So, we’ve gotten the CGM now (Dexcom g6) and are watching the hills and valleys (rather than just getting the every 3 hours info). We are not on a pump at this point— MDI seems to be working well for now.
I’m wondering at what BG number people start to feel “not their best” or out of sorts? Liam doesn’t seem to recognize it yet (but we’ve managed to keep him in range I’m guessing 90% of time time since diagnosis).
If I see him at 210 on the CGM but he’s on the way down do I let it ride or use more insulin to move it faster knowing I’ll probably need to offset it with food on the back end? What are the “screw the 3 hr check- he needs a dose now” high numbers?
Going low I normally start feeling something well before my G6 reports anything. My guess is that I become mentally aware of the low at about 70mg/dl, but it might also depend on rate of descent.
Going high is less reliable. I can ignore numbers around 250 if I’m sleeping; I might wake up but I’m not sufficiently badly affected to be unable to go back to sleep. When I’m awake I think I start to be affected around 200 but I often simply don’t notice this. It’s a subtle psychological change, it’s not as debilitating as low blood sugar. In many cases my wife will notice; e.g. if I’m involved in doing something (like typing this response) I won’t notice but if my wife interrupts me I will be annoyed and she will notice this; this just happened, my BG is 193.
My wife is also BG aware; she’s pre-diabetic and has shown lows in the 50’s and highs to maybe 150-160. So far as I can tell her sensitivity to low BG is less than mine, but her high sensitivity is greater than mine, or at least it kicks in at lower levels.
I suspect this is something we learn. Well, obviously seriously low BG has a direct physical effect which cannot be ignored, but the changes caused by manageable levels are more subtle. Those changes, say in the range 70-250, aren’t that different from the symptoms of other things including just being generically “ill”. Learning that they might indicate low or high BG comes as a result of BG tests and, perhaps much more important, simply assuming that the cause is a BG problem by default.
I don’t normally see that happening unless I have already done a correction bolus. In that case I let it ride, at least for an hour, probably longer. I think I do tend to both under-bolus and under-correct; so I’ll do an insulin bolus for a meal then do a correction a couple of hours later.
For me anything over 180 is a “correct now” number, but that really is an arbitrary choice and I don’t think I would ever do a correction bolus if I was heading down.
I use Loop so Loop will inject a certain amount for anything above my correction range, which is currently set at 80. Loop calculates the insulin amount needed based on the user’s settings and its predictions of what your BG will be. This works incredibly well for me.
But as @jbowler says, if you are on MDI it may not be a good idea to correct if you are trending down.
On MDI I would not chase a downward trend with additional insulin unless I saw it start to level off at too high a number. In our experience you really can’t speed a downward trend up too much and still successfully land it. Now with the Tslim pump you can do some of this with Basal IQ enabled, but you have the safety net of reducing insulin at the correct moment which you can’t do on MDI.
When we first started using the Dexcom, we over-reacted often leading to many peaks and valleys. Way too many. Now we use the info in a more learning way, i.e. what could we have done to prevent that peak rather than creating more roller-coasters. Doing that you will remove many of the peaks. With that being said, we struggled mightily during high growth periods with the growth hormones getting dumped into the situation.
Over 250 is the stop what you are doing and dose now for us. 200 if he has sports later in the day.
Completely agree with @Chris that the CGM is a great tool but can also create a rollercoaster if I’m too reactionary with the trends it’s showing me. I’ve tried to learn to be more patient, but it is tough!
For me it depends on how quickly my BG is falling or rising, but generally I’ll start feeling more irritatable once I’m over 140. I will feel my lows genereally once I’m below 60ish but not always, and sometimes even once I get my number back up I’ll still feel low
I would say if he’s already dropping while high then it’s probably better to wait it out and see where he ends up flattening out and then giving more insulin if necessary. Just to try to avoid having a low and having to treat for that and the possibility of overtreating and thus creating a rollercoaster.
My daughter is 4yo, she was using MDI/Dexcom for almost a year. when she turned 2 we switched to Omnipod and find it much better in many ways.
There are a lot of variables in your question but I will give 2 examples
If my daughter was 210 90mins after dinner I would give her 0.5u to bring here down 100 to 110 (approx)
If my daughter was 210 at 2am and I had given her 0.5u at midnight I would let it ride until it stops going down.
for my daughter “stubbornly hanging around 250” for 2 hours I would give her 0.5u even at night.
You mention food but if I wasn’t sure I would have glucose gel ready - glucose gel works much faster than milk or juice and the CGM doesn’t get as confused/stuck in 40’s/50’s. I use Dex4 or Trancend – see recommendations below. I usually weigh out 3g small spoon or put the gel in a careTouch syringe. It is really so much better than milk, chocolate, apple sauce, cake frosting etc.
Thanks all! That gives me a feel for what people tend to do. Knowing more (seeing the additional detail) is kind of a double edged sword, I love seeing the lows coming so I don’t wonder (he doesn’t give any indication he feels them- but he also hasn’t been that that low yet that we know of) and getting notices at night- but it’s hard watching, waiting, and being patient.
If it is any consolation, my son also chases rather than waiting when he gets frustrated or is at a higher stress level. So it isn’t just parents that have trouble sitting on their hands and waiting patiently…
I feel it when my BG level goes about 150. I try to keep my A1C values below 6.0. I use Multiple Daily Injections, MDI, to keep my A1C below 6. I also use a CGM with a standalone smartwatch to make sure I don’t have any projections that will be below 72. I use this this configuration with the xDrip application. I would not trade this arrangement for any other configuration. In fact I have backups for all of my control elements, Sony SW3 and Smartphone. Since I work in a controlled environment the Smartphone can’t be used so the SW3 is my ‘Watchdog’.
