I’m just wondering how everyone uses the data from CGM’s and pumps in making adjustments or treatment decisions? There are so many different reports, data to analyze from Dexcom Clarity app and the Tandem app that it’s confusing to focus in on something useful. I’d like to refine my skills in using the data generated for practical decision making and pump adjustments. Right now I’m using a Tandem pump and dexcom g6. What particular reports does everyone find most useful? Thank you.
hi @DFBB , I use Clarity. grab a 7 or 14 day interval, and view the “Top Pattern” and look for “something” in the example below, it seems like I am just missing my meal bolus for lunch and dinner by just a smidge …and it looks like my basal is a bit too high from about 3 to about 7.
Diane @DFBB, I use several, but not all, of the Clarity, the Tandem, and the Tidepool reports for making adjustments. The particular reports used depends on where is either “see” a need for adjustment depending on what mar appear wrong, or changes to enhance my overall management.
In a way, my response above may sound evasive or even contradictory, BUIT … For instance, when I think basal rate for a particular timed-period might need adjustment, I will use the Tandem and the tidepool “day or daily” reports for several consecutive days and look for fluctuation. Both these reports give a picture of BGL and basal-flow together, and the Tidepool also includes every bolus showing carbs eaten and calculations. Since I’ve been using CIQ, I closely observe the actual basal insulin being delivered compared with the basal rate I programmed. Clarity reports are wonderful for identifying “patterns” where problems may exist. A real positive feature of Clarity is the information I requested to be sent to me on my phone and email [use “Notifications” under your Profile setting]. Just this week, I received a Notification that Dexcom identified a pattern with my BGL going low at a particular time of day - for 3 days - and notified me and included three steps I might consider to eliminate a particular danger.
Bottom line, choose the reports that mean something to uou. One of the other things I like about Dexcom Clarity notifications, the morning after I achieve my tighter than standard TIR, I get a “pat on the back” congratulations
I use Dexcom clarity when adjusting my doses and I tend to look at my TIR & GMI as well as the “daily” and “overlay” pages of my reports the most. There’s also an option that will look for patterns but I’ve found that clarity usually only catches super obvious patterns. (Micromanager me likes to search for subtle patterns).
I make changes after seeing the same thing for 3 or more days in a row.
I don’t change my I:C ratio unless if my BG is consistently high/low 2-3 hours after I’ve eaten.
I tweak my basals by .1 u per hour if I’m running high or low at the same time for multiple days in a row and I’m sure its not related to meals (like recently I was constantly going high between 12-6pm and I knew it couldn’t be I:C because I would have my normal spike and come back to a higher BG a few hours later.)
I’ve found that insulin dose tweaking is definitely an art…. Sometimes I think it’s an I:C issue, and it’s actually a basal. Or vice versa. Or sometimes it’s neither and I just need to wait 15 minutes between blousing and eating!
I’d recommend talking to your endo and seeing what amount they’d recommend for tweaking, what patterns they look for, and how much basal they expect you to get. For example my endo told me she wants my basals to be about 40% of my daily dose and my boluses to be the other 60%. There’s also some online articles on blogs like diatribe and beyond type one that discuss some of these topics (CGM graphs, TIR, total daily doses, etc).
Gary Schneider also has a section in his book “think like a pancreas” about looking at CGM graphs and tweaking doses which is extremely helpful.
Well I’m not looking for big changes, because my time in range is fine. So I’m looking for trends that repeat. I eat at 11:30. I know that from 12-4 is all I:c and 4-6 is all basal (rapid insulin lowers blood sugar for 4 hours). Basal is supposed to keep me steady, whatever my blood sugar is at 4 hours after a meal it “should stay there” until my next meal. I wont really adjust basal based on this, but I may skip lunch for 2-3 days and watch. If I’m skipping lunch then I can see and test my basal rate from 12- 6 as long as I don’t have a late breakfast. I also know every spring and every fall I need a basal adjustment.
Diane @DFBB, another tool I use to observe if or when I should consider making adjustments, especially timed-period basal rates is the t-Slim x2 “History”. This, putting aside extraordinary factors, may assist in determining if change in I:CR is more appropriate than change in basal rate.
As you have noticed, the last line in each of your pump Profiles shows the calculated expected total basal dose for 24 hours. Compare this number with the average per day delivered basal. With CIQ operating, there is very small chance that these two numbers will ever be exactly the same but, if the difference is significant, I suggest that you print from the Tandem t:Connect 7 consecutive days of daily delivery and see if you can see if there are particular timed-periods where the “delivered” dose consistently is different from your “programmed” dose.
One of the several adjustments you may want to avoid is “overbasalization”; overbasalization is a term introduced a few years ago by the worldwide panel of “diabetes expertise” gathered by the ADA for maintaining and updating the diabetes “Standards of Care” guide for professionals.
I run my Medtronic Carelink reports once a week and they have a comparison feature where you can choose the period and I compare that past week to the week before. I look for patterns and comparisons and see if I need to do any adjusting. My Endocrinologist, who I see every 3 months, pulls the last 30 days and also makes the same suggestions based on the data.