo! Yes, i am, my diabetes is now treated as T1.
     
    #7 enzina, Sep 11, 2018 at 2:05 PM
    Last edited: Sep 11, 2018
  8. Kim Possible

    Kim Possible Type 1 · Expert

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    Regarding getting more of your readings in target, this really depends on what trends you are seeing.

    If you are always high, you may need to increase your basal.
    You can do a basal test overnight by checking what your readings do when you are asleep - if they are flat, you probably have the right amount of basal; if they rise, you could increase your basal; and, if they call you could reduce your basal).

    Once you are confident with your basal insulin, it is time to review your bolus.
    This may vary at different times of the day.
    So try it - eat your breakfast with your usual insulin and see what happens with your levels.
    If they return to your pre-breakfast levels, you have the correct dose for that time of the day.
    If not, you could tweak your bolus.
    Then repeat for other meals/times of the day.

    You may also want to review your correction dose in the same way.
    Again, this may vary at different times of the day.
    Confusingly, this may also vary depending on your Bg level; it is common to become temporarily insulin resistant when your Bg is high and need more insulin to correct.

    Another thing to consider is what impact various activities have.
    If you exercise regularly, you can watch what happens to your BG when you are running (or whatever exercise you do).
    You may see a large drop which you will need to manage.

    Finally, you may want to review your Libre readings to decide whether to bolus earlier.
    This may depend on what you eat.
    But, as simply as possible, consider your insulin working at a fixed rate and your food converting to blood glucose at a different rate. You want to time your insulin dose so the peak of your insulin matches the peak of your BG conversion.
    Different foods will convert at different rates so your insulin timing is likely to vary.
    Eating less carbs may make this easier to detect and react and harder to make mistakes.

    However, as @Knikki suggests, it is easy to get hung up on the numbers and let them take over your life.
    To me, managing diabetes is a matter of balance - balance of carbs and insulin but also a balance of "normal life" and "diabetes life."

    Also, don't believe everything the Libre tells you.
    It is great for detecting trends but it is not considered as accurate as pricking your finger.
    Some people get very accurate results from Libre - other's don't.
    And it is less accurate when high or low.
     
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  9. Alison54321

    Alison54321 Type 1 · Well-Known Member

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    My target is 4 - 7.8 I've been in the range 84% last 7 days, but that was a very good week, it's not always that good. Over the last 90 days it's been 79% in target.

    How do you improve your ability to stay in range? I tend to micromanage mine with small corrections, but when I first started using libre, at the end March this year, I used it to make some bigger changes. I switched from Lantus to Levemir, and worked hard to get my basal doses right, and make some changes to timing as well. I made a lot of changes.

    You might want to start by looking at your basal dose. If you look at the daily patterns, on the Libre reader, you can see trends, that give you some idea of when your blood sugars are regularly going too high, and then you might want to think about why that is. Maybe change your basal dose a bit, or there might be other reasons, if you can identity the worst times of day, and what's going wrong, then you can make changes there.

    Then once it's more in range, you can use smaller corrections, and micromanage, but when you're so far out, you have to think in a slightly different sort of way.
     
  10. Ledzeptt

    Ledzeptt Type 3c · Well-Known Member

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    Hi @dondo

    I think you’re doing the right thing by setting a target and trying to improve upon it. I don’t want to give you my time in range figure because I don’t want to make this a competition.

    @helensaramay has given good advice and I also follow a low’ish carb routine as others have mentioned (about 30g per meal) to keep my BG in range. I’d recommend the website diatribe.org and particularly their book “Brightspots and landmines - the Diabetes guide I wish someone had handed me” - it stresses the importance of not getting hung up on numbers, but using them as information to take action I.e. when to inject, how much, what to eat, exercise etc (and the Libre is a great tool for giving us this information).
     
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  11. Alison54321

    Alison54321 Type 1 · Well-Known Member

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    Sometimes people just want reference points, to give context if the OP asked for the information, then presumably that was why.
     
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  12. Draco16

    Draco16 Type 1 · Well-Known Member

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    Hi,

    I've set my range to 4.1 to 8.1 and over last 90 days have been there 88% of the time.

    Tips (that work for me, we're all different, etc)
    1. Carb count accurately. And know your ratios.
    2. Lower carbs. More carbs requires more insulin which means more room for error which means more swings out of range. I'm not low carb by any means (c200g a day currently) but max 50g at any meal.
    3. Pre-bolus. Even with Fiasp
    4. Get Fiasp. Not only does it make pre-bolusing more practical, it means corrections work far quicker, bringing you back / keeping you in range.
    5. Get a half unit pen. Half unit lowers me 2 mmol/L, vital for small corrections.
    6. Get your basal right. It is the foundation to good control.
    7. Get a CGM. The trend info is the key. A rapidly falling 5 or rising 7 can be proactively managed, before it goes out of range.
    8. Eat at least 3 (ideally 4) hours before sleep. Check level just before and then (as you have 1&6 about right) all you need to do is a very small tweak / or nothing at all. Then you can stay in range overnight. Even 6 hours sleep is 25% of the day (in range, in the bag) remember!
    9. Exercise. Seems to keep our bodies systems ticking over.
    10. Relax. You'll never get this perfect.
     
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  13. LooperCat

    LooperCat Type 1 · Well-Known Member

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    My range is set to 3.9-7.0 - I was in it 64% on the 90 day thing and 81% on the 30 day - which pretty much reflects when I got my pump at the beginning of August. Eating very low carb helps me do this. I did manage three days solid in range the other week, but ruined my run with a bottle of wine... ;)

    Edited to add that I also have a MiaoMiao transmitter, so I can calibrate my Libre to a fingerprick test.
     
    #13 LooperCat, Sep 11, 2018 at 9:54 PM
    Last edited: Sep 12, 2018
  14. Brendon.Dean

    Brendon.Dean Type 1 · Well-Known Member

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    Do you rely solely on the the freestyle libre to get your blood glucose readings?
     
  15. becca59

    becca59 Type 1 · Well-Known Member

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    Set at 4.5-9 on 74% for the last 7 days. Watch my carb intake, but not ultra low. Average about 80 carbs a day.
    Biggest help to keeping in range I found was to pre-bolus, and not be afraid to split it. For example meals with a high fat content-cheese, or slower rising carbs-whole meal versions.
     
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    #15 becca59, Sep 12, 2018 at 7:56 AM
    Last edited: Sep 12, 2018
  16. Happy hippy

    Happy hippy Type 2 · Well-Known Member

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    Hello all.
    This got my attention as I’m very poor control of sugars 14 to 19.
    I’m UK and type two. I’ve had high blood sugar for a few years now.
    My hospital Drs just increase meds and insulin when I see them!
    I use Lantau solo star 42 units am and 8 units pm with gliclazide Pioglitazone am.
    I’m very unhappy as I can’t have my hip replacement surgery until my sugars are better controlled.
    I’m in constant pain and take Morphine.
    I have withdrawals at the moment due to stopping A high dose of Gabapentin over the last four weeks (1000 mg three times a day) by request of the Pain Management team at my hospital.
    I also have Ulcerated Colitis so have to be careful with salad and too much veg n fruit as they can unbalance my colon.
    (I had an Illiostomy for two years 09-11)
    So I’ve been rejoined so mustn’t strain lol
    The trouble is the Gastrology team and Diabetic team tell me to eat different things so it’s not easy.
    I feel so unwell right now I don’t really have an apitite at all.
    I really don’t know what to do!!
    Maddy x
     
  17. Happy hippy

    Happy hippy Type 2 · Well-Known Member

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    Ps I test with a Bayer Contour Next usb.
    What is Libre target one?
     
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