Living Alone and afraid

I’ve been T1D for 40 years. Many years ago my endo said I should not live alone. I never thought I would reach that point. Now after living alone for the past 9 years at age 55 I am rethinking that. I have been having more low lows lately. My daughter and boyfriend each have Dexcom share on their phones but there are times when it is not enough. Yesterday alone I had five lows and had to call my son to stay the night. CIQ is tightening my in range time but waiting until I am 70 before it turns off basal does not work if I have too much insulin on board. I’ve reached the point where I am afraid.

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Synthia @synstokesyahoo-com, living alone can be a challenge. A couple of bits and pieces come to mind that might help you

First, set your pump or CGM low threshold at a higher reading. I have mine set at 85 to give me time to think before acting. Also, I have my senior alert on to tell me I’m falling at 2 mg/dl.

Second, try setting a Profile with smaller basal insulin flow, especially from mid-evening until shortly before the time you usually get up. If the lower basal causes your BGL to go high CIQ will try to get you back into target range.

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Dennis I’ve not heard of this senior alert. Is this something built into the Tandem software? I’m still learning to trust the CIQ. Sometimes I get great results but other times it does not correct in time to stop the low. I always drop fast. Thank you for the great ideas as always.

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Synthetic @synstokesyahoo-com, high and low reminder alerts can be set both in your Tandem pump and in Dexcom Clarity.

Set in pump, choose Options, My Pump, Alerts & Reminders, Pump Reminders. On this screen, you can set both high and low alerts. You choose your “Low” at any value between 55 and 120 mg/dl. Your "High " can be any value less than 301 mg/dl.

Dexcom Clarity either phone app or Receiver. On phone app, tap the “Settings” at upper right, and then “CGM Alerts”. Here you will see a whole mess of alarms and alerts you can customize, including rise and fall rate alerts and also set your threshold.

The Tandem t-Connect phone app also has similar alerts.

All the above information in included, and repeated, in Tandem User Manual.

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I have my alerts set and I have tweaked them some to let me know when falling. I may have set them too low to avert all of the nighttime alarms. When in sleeping mode I’m always going high so I just now increased my basal. I would like to be able to depend on that at night to keep me steady. I do not know why CIQ cannot correct that although I do want to have the truest settings possible so CIQ isn’t always correcting. I’m heading to the manual. COVID-19 has not allowed me to have the one on one training. I found the online training woefully unhelpful. I am on a Facebook group for CIQ and I know I am not the only one experiencing issues early on. This is a total game changer when all setting are right.

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What I found that worked well for me, Synthia, was to have my basal rates as correct as possible before I activated CIQ. I was scheduled for two days of surgery [one week apart] that necessitated that I be put-under in January, so I put off activating CIQ. I had “tuned” my basal rates to maintain proper glucose levels, without correction bolus or food, from 6 PM until the following 2 PM.

If you have the “Sleep” mode activated, CIQ will not administer any Bolus Corrections; it will attempt to maintain your glucose at 110 mg/dl just by adjusting basal flow. If you look now at your data in t-Connect [Reports, Timeline], you will see two graphs; the top graph has your glucose line and any Bolus delivery - the CIQ activated bolus are identified with black color. The lower graph has your basal delivery; your Profile delivery rate is pictured as a thin horizontal line, with actual delivery indicated by two shades of blue color, the darker blue indicates that CIQ made an adjustment. Red color indicates that basal delivery was suspended. Use this graph as a guide in changing your basal rates in a Pump Profile.

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Hi not to sound the alarm but you should be VERY concerned about this , if everything was perfect and the planets align yes no problems but when you are in a deep sleep and your sugar is going low a bomb will not stir you ( at least me ) there is no doubt in my mind without my wife I would have died many times over the years sugars in the teens and low 20’s This is a very hard problem and it only gets harder as we mature in life. I hope the best for you.

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Hi @synstokesyahoo-com. While you’re not able to do one on one in person training for your device I wonder if you and your rep could set up an online session using Facetime, Zoom, or any of the gazillion options out there. I’ve found hands on training is not literally "hands on":blush: so you may get the same benefit, or nearly so.

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Try the sugarmate app. It completely free, has tons of features and most importantly, it will call you if your sugar drops below a user set level during iser set hours. Its pretty nice

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Hello. I share similar concerns although no pump or CGM so it’s just finger pricks. T1D x 47yrs My son moved back temp as he was laid off but I’d recommend running higher. That’s all we can do. I wake at 2am each night and test but we are humans and have other lives. Adjust as needed. Don’t live in fear of anything. Just 20 points higher target should help.

@synstokesyahoo-com. Synthia, @Dennis & @wadawabbit (Dorie) have given you great information. They have been here for a long time and their words are true and can be trusted.

I have another idea. Have you been keeping a diary or log of when the lows occur? Plot these lows and check your basal insulin during the time these lows occur. Your basal may be too high. If you change your basal, make only small changes in consultation with your doctor, the CDE (Certified Diabetes Educator) or nurse in the office. Changes should be something like 0.05 or 0.01 units per hour.

A second idea is your IC (insulin to carb) may be off a little in the time the lows occur. For example, if you eat a serving of yogurt with 16 grams of CHO (carbohydrate), how much insulin is your pump programmed to give to cover the CHOs? If it is programmed to give 1:5, consider 1:6 after consultation with your doctor or pump trainer.

Third idea, consider the “duration of insulin action” setting in your pump. If the duration is set too low, the pump will think the insulin is ‘gone’ when it is still acting.

You are wise to be concerned. Use the alarms in the pump and CGM to your advantage. I am not familiar with the Sugarmate app suggested by Joseph. It was purchased by Tandem on 24 June 202 according to several news postings.

Synthia, share how you manage this hurdle. The solution you share will teach us all. Thanks.

I don’t really have any advice to add. I’m just here to say that I understand. I’ve worried about living alone since college. I’ve confided in a few of my coworkers and asked them to call 911 if I’m missing from work one day, but if I had a low overnight even that would be too late. I don’t currently have a CGM with alarms. I’ve always been able to feel my lows coming, but it’s getting harder lately. I’m thinking I’ll need to make a switch to a new CGM soon. I also started using a pump right before the pandemic, so I completely understand the feelings of abandonment, too. This website’s a great resource and telehealth appointments are helpful if you can get all your data to your health provider online.

Anyway, I’m sorry you’ve been struggling and I hope things get better soon.

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Hi @bsteingard. I think you will find a lot more peace of mind when you get your CGM. You can set alerts to let you know if you are below or above a certain level, but you may also want to set alerts to tell if you are rising or falling rapidly, which could give you a head start on things.
Not long after college I met a fellow diabetic at work. She told me about the latest and greatest technology - a home BG meter. And when I say “home” is because (you may or may not recall) they were to large to carry with you. To my shock and awe she told me she lived alone, and my response was :flushed::flushed::flushed:?!? You’re diabetic and live by yourself??? She told me the only times she lost consciousness were when she had company stay over - she didn’t know why, just thought she was not being as vigilant and attentive to her care as she usually was.
When I was in high school and the family went away I would set my alarm clock for every couple of hours to see how I was feeling.

Oh, @wadawabbit, no… I’ve had a CGM for about 2 years, but it’s a Freestyle Libre 14 day system, so it doesn’t alarm. Until recently I was fairly confident that I would wake up when my blood sugar dropped overnight. I’d get sweaty and numb all over and would wake up knowing something was terribly wrong. I’ve never been hospitalized and the last time I needed help to treat a low I was in high school (I’m almost 34). But I’ve wondered all the same how long it would take for someone to notice I’ve gone missing. And I’ve been more worried recently because my low blood sugar symptoms are changing. I’ve always felt hungry, shaky, or numb before, but lately I’ve been getting sleepy, nauseous, or headachy. So, for example, when I’m at work or just come home from work - outdoors in 95 degree heat and 70% humidity sometimes with only 4 hours of sleep on board - and already feeling sleepy, nauseous, or headachy it’s really hard to tell when my blood sugar’s dropping. Plus, thanks to the CGM, I’m noticing some mild overnight lows that don’t wake me up but sort themselves out in the morning (thank you, dawn phenomenon). I’m worried they won’t always sort themselves out. I want a new CGM, but I have to decide between the Freestyle 2 or the Dexcom.

I’ve had diabetes since 1993. I doubt I have any experience with the “home” meter you mentioned, but I do remember my first couple meters were the size of my mother’s hand and needed what felt like a gallon of blood.

I understand that there’s a Freestyle 2 now that does give alarms. I keep A freestlyle on hand as a backup and know you have to swipe to get readings. I’m guessing with the Freestyle 2 you have to swipe before it gives an alert. But the key words in that sentence are “I’m guessing” so by all means check it out for yourself. To me the Dexcom can’t be beat - it’s always active so you get alerts as soon as it senses something.
In a side note, have you considered something like a First Alert? If you’re low and need help you can press a button and the service will contact someone on your behalf. It’s actually a good idea for anyone who lives alone - whether you have a medical condition or not, and whether you’re going or old.

Apparently the Freestyle 2 will give an alarm that you’re going low or high, but won’t tell you how low or high exactly until you swipe with the reader, which I’m ok with. I’d like to not carry so many devices (phone, Libre reader, and pod PDM), but my current phone doesn’t have the tech it needs to work with Freestyle, so I think that’s a point in favor of Dexcom. My CDE also thinks I should switch to the Dexcom because it’s more accurate and is more likely to work with any future Omnipod AI tech, but I get this sort of “devil you know vs devil you don’t” feeling when I think about switching.

I haven’t considered something like First Alert. In college the dorm phones had these buttons that would notify health services that you were having some sort of emergency. I think they would try to call you back and if you didn’t answer call 911 for you. But I always wondered how I was supposed to use the button if I wasn’t lucid or conscious. If I’m lucid enough to use the button or call 911, I’m lucid enough to treat the low blood sugar myself. The few times I needed help I wasn’t capable of asking for it (I was seizing or had fainted, for example)

True, you have to be able to summon help with First Alert. Even so it could be good to have as a backup as you’re treating a low or if - heaven forbid - you’re on the cusp where you may not be able to yourself.
Thank you for your insight on the Freestyle 2 alert - it’s good to know it does give you something before you swipe.