Psychology & Diabetes

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For the past three years, we’ve had Liam’s ranges set at 70 as the low and 180 as the high. We’ve managed to stay under 7% A1C for most of that time, but only 6.9. So, after our last Endo visit I decided to make some changes to our ranges. I changed the low to 60 (because honestly, I’m OK with BG getting to 60, but not below that…so psychologically, I’ve convinced myself that 60 isn’t bad (of course as long as he doesn’t live there). And for my high, I changed the high range threshold to 150 because, in order to maintain around an A1C of 7%, we need to stay at or under 150 as much as possible.

So, that was the psychology that went into my changing the ranges.

The result? Just in the past three weeks since our Endo visit, I’ve brought his 90-day average BG down to 145, from the 150 that it was at our last visit. This means his A1C is around 6.7 right now.

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I make this thread to emphasize how much psychology goes into number changes. If we accept 180 as our upper limit, then we will never push ourselves to get lower. By changing the upper limit to 150, I’ve found that I’m more aggressive in correcting his BG’s when they are over 150, instead of waiting until they are over 180. Same with the lows. Because we have more leeway in treating lows, I’m finding that we now have more time to treat lows and this also keeps him lower, longer.

I’ve found having the PHYSICAL REMINDER of those lines to be making a lot of difference in our treatments and it’s helping so far. Yes, we still need to work on the severe lows. Yes, we still need to continue bringing down those highs, but this most recent change I made to his upper and lower BG limits is already proving, for us, to be a great strategy in lowering BG’s.

So, instead of settling for BG’s that are over 180 before we treat, we now settle for 150 and treat if he goes over that. Most of the high percentages we are seeing is due to his nighttime highs which are crazy for us right now. No discernible patterns right now to make any real changes because one night he’ll be high all night and the next night, same variables, and he’ll go low with basal turned off nearly all night.

Anyway, I thought I’d share this because I’ve found the psychology that goes into managing diabetes fascinating and it’s amazing how much better we’ve found we can do if we push the boundaries on what’s acceptable for BG management.

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Thanks for this!!! Exactly what I am trying. I am new to Dexcom G6 or any CGM. I have been Type 1 for 53 years. I guess it was a combination of a lifetime of what I knew. Fear of unknown!!! Not sure I will ever go on a pump. Never had an A1C lower than the 8 range.Praying this will work!!!

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I have my alarm threshold set at 150 but often look at reports for 180 - the higher “time in range” makes me feel better about myself :wink:

A different aspect of the psychological impact of the thresholds I guess :stuck_out_tongue:

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I do that too!!! Best of both worlds.

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@ClaudnDaye numbers are looking good for your little guy! I still have not got my little guy a CGM (we just test a lot) but plan for it this fall when the G6 is out in Canada.

Yup - Alarm does not mean bad. It just means that it is time to do something. I set my “do something” alarms at 80 and 144.

I use xdrip so I have a second set of alarms with lower/higher setpoints. I set the second set (which are real alarms), to be audible at night when I am sleeping.

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I always wished the rising and falling alerts could be customized better on the native Dexcom device.

I don’t use those alerts, because you could be rising or falling all the time. Rising at 70 is no big deal.

But if you could set a rising alert for only above 120, for example. That would be very useful.

Maybe the newer versions do this? Or some of the custom CGM apps?

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Where I set my alert depends a lot on how burned out and how much alarm fatigue I’m feeling. It varies between 10.0 and 8.0 mmol/L (180 and 145 mg/dl). For a while, I had it set at 7.0 mmol/L (125 mg/dl) when I was eating low-carb. Sometimes I even turn the high alert off. I’ve had the high alert off lately, and this post prompted me to turn it back on set at 10.0 mmol/L.

I find the Dexcom phone app extremely annoying compared to the G4 receiver. The alert sounds are extremely irritating and they seem to come on even if your phone is set to Do Not Disturb. I’ve had those alarms interrupt meetings and webinar recordings and other work things. I’ve turned off app notifications so hopefully not everything will at least stay on vibrate.

I’m also having the most difficulty with highs overnight lately. I go to bed and it’s like as soon as I fall asleep my blood sugar skyrockets and then flatlines at a high level for the entire night unless I happen to wake up and correct it. The basal adjustments I’ve made seem to work for one or two nights, then I go back to being high. Very annoying!!

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Although the alarms are annoying, I actually want more of them…better ones. Phone calls like with lows. Like you, I have alarm fatigue so sleep through every high alert. I wake up some nights and Liam has been at or over 300 for hours. 300 doesn’t happen often but 200 - 250 more frequently than it should.

Many times I see it and give a bolus but it’s just not enough… Then I go to sleep thinking I’ve solved the issue only to wake up two or three hours later either seeing only a flat line at that very high BG, or is gone even higher. Too little insulin and it does nothing… Too much and it’s a crash. Tightwire act…

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This is true for me, too! I used to be so proud if I had a day in range from 80-200. Now I’m not okay with that - and my A1c has come down an entire point or more since I changed my range to 80-140! As the others have said, it’s not a bad thing - just a sign that something needs to happen.

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It’s funny how those lines serve as visual cues to us that we are “doing good”. When we realize those lines dictate (even if only subconsciously) our choices (which I finally realized), changing the lines equate to tighter, more aggressive management.

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Not always, because of burnout and alarm fatigue. My medtronic guardian sensor would alarm so often I began to ignore all of its alarms :woman_shrugging: It’s all about finding the happy medium, and IMO that sweet spot is pretty unfixed, dependent on the individual of course and also their mood from day to day

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I wish there were at least two levels for the high, like the low. I would like a “high” alert to be like, hey maybe do a thing! and then more of an urgent high one, to be like HEY YOU ARE NOW DEFINITELY UP THERE. And like for the low/urgent low, I’d probably want it so that only the urgent high comes through when I set the phone quiet for sleep. I realize I could just move threshold every night, and sometimes I do that, but I also think the two different alerts, with different sounds/vibration frequencies, would be useful in the daytime too.

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SugarMate will have those Incorporated soon. I couldn’t agree more.

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Not sure of the features of different models, but on the G4, the High Snooze essentially does this, doesn’t it? It alerts you that you reached your high level, and then alerts you again if you’re still above your high level in 10 minutes or two hours or whatever time increment you set. Not a different alert but persistent and hard to ignore.

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No, that’s not the same thing really, especially since it can be 10 pts over the threshold and still going off, or it could be 100 pts over, and the alarm is the same. I want an alarm that is meaningfully different, so when I hear it, I know. There are times when I might not rush to deal with a “high” alert (but the nudge is helpful to know about), but would drop what I’m doing (or want to be woken up) to deal with an “urgent high”, say.

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Spike/xDrip+ actually do have the “urgent high” feature if you wanted to use it!

I know for Spike at least you can also kind of do a roundabout way of using the Dexcom app and Spike at the same time if you have Nightscout (have Dexcom send data to Nightscout, have Nightscout send data to Spike)

Though Nightscout also has the urgent high, and I think you can have the Nightscout apps send you alarms, so that might be a simpler way to go. I’ve never used the audible Nightscout alarms so I’m not sure

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Gotcha – different levels of high rather than how much time you’re above the high limit. Yes, would be very useful. I’m rarely somewhere where I can’t look at my receiver, so that didn’t occur to me.

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Yeah, I keep thinking of getting an apple watch for that reason. Most of why I haven’t is that I really don’t like the style of them (or any smart watch that would work). I did find a band recently that makes it a little more to my liking though, so maybe I’ll cave one of these days…

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i just cant get into the cgm system; its just not the right fit for me. i set my alarm on my iPhone to wake me up throughout the night at specific intervals. it beeps, i test, i make adjustments if necessary, i write it down, and i go right back to sleep. i do this every night, so i am completely use to it, and, importantly, it no longer bothers my husband as it use to :rofl:

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AND PS:

when i did use a Dexcom, i got false lows ALL THE TIME. i was one giant, walking alarm. it was a horror show.