Better readings w/ DEXCOM

So, I posted on the Dexcom group last month or so about my son Santi having really bad readings in the DEX (more than 100 points off). It was driving us crazy because we had to react to the alarms and finger test him with the meter.

This week has been much better. My son just turned 3, and we were following the manufacturer’s recommendations to place the DEX on the abdomen area. Well, as many of you know there’s no much fatty tissue there. So instead, we tried the love handle area (lower back to the sides), and the readings have been much better. I would say 70% better or closer to the meter’s readings.

If you’ve had good results in other placement areas with the DEX, please share. We also use the OMNIPOD on his back arms or upper butt. However, we’ve seen better insulin absortion results when the POD is placed on the back of the arms.

Another TU friend (Susan Anderson who posts really useful information) helped me figure out why BGs were going high right after POD changes. I’m using her suggestion to bolus with a recently placed POD either 0.5 units when his BG reading is below 200 before POD placement or 1.0 units if above. This tip has worked really well. My son’s target range is 100-200 same as Susan’s child.

One more thing, while reading other groups’ posts (flatliners specifically), I noted they keep their range 70-140, which is normal for adults. Santi’s twin brother (Niko), the one on the back in the pic, is not diabetic and he’s within that range. I wonder why ENDOS recommend the 100-200 target range? I’m going to discuss this next week & will post on the answer they gave me, but please share your experience as well. I wonder if I can’t be more within normal target range. We have continuously decrease his A1C numbers-- last one on 7.3, but I think we can do better… any thoughts? THANKS.

That’s exactly where we put both of those devices. My 10 year old has no fat on his abdomen, and has always worn his omnipod on his arms and his dexcom on his “love handle” area. We have pretty good absorption I think, and pretty good accuracy with the dexcom.

Even when using Dex, we cannot keep blood sugars in the 80 to 140 range, even in the absence of food (growth hormones). And when eating she spikes higher than 140, definitely at the one-hour mark. We are using the fastest insulin possible, Apidra and that helps, especially with corrections. I also question whether it is typical for Type 1 adults (not LADA), to maintain blood sugars within this range 75 percent of the time. At this point in time, insulin is still too slow to bring down blood sugars and blood sugar rise after eating food is faster than insulin. Once there are better insulins this will change. I think endos can recommend any number but realistically, you are going to see 200s daily after eating, at least in the first hour, and you are going to see highs 200 and over, non-food related, frequently due to growth hormones and many other factors. Just correct the high numbers as quickly as possible and test often.

A word of warning with toddlers and trying to get ‘better’ numbers…

In my personal experience, toddlers’ BG numbers are very volatile. In addition, they do not or cannot always recognize when they are low enough to need glucose but not dangerously so. Trying to use lower targets exponentially raises the risk of severe lows! Per my discussions with Dr. Buckingham, repeated lows can be even more dangerous to our children’s growing bodies and brains than running slightly high.

I share my learnings because I am an admitted control freak. I want to be able to totally control this disease on behalf of my son. However, when I tried for lower targets (particularly when he was younger than about 7), we wound up with many scary and unexpected lows. I needed to let go of my control issues and head back to the 100-200 target range. When i did, things were MUCH better.

Re: toddler BG numbers & them not recognizing lows, this was also our experience with our daughter when she was a toddler. Our pump trainer & our pediatrician told us that if she had too many lows, it would hinder her growth hormones and she wouldn’t grow as much. So, we’ve always aimed for 100-200 and now that she is older and we have the sensor, we are trying to have tighter control.

I agree with the others that you can’t safely target an adult range for a little guy even with a CGM. I think that 7.3 is very much acceptable for someone his age. You can try to avoid the huge spikes by trying to give him lower glycemic foods. My kids are adults now but my daughter is developmentally disabled, so we have to manage her diabetes. Since the CGM we have eliminated a few things from her diet, such as some cereals and that way she doesn’t spike. It seems as if most people use backs of arms for the Dex at that age, but it is hard when using the Omnipod also. My daughter wears Omnipod on her arms and the Dex on abs. She can’t wear the Omnipod anywhere else because of skin issues with that adhesive.

What has helped us most with spiking is to bolus about 15 min before eating. This is not always possible especially with a smaller child and you don’t know exactly what they are going to eat. What we sometimes do is bolus for a certain amount of carbs below what I know he will eat, then after he is finished I bolus for the rest. Of course this only works with a pump you would not want to give two injections per meal, one is enough. We have a dexcom and still get high numbers for no obvious reason every few days, with children you do your very best and pray they continue to advance treatments and find a cure. As for placement I can’t tell much difference in readings but he has some meat on belly. Blessings!

In addition to hindering growth hormones, there’s simply a tendency of the brain to adjust to the lower glucose present and not experience the same level of symptoms. So if the child goes low too often, or stays in the lower part of his/her range all the time, he or she can develop insensitivity to low BG. I’ve seen Eric running and playing with not a care in the world with a BG of 54, under those circumstances. My doc says that when I see such insensitivity developing, it means I need to look at the basal rate and see if it’s too high, and also to maybe back off the carb ratio and shoot for slightly higher numbers. And sure enough, if I keep him in the high-to-middle part of his range long enough, he regains his sensitivity to lows.

What I do to alleviate spiking is, if Eric is at the midpoint of his range or higher when I test before a meal, I’ll give him half the insulin for the meal right then, let him get started, and give him the other half when I’m sure he’s going to finish. That way, there’s at least some insulin starting to work on the carbs during the meal (Eric’s also a fairly slow eater!). I won’t do it if he’s below the midpoint, though, because he doesn’t have as much “cushion” and sometimes drops down to 70 or lower in the hour after the meal, simply because the insulin is working faster than the food is absorbing. What I do in that case is give half or all of the meal’s insulin midway through the meal. Half if it looks like he might not finish, all if he’s eating eagerly.

Follow -up:

Thanks to all of you for taking the time and sharing your experiences.

I talked to our endo for almost two hours regarding the issues discussed here, and this is what she suggested:

Regarding Dex & POD sites: efficiency depends on the individual. Follow Dexcom/OmniPOd recommendations until you find what works best for you.

Regarding target range: For children younger than 6, the target range of 100-200 has been set by professionals to take into account the hormonal changes that occur at this age. She says that the 80-100 range does not mean it has a negative impact. She sited the relation of A1C test and Avg BG as follows:

A1C - Avg BG

5 - 90
6 - 120
7 - 150
8 - 180

She also suggested what some of you are already doing to reduce the spikes: Give half of the dosis before meal -if you’re not sure if your child will eat what you’ve prepared, and balance when finished.

Lastly, Regarding spikes after meals, she is willing to try Apidra insulin since it’s quiker than Novalog-- as Jan here commented as well . She did say, however, we had to be careful if changing from Novalog to Apidra as the basal rates may change. This might be a topic for other posts…THANKS !

I agree the 80-100 range does not have a negative impact. What those of us who have cautioned you meant was, trying to keep them that low often results in lows (below 70 is my criteria) that you do not want them experiencing. It is not easy to hit that target in a toddler on a regular basis without some scary lows coming along with it.

I’ll be interested in how Apidra works. We have been on Humalog since DX and have never even investigated any new insulin. Please do keep us posted.