1.6, yikes!

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1

About a week ago I took my nightly pills (beta blocker and antihistamine) with some almond milk instead of water. The next morning I woke up with a blood sugar of about 4.5 (81). Morning blood sugars are a HUGE struggle for me, probably the hardest thing to keep steady. Usually I am either high or low. Lately I'd been waking up around 10 (180) every morning. Anyway, I did it the next night and the same thing happened. So since then, every night I have about a cup of almond milk before bed, and every morning I've woken up perfectly except for yesterday when I woke up low.

Overall I get so confused about overnight readings because although I wake up to test several times per week, sometimes I am high and sometimes I am low (or have dropped a lot), and some mornings I wake up low while others I wake up high or in range. One of the biggest areas I think a CGM would be helpful for (the other being seeing what happens after I eat different foods).

Yesterday I was stuck around 10 (180) all afternoon and then after dinner I shot up to 15 (270). I was super annoyed so piled on the corrections. One thing I dislike about the Ping is that it is not NEARLY as good at preventing stacking of insulin as the Cozmo was. I don't know what it does differently, but I often notice it doesn't reduce bolus suggestions much at all even if there is a lot of insulin on board. Anyway, last night I sort of forgot about that, and I took almost 10u of insulin over a period of three hours (that's a lot for me).

I went to bed around 10:30, and around 3:30 I woke up for no reason and could not figure out why. I didn't feel low at all, but as usual I went to test.

I was 1.6 mmol/L (28 mg/dl)!!!

I had to test twice to see if I was really that low! According to the meter, I was. I ate four glucose tablets and less than 10 minutes later was 5.1 (91). So then I thought maybe I hadn't really been that low after all. I ate some cheese and a glass of almond milk, just in case, but I was sure I'd be high this morning because it looked to me like I was already rebounding!

Nope. This morning I woke up at 6.8 (122). Crazy!!!

That's the first really major overnight low I've had since living on my own (since August). I've had many other overnight lows, but not super scary-low lows! This one was totally my own fault, but I think at my appointment next week I'll ask about CGM. I could technically get a new pump (even though I've only had the Ping for two years) as I'm with a different employer so have different health benefits. I don't know if the stand-alone Guardian unit still exists in Canada (I haven't been able to find any information on it), and no clue if/when the Dexcom will ever get here, so I wonder if it would be worth putting up with the non-waterproof pump and super low-contrast screen for the benefit of the CGM (assuming it's covered).

2

I would strongly suggest not eating anything at all for at least 3 hours before sleeping and not taking any boluses either. For your purposes the Medtronic CGMS would be adequate especially since you live alone. Would a wafer thin credit card size magnifier help you see it better?

I wouldn't hold my breath for the Animas Vibe/Dexcom combo. The stand alone Dexcom will not come to Canada because Animas has an exclusive. The Guardian is no longer available.

3

I don't eat before bed, I've found that's too iffy, so usually dinner is my last meal (around 6:00) unless I am running low before bed in which case I have a small snack (no bolus). I do correct before bed because if I don't I end up spending all night high (usually I will try to test twice to see if I'm heading up or down). Usually if I correct, I will wake up a few hours later to make sure I'm not low. I think last night I was just not thinking!

Too bad to hear the Guardian is no longer available. I thought that might be the case since I couldn't find any information about it. The Dexcom I have been holding out for for *years* now and I'm getting tired of waiting, especially because there is no indication that they are even working on coming here!

Unfortunately with magnifiers I need extremely strong ones (prescription), and when I looked at a Minimed pump a few years ago when I was deciding between Animas and Minimed I couldn't read the screen easily even with a 12x magnifier. I wonder if there would be a way of trying it out before deciding, but before I even go there I'll talk to my endo about it.

4

Part of the deal between Animas and Dexcom was that Dexcom would not market the stand alone CGMS in Canada. Animas has exclusive rights to Dexcom in Canada and they intend to grab a whole bunch of customers from Medtronic by offering a far superior CGMS as part of their combo. This may include me although I do prefer the Medtronic Pump.

I keep hearing that the Animas Vive/Dexcom will be available in Canada any day soon. Phone their 1-800 help line and see if they have any idea when that will be. If you get the Medtronic, you'll be stuck with it for 4 years. I got a free trial of the Animas, I'm sure you can do the same with the Medtronic.

5

I already have an Animas Ping, though, so presumably if they did come out with the Vibe, I could just upgrade to that even if I was using a Minimed (the sales guy I talked to a year or so ago said the upgrade would be reasonable, maybe $750 or so). Last I heard there were issues with the Dexcom signal and weather balloons? I guess that's been resolved, hopefully! I do much prefer the Animas in terms of screen clarity (and also what I've heard of Dexcom CGM versus Minimed CGM), so if that's coming soon I'd prefer to wait. I'll give them a call next week and see. Of course, this is assuming Great West Life even covers CGM sensors, although my endo said they are good, so they might.

6

drsoosie mentioned that she drinks almond milk in the evening and that it helps her smooth out AM BG too. I keep meaning to try it but am lazy and, well, drink beer at night but I'm going to try laying off the beer and will see how almond milk works. Even though the 1.8 may seem like something to fix, it's not that far off and suggests to me that you're continuing to make great progress with what you're doing!

7

I just realized that I'm using a new lab since I moved (this was my first time) and it uses a slightly different range for A1c. My old lab used 4.5 - 6.0 as normal, and this lab uses 4.8 - 6.2 as normal. So even though my A1c was 7.3 last time and 7.3 this time, I think it may have gone up or down slightly. Does anyone know how to convert my A1c to what it may have been at my old lab (after this I'll just use this new lab, but I'm a bit confused about how to compare them).

8

I just thought about it and drew a little number line diagram, and I think my A1c may have been about 7.1 if it had been measured at my old lab? If so, that is super awesome!

9

I wouldn't worry about comparing the labs. Your next result will depend more on your tactical approach to each BG than what your last A1C was. If the first 7.3 was an ok result, maybe it was disappointing to get another "just" a 7.3 but you've done tons of work, been through new adventures in the pool (and getting to and from the pool, yikes!) and all of that and maintained a decent result. The 1.6 for a single result is perhaps a bit hairy but represents one, tactical mistake but I'd say the A1C suggests your overall strategy is working and small adjustments in numbers will keep making good progress for you.

10

The Ping does show the Insulin on board, but doesn’t subtract it unless you are just doing a BG bolus. But that doesn’t mean that you can’t subtract it yourself. I often will reduce my suggested bolus by subtracting out the IOB.

11

I usually look at the IOB and subtract it from the bolus myself if I think I'll go low. I think last night I was just really annoyed at running high most of the day and wasn't thinking that rationally! The Cozmo used to subtract insulin on board no matter what kind of bolus you were doing, and I wish the Ping did that. Definitely won't make that mistake again!

12

Some locked-in highs seem to need stacking in order to make them come out of orbit. But you don't want to stay too high for an extended period of time.

One method I use to help correct a persistent bad high is to set an extra large dual-wave bolus. When my BG starts to drop to below 180, I cancel the undelivered bolus. Usually the BG continues to normalize, but doesn't crash. With a bit of luck it stops on a dime at 100.

I can't do a muscle inject without feinting. Although if a nurse does it, there's no pain?

13

I called Medtronic this morning (Not related to your discussion ;wanted to know about infusion set tubing length for my Sure-t') Took advantage of the connection and asked about the Guardian as I had seen it on the web; the gent confirmed Guardian is available ...found something else you maybe interested in ??
Too computer unsavvy to supply the link , but please google Reimbursement Assistance Centre
http://www.medtronicdiabetes.ca/download/documents/Guardian%20RT%20Brochure%20ENG.pdf

If you like to call : 1-806-444-4649 , prompt # 1 ...suggest to wait till the holidays are over ; waiting to get connected a bit dicey .

14

Thanks Nel, I'll probably call them next week before my endo appointment to check. If the Guardian is available and my work benefits will cover it, I'd seriously consider getting it if Animas is going to be a while coming out with the Vibe in Canada (I'll probably call Animas at the same time to see what they say about this).

15

Nel is correct, the Guardian is still available. Unfortunately it has the same display screen as the Medtronic Pump.
http://www.medtronicdiabetes.com/products/guardiancgm


16

Has your endo tested you for gastroparesis? Your symptoms exactly match the problems that this complication can produce.

17

I've never been tested for gastroparesis, not even sure how that test is done. But when I look up the symptoms of it, I don't seem to have any of them. It mentions erratic blood sugars, but it mentions going low after meals and then going high hours later. I tend to have the opposite problem, spiking high after 1-2 hours some meals, but not all. Most lows I get are explainable, either from stacking corrections or exercises. Sometimes I get lows in the middle of the night that are totally random, but I get MANY more random highs after eating compared to random lows. I think hormones and such play a huge role as well. My "erratic" blood sugars aren't a new thing that appeared recently, more like a lifelong problem I've just never been able to figure out.

18

You might want to talk to your doctor about your doses of insulin and make an adjustment, if necessary. Perhaps you're taking too much insulin when you go to bed. The danger is if you go into a sugar low while you're sleeping.

19

I have an endo appointment tomorrow morning so will definitely be talking to him about this. Unfortunately, most endos I've met with, including this one, can't spot any consistent patterns in my readings so have trouble making recommendations about doses. They usually just tell me to keep testing a lot and correcting/treating as needed. The endo I'm seeing tomorrow is a new guy who is apparently excellent, and I've only seen him once before, so I'm hoping that he may have some suggestions now (even though the first appointment he said he couldn't spot patterns and had none). I did adjust my basal down by 0.05 u/h and haven't had any lows today (have had them daily for the past week or so), but since doing that I've been running on the high side.

20

Ya, I really think you need an insulin adjustment. There should be some diabetic nurses available who can easily determine patterns in your sugar levels. After I had my kidney transplant, I had to write down my sugar levels about 5 times a day. The nurses analyzed them and we re-adjusted my insulin levels accordingly. Since then, they've been fairly good.

Good luck with everything!