Don’t get me wrong, I don’t like being below 110 very much, but my doctor likes me to hang in there until I see numbers go to 80 before doing any corrections (I sometimes sneak a few carbs in when I hit 95 depending on the situation) My numbers ended up coming down beautifully (a bit too much now) so it seems the bread might have been part of the problem, I just saw the spike earlier and was discouraged at first. Of course the goofy tslim tried to deliver a bolus but I got a walk in instead of letting it do that!
Lauren, I understand where you are coming from so, I have my Dexcom alert set so I’m notified when it predicts I’ll go below 85 - a safe place for me. The most important words in the above quote from your message: … “depending on the situation”. For instance, if you have just completed a nice run you may want to snack when you are at 110. It all depends on how YOU are feeling and what you know about yourself. Numbers are just “guideposts” or navigation markers along the path of life. What might be a useful guide for you is knowing how to relate your 90 day running average [from Clarity and other tools] to HbA1c: 6.0 A1c = average BGL 120 mg/dl, 5.7 = 110 mg/dl [aprox.].
Numbers are just numbers, more important is how you feel. Tomorrow I’ll once again explain ti the Endocrinologist, and she understands, that the lab report produced this week showing my A1c at 5.3% is BS [that doesn’t stand for “blood sugar”] and that my actual HbA1c by my calculations should be nearer to 6.0% - I like to keep my daily average BGL between 115 - 120 mg/dl. That said, I think the HgA1c / HbA1c lab test is a good guide - I was involved in the 1974 project that developed this standard in 1974.
The g6 seems to take a 24-48 hours to get super accurate. It’s kinda frustrating. When using control iq I want to test randomly 2-3 times and have my meter and CGM reading within 20 mg/dl of eachother (is that unrealistic?). I’m hoping that the new g7 is as accurate as they say it is! I can’t wait to get it and try it out.
The exercise mode bugged me because I need to turn it on ahead of time to go high enough to avoid lows and then I usually forget to turn it off after I exercise, so I’d stay high for an inordinate amount of time and it would take me a while to figure out why.
This is also my first pump, I was dx’d in 2020, I started my Dexcom G6 6 months later, and got my tandem pump in 2021.
Lise @6yGodsGr, you are not unrealistic to want readings within 20 mg/dl, I’d like that too, but Dexcom suggests that we follow the “rule of 20” which says 20 mg/dl or 20%. This allows for the “allowed” 15 percent or mg/dl inaccuracy permitted for BGM plus the 5% for the CGM. To me, the differences appear too big. The Dexcom website has in its FAQ section a table showing the range of varrience that should exist before attempting a G6 calibration - a link follows here:
I too often forget to turn off Exercise Mode; I wish it was set up like Sleep Mode where we can have an automatic “OFF” time - I’ve made the suggestion. As far as turning on the Exercise Mode, you are wise to turn-on well before beginning exercise - depending on my intended level of activity I will initiate the mode as much as two hours before beginning; this will for me stop most of the automatic basal rate changes. Keep in mind, that CIQ dose calculation does NOT include infused basal insulin in ant IOB reductions. Each of us is different from others in management needs so you will need to experiment some with your timing.
@xgoingdownx @since you’re new to the forum I wanted to say that @Dennis is a frequent contributor with a huge - and I mean huge - wealth of knowledge about diabetes. You’ll find this out for yourself. I’m going to add on to his response to the quote regarding the range your doctor recommends, but first I would is to ask what was your range while you were on MDI - did your doctor lower the bottom number when you went on pump, in the interest of better control?
Far be it for me to advise you to go against their advice, but since we live in our bodies 100% of the time we may need to “negotiate” for practical purposes: me - and again this may not apply to you - I like to aim a little higher on the low end because I have to climb steps and that tends to lower my numbers. Our home is in a terrace and we have to climb steps to get to the car: If I have to run out unexpectedly - which happens often - I can’t launch activity mode in advance. And CIQ or no, my “tipping point” was always about 120 - it was like flipping a switch and I would start to drop. So practically speaking - for me keeping my low number a little higher than some might use for tight control, helped. (Confession here - after several years on TSLIM and CIQ, I recently switched to Omnipod and I realize I can’t recall the highest number you can use for the low end on Tandem. I hope that makes sense and just wanted to mention it in case anyone comments about my number.) Less lows meant less over-correcting and my graph looked less like a tour de France mountain segment and more like a ride through the park. A few points helped avoid extremes.
Far be it for me to try to push you to go against your doctor. Just keep in mind - while there are guidelines to follow we need to be sure we’re not using numbers for the sake of numbers, but making sure they work for us and keep us safe. If you feel your low number isn’t working for you, by all means have that discussion. Something to keep in mind.
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@Dennis I certainly don’t mind running in those 115-120 ranges but it doesn’t often work out that way for me. My a1c has almost always been between 6.8% and 5.7% (that was my most recent after being on the pump for a few months) over the 8 years I’ve been diagnosed. I feel better being between 120 and 135 most of the time just because I’ve found even just walking around my house tends to drop me after a while (I’ve gone shopping at 120 using exercise mode and come out of it close to 100, and I do try to start that mode before doing these things).
@wadawabbit When I was on MDI I think I was on the same range, 80-180. My doctor is happy to see any numbers between that range, so I try to keep myself where I like to be, honestly. I haven’t had the problem of over correction too much since being on the pump. The day it happened was due to me having a meal and then instead of rising at all I just started falling instead. I let myself get to 65 (by finger stick, Dexcom had me higher, but it was off because I definitely felt it) before trying to correct and then later I was sent sky high. I try not to let myself get to that state and I have my alarm set to alert if I’m going below 80 but I should probably have it set a little higher just for notifications sake.
Lauren @xgoingdownx, your HbA1c is right where the CIQ algorithm intends for all users to be,
Keep in mind, your “walking around” target is 120 mg/dl approximating over three months to yield a 6.0% A1c. Also remember that when you are in sleep mode the CIQ target is 110 mg/dl that leads you to the comfortable 5.7%
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I agree with “Don’t chase the dragon.” It just leads to a frustrating roller coaster ride. It’s better to give a small 1u correction and wait two hours and see what it does (then you’ll know what your correction factor is) – insulin stacking is the road to a massive low after a massive high…
As for Dexcom, I have the absolute opposite reaction than Joe:
I love how Dexcom warns me with PLENTY of time to react before I crash. – Only cure for going high is fast-acting insulin. I use Fiasp in my pump and the highs are mostly handled by Control IQ and short-lived.
How does Fiasp compare with Humalog or Novolog? I think I’ve heard it works faster. Any experience to share?
Oh I hardly ever give correction boluses because I tend to come down nicely after a little bit. That’s my entire issue with CIQ is that it’s too quick to give those autoboluses when it sees that I’m high. I’m also wondering if part of the problem is also my correction factor - either way, I’m not trying to chase perfect numbers so much as I’m trying to avoid super high highs and just about any lows altogether. Lows give me a lot more anxiety than highs do.
I’m struggling with Dexcom at the moment as I’ve had 2 sensors replaced within the last few months and I’m about to need another one because I couldn’t sleep at all last night. I kept getting compression issues -I can’t even lay down without this thing dropping when my actual blood sugar isn’t moving at all. (trust me, I tested a lot last night) Really hoping that whenever the g7 is available and working with the tslim x2 that it won’t have nearly the same amount of compression problems as I’ve experienced so far. (I would just turn off CIQ at night and disconnect from the bluetooth on this thing but CIQ has my basal all over the place at night it seems and it feels almost dangerous not use it while I’m sleeping). Otherwise, I’ve not had a ton of issues with Dexcom as far as being accurate, at least while I’m steady.
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Dorie @wadawabbit, Humalog and Novolog are “Rapid-Acting” insulin formulations, considerably faster acting and with shorter acting duration than the “Fast-Acting” rDNA and animal insulin.
FIASP is classified as Ultra Rapid acting insulin similar to Lyumjev. Lyumjev and FIASP effectively begin their work of lowering BGL very soon after infusion/injection and “clear” the body in shorter duration. I advise avoiding infusing before beginning a meal unless BGL is significantly above target.
I got 2 innacurrate sensors in a row and had them replaced by Dexcom last week. So far this new sensor is doing ok. Still 10-20 off but way better than the 30-50 off of the previous two. Winter break started so I’m switching control iq back on and I’m adjusting some of my settings.
I also can’t wait for the g7- I’d be happy to get it before it’s integrated with the tandem pump.
The last sensor I had was horrid. At one point my dexcom was saying I was 177 & I was 226 in reality. This new one seems better but I’ve still had to calibrate it a few times. I wish I could say I’d take the g7 before Tandem integration but I really rely on sleep mode at night because I can see where it lowers my insulin by at least half if not more during those hours. If I didn’t use control IQ overnight I’d be going low constantly. (Which happened a night I tried not using it due to that sensor being so whack & I even cut my basal in half)
Good luck trying CIQ again!
Hi- small update.
I used CIQ for one day before switching it off because I got COVID and my BG was so excited that I didn’t want to add CIQ into the mix.
(As for COVID I had small ketones once, mild cold symptoms - fatigue, headache, runny nose, etc- throughout, I didn’t see any straight CGM arrows for a week and a half, but I’m fine. Very boring experience, yay!)
I went to see my endo today and we talked about the issues I’d been having with CIQ- bad sensor readings, weird boluses, basal rates, etc - and she said that looking at my numbers without CIQ on, it’s all right with her if I don’t use it. “Maybe it doesn’t work as well for you and that’s all right” phew. I was pretty nervous about bringing that up! I was very happily surprised to find out that my A1c is 5.6, no idea how that happened.
Another positive- my last sensor was ok, the one before that terrible, but my current one is doing pretty good. It’s actually catching my lows and following my highs pretty closely!
The diabetes nurse I talked to who also uses tandem and Dexcom and has CIQ turned off (she’s pregnant and it wasn’t working well) also told me that even though we can change settings in our pump (like target BG and insulin duration) those are actually set in stone by the CIQ algorithm. Insulin duration is always at 5 hours and target BG is always at 110, even though our pump settings/personal profiles may say otherwise. She said that could be contributing to the irregular/weird automatic boluses.
I’m not ready to give up CIQ forever, I’ll probably use it again at some point, and hopefully with better results!
For the night time lows I’ve been eating a protein heavy snack (spoonful of pb, a piece of chocolate because its chocolate, and a glass of milk) before bed and I’ve cut my overnight basals by about 30-40% so that I’m (if everything goes to plan) cruising in the 100-150 range overnight. I’ve been able to avoid the majority of midnight lows that way. I also set my low alerts higher so that my CGM wakes me up at about 80-90 mg/dl instead of 70 mg/dl.
Technology is a blessing and a curse. I hope your last few sensors have been cooperating and that this helps a little!
I’m sorry to hear you got COVID but am glad to hear you’re doing well now. Whether or not to use CIQ is of course your choice but with an A1C of 5.6 it sounds like you’re doing well on your own!
That said, one day really doesn’t tell you much. A faulty sensor could be to blame and could happen any time (although hopefully that’s rare), and it does take a few days for changes to settle in when you make them - likewise with starting on CIQ. I started on CIQ a few years ago so I don’t recall the details but I think we did have to tweak my settings to work with the algorithm.
Can’t speak much to it now as I’m using Omnipod, but do want to encourage your decision to consider CIQ if it might benefit got later. Right now it sounds like you’re doing terrific on your own - kudos to you!