Type 2 Ups & Downs - what should I be looking for?

[Ladynijo]

So I’ve been giving the Freestyle Libre 2 a test run, and collecting data on what effect different foods & various activities have on my blood glucose levels. It’s fascinating getting live bio feedback but I’d like to understand what I’m seeing and figure out how to improve the situation.

I’m not so bothered about the exact numbers, more the pattern. The only number that matters from the doctor’s point of view is the Hb1AC, and my objective is to bring this down to pre- diagnosis level. In February he didn’t tell me what it was (yes, really helpful) but the diabetic nurse said it was only just diabetic - from that I am guessing it was around 48 or 6.5%.

My questions-

On the daily graphs, for some meals I’m seeing sharp rises and equally sharp falls. Always it returns to the level it was before within 2hours, sometimes less than 2 hours. Sometimes it overshoots and goes way below the pre meal level, like tonight it was 6.6 before meal (it’s been bumping around that all day), shot up to 8.3, then fell to 5.5.

- does it matter how high the spike goes so long as it comes down again quickly?

- is the overshoot a problem? Does it mean I’ve overproduced insulin for the meal and what does that tell me?

- is it better to have steep spikes and falls, or less rises & falls around a middling level? I’m thinking that both will give similar averages.

In the example from yesterday, I was fasting until 12.30, the rises are due to exercise & work; the evening meal is the sharp spike & fall.

There is an interesting correlation between the carb (not calorie content) of the meals which I am conscious of and am beginning to exploit.

Any thoughts or observations gratefully received.

 

[ajbod]

A sharpish rise and fall is what non diabetics would see. It shows a very good response to Insulin. The slight overshoot could be for 2 reasons, neither problems. 1 Your body is so used to over producing Insulin, that it needs to learn to put out less. Or 2 it would be quite normal, because the Insulin is not accurately dosed so to speak, so the odd overshoot would happen anyway. The liver kicks out some Glucose to regulate it if it thinks it's gone too low.
Non diabetics see steep spikes, and rapid falls. higher spikes than most of us like, because our blood sugar regulation is rather wonky, hence we aim for lower spikes.
Your rise throughout the morning, is coming from your Liver, post 12.30 looks very good to me. Some people find a small protein snack in the morning, stops the rise, as your body realises there is food around and you're not starving, so doesn't chip in with more Glucose. It might be worth trying, the Libre will show if it works for you, if not, nothing ventured eh.
Overall if every day showed those readings for me, i'd be well chuffed. Keep it up, it all looks well.

 

[Ladynijo]

Thanks very much for the response. Obviously everyone’s body calibration is different but I’m finding it difficult to gauge what is ‘normal’ and what is not in BG terms. I wasn’t given any assistance by the HCP, just told ‘you’re diabetic, here’s medication, come back in 6 months’ and my 10 mins were up before I could think of all the questions I needed to ask. I’m now trying to understand where I can improve the numbers, because clearly that is why I now have a label on my forehead saying diabetic!

I’ve experimented with skipping breakfast whilst I had the Libre because I used to do that for years and I wondered whether actually having something to eat was causing the rise. Clearly not, so I’ll give the protein snack a go as well. Generally the 0 carb or high protein meals produce little movement either way, although it does seem my body reacts differently to similar carb loads depending on the time of day.

Good to know there is nothing out of the way with the spikes, I’m happy enough that they come down every time, so clearly the bod is producing enough insulin to metabolise the food.

I’m coming to the end of the Libre trial and I probably won’t do it all the time, but may just get a couple of sensors in to provide further information as I progress. I have my review in about 6 weeks time, although I can just see that even if the outcome of the Hb1AC is much improved, the GP is simply going to say ‘its come down, see I told you, you need medication!’

 

[LittleGreyCat]

It is possible that the over shoot is a sign of insulin resistance.
That is, your body starts producing more insulin but it doesn't work immediately because the cells are resistant, so more is produced and then when it starts to work you have a bit too much in your blood.
Ideally you shouldn't have high spikes.
This will take your HbA1c up.
Have you tried avoiding most/all carbohydrates to see if that smooths out the graph?
Just made a mental note to post a screenshot from my Libre for comparison.

 

[pkirk25]

It's not the question you asked but, as an observation, the target for time in range is 70%. Your time in range is 100%. That's really good news as it means your body is handling your diet correctly. If you could keep that up for 3 months, if I understand the informatin correctly, I think you would be in remission on your next hba1c.

CGM and Time in Range | ADA

Data collected by your CGM reveals your time in range. Learn how this works and how you can use the two for good diabetes management.

diabetes.org

 

[jjraak]

Hi @Ladynijo

Liking the sensible approach to assessing the data.

A hug for your 10 minute dismissal at DX, same here sadly.

But the forum stepped in for me, & hopefully for you to be our 'Centre of excellence & learning ' so sadly lacking in many scenarios on here.

Great answers above.

If I could offer a differing viewpoint...?

The LCHF diet essentially helps us mimic a non type 2.

To make sense of the rises & spikes I used a meter.(obv CGM offers a better insight )

I found it helped early on if I saw my readings as walking in a long corridor, at first blind to the risks & dangers.

A little reading established some guidelines to try to stay within.

Pre meal from 5/6
Post meal under 7/8, if not back to pre meal state for me worked well.
[Edit: the normal thinking is a 2 mmol rise is what works best after 2 hours.
My explanation above should read 5-7 and 6-8 or below is where I aimed for ]

For non type 2's any bump into the corridor walls is easily brushed off, for us however it can lead to bruising (aka complications) which can impact almost any part of us.

If I get a higher spike than expected, I examine why & try to eliminate or reduce what I think caused it

Hopefully I can reduce such incidences over time.

So higher spikes I personally would try to manage better.

But as you say, we are all different in how we respond to foods & stresses that could impact us.

Best wishes finding the answers & solutions that work for you.