I have been a type 1 for about 24 years and I’m pumping and on CGM. But I just do not understand how any Type 1 has a 140 high alert on their CGM. I’m not in bad control, my A1c is 6.2 but I cannot fathom a 140 high alert. It would be going off all the time!
I sometimes feel like my Type 1 is just not like everyone else on here. I’ll give you an example.
Yesterday I planned on mulching my property which required a lot of physical work. So I reduced my basal down to 30%. I had some toast for breakfast. BG was around 120. I did not bolus knowing that i would be working a lot. By lunch it was around 180, fine for me. It was creeping up. I had a pb&banana sandwich and dosed what I would normally dose but no correction. Waited 1 hour, went back outside and CRASH. Low of around 70. I had a granola bar, no bolus. Recovering. Then when I was done for the day I relaxed in front of the TV. Then my BG started to rise and rise and rise 120 140 160 180 200 220. I corrected for the granola and it kept rising and rising…finally came back down.
This happens almost every time I work in the yard. I just do not understand how other TYPE 1s have a high alert of 140 and come across that this is normal. And and I hate when everyone who does have this high throws it in other readers faces, like its some big accomplishment.
Another point - how will a Hybrid Closed Loop pump ever deal with the scenario I just described???
Anthony, thank you! I have started to (affectionately, mind you) consider those ppl to be freaks lol They are in the same boat (in my mind) as the 4.8 A1c folks. I mean, God bless 'em for that accomplishment!
I generally have to talk my competitive self down from the ledge & just tell myself that we’re all different & i have to run MY race. But it’s a little frustrating. I’ve been T1 for 15 mos & flat days are rare. My Dexcom range is 80-200 & even that gets annoying sometimes. Last A1c was 7. Not bad when you consider it was 17.8 when dx’d.
As they say, YDMV but thanks for making me feel more normal.
LOL, I’m one of the freaks. But only recently, since this past summer. I’m not very active and during this partial year have been eating low carb to prepare for pregnancy and then for the pregnancy itself. I have a desk job so my days are generally pretty steady. It is mentally and emotionally exhausting, though, to try to keep my bg consistently in that 70-140 band. In the last few months, I believe I’ve been about 60% within the band, 20% under, and 20% over.
Before the pregnancy, I think my upper band was set at 180.
I use xdrip+ instead of a Dexcom reciever which may make more or less of a freak. With xdrip you can completely configure the alarms and when you acknowlege an alarm you can set a snooze time.
I have an alarm set at 144, 180 and something higher for a site failure.
If the 144 alarm goes off after a meal, it reminds me to check if I need a correction. My snooze time is 2 hours so if the correction doesn’t work I can check again. So it is more of a reminder than an alarm.
When I used a Dexcom reciever I had the alarm set at 180 most of the time because otherwise it would always keep going off if my blood sugars were hanging around the alarm setpoint at 140 ARGH DEXCOM PUT A SNOOZE FUNCTION IN!!!
Not sure who has thrown around in your face their personal targets / alert levels. If that happened, it’s not cool. And not because it’s some big accomplishment (not getting any alerts would be, but I am sure that happens to exactly nobody), but because the general spirit on this forum is – wisely – YDMV.
As somebody who typically has a high alert at 140 (and currently, since I am pregnant, it’s at 130), here is my logic: I want to be able to react as soon as possible if I am rising since the ultimate goal is to stay within my targets the longest amount of time possible. The sooner I can react (with micro-corrections when necessary to bring my level down and the right amount of carbs or sometimes even with just lowering the basal and no additional carbs, when the BG needs to go up), the shorter the time I spend out of bounds.
Personally for me, when I will be active (anything over a 15 minute walk), I might actually eat a whole meal (30-35g carb) without any bolus and only do a correction if necessary after the fact (which is actually rarely necessary). I know for sure this doesn’t work for everybody.
Bottom line, set your targets and alarms to what works for your long-term goals, BUT also set your basals and I:C ratio correctly, so that those alarms don’t drive you crazy.
The hybrid system will probably have done a lot of basal adjustments for you in the scenario you describe.
I’ve had Type 1 for 25 years and have had a pump for 10 years and CGM for 2 years. I started out with my high alert set to 10 mmol/L (180 mg/dl), but within a couple of months, after testing my basal rates and ratios and figuring out how to pre-bolus, I moved it to 8 mmol/L (144 mg/dl). With the CGM I try to note which foods or events consistently send me over that level and try m y best to avoid them or to at least minimize the blood sugar swings. I find exercise is the hardest to manage, and tend to handle that through a combination of reduced basal rates, snacks before, and glucose tablets at any sign of a drop during or after (I usually do not wait until I’m low to treat, I often set my low alert to 5.5 mmol/L (100 mg/dl) during exercise and will treat at that level, or even higher if it’s a steep drop).
Having my alert at 8 mmol/L does NOT mean I never go over that level or that I achieve flatlines every day. Very few days go by where I don’t go outside that limit multiple times. My last A1c was 6.8%, so definitely not in the ultra tight control club. But I have it set to that level because, most of the time, if my BG rises over 8 mmol/L I want to take action to steer it back towards my target range, even if that action is just taking a 0.25 or 0.5 unit correction. I have my “high snooze” (repeat) set to two hours, so the most the alert ever goes off, even if I run high all day, is every two hours. (The issue of hovering at 8 mmol/L, as @AE13, is one time I do get really annoyed, but that can happen regardless of where your alert is set if you’re hovering there…) If I’m running high all day or just feeling burned out, I will raise my alert to 10 mmol/L for a few days to get a break.
I see people with CGM alerts set to 11 mmol/L (200 mg/dl), 14 mmol/L (250 mg/dl), and above, and I don’t really understnad that. What is the point of having a CGM if it’s not going to warn you that you’re high sooner than you would find out if you were testing a lot? The point of having the alerts isn’t to have them never go off, it’s to have them alert you as soon as you want to know so that you can take action to steer things back into your target range. At least that’s the way I look at it. I pay for my CGM 100% out of pocket, so I set the alerts so that I can take as much advantage of the system as I possibly can. If I had my alert set to 14 mmol/L it would not be worth spending thousands of dollars a year versus just testing ten times a day with free (covered) test strips, in my opinion. But you also have to set the alert at a place where it’s not going to drive you nuts, and that’s different for everyone.
Anthony- I’m glad you posted this! My sugars behave almost the exact same when working hard/stopping. Its as if my body switches modes to be super sensitive to insulin, then recovers later by being less-than-normally sensitive.
You’re not alone! (FYI my dexcom high alarm is 200, but I do have alarms on the rising arrows to catch mis-dosing. It does go off more than I’d like )
140 alert notwithstanding, one thing you may be overlooking here is that exercise with insulin on board is VERY DIFFERENT from exercise without same. Many years ago an endo pointed out to me that at rest, it takes something like 35 chemical steps to bind insulin to glucose and make it available to the cell, whereas the number required during exercise is ONE. In my case the exercise-after-lunch quandary always involves this balancing act. If I’m planning to eat something I need to bolus for, I cut the insulin amount in half, though then I have to consider myself committed to that bike ride–sucks if it suddenly starts raining, like today. I also bounce back quite a bit from an exercise low, so for me personally a 70 post-exertion would be pretty acceptable and I wouldn’t bother treating it without giving it half an hour to come back up a bit.
But fwiw, I’d have a hard time if my “high” alert were set at 140 too.
ETA: for the same reason (IOB) a brisk 15-20 min. walk an hour or so after lunch is a great way to supercharge your dose and stop a post-prandial spike in its tracks, though again it may still trend back up a little after the immediate effect wears off.
The YDMV or “your diabetes may vary” is a simple truth that most of us accept. I especially like the “may” part of that sentiment. I believe that we each experience diabetes along a spectrum of symptoms, but I think there’s plenty of overlap, too. One of the biggest benefits I’ve enjoyed at TuD over the years is discovering that someone else’s diabetes tactic works for me. I’ve found, however, that I need to respect the differences between diabetic individuals and their experiences.
TuDiabetes is a site that enables us to support each other in the struggle we all encounter each day living with diabetes. Like life, living with diabetes is sometimes a wining proposition, sometimes a losing one. In any community, people naturally want to celebrate the victories as well as acknowledge the losses. And hopefully draw good lessons from both situations.
I have a competitive nature but I try to keep that well under control when it comes to interacting online about diabetes. Since 2012 and some significant lifestyle changes I made, I turned a major corner in making good progress in controlling my blood glucose. I’ve enjoyed many successes since then (as well as failures – I do still have diabetes) and have written about them here. As I wrote these celebratory accounts, I thought about what it must feel like to someone who’s going through a rough patch with their diabetes and it makes me cringe a little. Does that mean we should never or rarely celebrate success? I don’t think so.
I am one of those people who set my upper threshold CGM to 140 mg/dL (7.8 mmol/L). I want to know when my blood sugar breaks that level. It’s not a nuisance to me but I understand why some may want to set it at a different level. I don’t, at least not intentionally, portray this setting as normal. It’s just a setting that works for me. I would never want to use that or anything else as a way to make other people with diabetes feel badly. I could not derive pleasure from that.
As far as your hybrid artificial pancreas questions goes, I do think it can be set up to help you through the scenario you describe but it would take time and effort to do that. The current artificial pancreas iterations are just in the beginning phase of their development and are not as automated as many people think or hope they’ll be.
I have my alert set at 170. If I did a correction every time I was above 140, I would be crashing a lot. My A1c is in the 6.5% range or lower. Congrats to those who can set the lower alert.
By no means is my control super-stellar either. But establishing a target range like “70-140” then actually taking action - meal planning and insulin dosing along with correction glucose and correction insulin - to stay in that range is what it’s all about. And that’s what you’re doing so that’s great.
If a CGM alarm at 70 and 140 is how you choose to stay in target range then it’s a useful tool., but you can also use the CGM or fingerstick data to have a 70-140 target range without any beeping alarms.
The bg meter/CGM is there to help you stay in range, not serve as criticism when you are out of it. I know not everyone in the medical community or general public views it that way. There are lots of vocal members of the online diabetic community representing the top 1% of control who might pooh-pooh a single deviation out of range as failure, but they do not represent the average or even above-average control spectrum.
There have been docs/nurses I just knew they were going to pooh-pooh me and take pity on me as a failure if they saw a single number under 70 or over 140. Yet unless it’s an exceptionally good day I am out of that range at least once every single day. I think most T1’s and medical staff who deal with T1’s know that this is an extremely aggressive target range, but then they fall into a trap where they don’t realize how difficult it is to stay in it.
You can set the alarm to only go off once when it breaks the alert number. Then it doesn’t go off all the time.
You don’t set it at 140 to prevent it from getting to 140. You set it at 140 to keep it from going to 160, or 180, or 200. It just helps you catch it earlier. It’s basically the same thing as setting it for 160, but you just catch it a little sooner.
Do you want your burglar alarm to tell you when someone is on your front porch, or do you want it to wait until they’ve broken the window?
Welcome back @Eric2 !! Glad you came back despite the recent events.
Regarding the 140, yes I completely understand the mechanics of WHY someone would want and need a 140 alarm. But that was not the focus of my post. For me I cross 140 way too many times for me to remain sane with alarms going off daily. That is what I really was talking about. I just don’t understand how the 140 people are able to bolus so accurately? And it’s also worth noting that food labels are allowed by the FDA to be off by 10%. So a carb listing of 50 can really either be 45 or 55 and still be labeled 50gm.
It just bothers me when I constantly read on here what users upper alarms are. Just say you have an upper alarm period, we don’t need to read daily that your alarms are 120 and 140. So, whoever takes offense to this statement is my target audience. Thanks!
For me, the Dexcom is what prompted me to go semi low-carb with my eating. I also pre-bolus (well, not so much now with Fiasp) by 30-45 minutes to minimize the spike. It would not surprise me if many people with a 140 mg/dl upper limit eat low-carb or semi low-carb. When I first got the Dexcom I found that I was spiking to 14-17 mmol/L (250-300 mg/dl) for hours after every meal, and since my goal in spending thousands of dollars per year was to get better control, I eliminated those foods from my diet. If I didn’t use diet as a method of control, then yes, I’d be above 140 mg/dl a lot more and an alarm at that limit wouldn’t be as useful (and I do raise my alarm to 180 mg/dl during times I’m having trouble with control). And as I mentioned, even with using diet, I still go over that level often.
[quote=“anon85331563, post:13, topic:61196”]
It just bothers me when I constantly read on here what users upper alarms are. Just say you have an upper alarm period, we don’t need to read daily that your alarms are 120 and 140. [/quote]
I’ve learned to stay out of threads if I know they’re going to annoy me. I do this for mental health, as otherwise I was constantly comparing myself to others and feeling “not good enough”. I don’t stop by the Flatliners thread if I’ve been having a rough patch, for example. But I think it’s a good thing that such posts and threads are available. If it weren’t for reading that people with Type 1 could achieve such control and reading about the strategies used to get there, I never would have improved my own control as much as I have.
One of the tricks to consider - it’s easier to raise your BG than to lower it. So if you are having a hard time with the carb counts, take a bit more insulin for your meal and then if you start to drop, take a little bit of food to correct it. It might be an hour after a meal, or maybe two.
IC ratios change. Different times of day it might be different, and different types of carbs come in at different speeds, so you might need to take insulin earlier or later. And depending on where your BG is when you figure out the dose, you might need more or less. Higher BG’s might need a different correction factor, not just more insulin.
Since all the carb counts can be somewhat guessed, your IC ratio might not always be the same, and your correction factors might be different, it might help you to guess on the high side, and correct with food.
To me it’s a no-brainer. I can either guess on the less-insulin side, and need more insulin an hour later and fight a high BG, or I can guess on the more-insulin side, and I get to eat a little snack an hour later.
Toughest thing to learn is not over-correcting. Be patient with everything.
Also, if you are frequently going above a certain BG, make sure you have enough basal going, and also consider earlier dosing for meals. If you eat when your BG is on its way down, you can avoid the high alarms easier.
I don’t have much to add given what everyone has said, but I keep my high alert even lower, at 7 mmol/L (126), and it’s made a huge difference for my a1c without having to change my diet much. I often find the problem is not that I need more insulin, but more up front at certain times of the day and for certain foods, so with my pump I can just suspend the basal for an hour or 2 if I get a 126 alarm and take the same amount up front - it keeps my BG under 126 without needing to correct with glucose later. I also find there are many foods that end up digesting way later than I expect and even using a square/dual wave bolus it’s difficult to prevent overnight BG rises without a CGM alarm waking me up before my BG gets out of control.
It’s strange, my experience with the medical community is that they only care about low blood sugars. They could care less if my blood sugars were between 180-220 all day, as long as they aren’t low.
I agree with a lot of what @Jen has said in particular. I started with my CGM on factory settings (upper limit 200), when my A1c was about 8. As I’ve tightened control, I’ve moved it down in 10 unit increments, and now it’s at 150. For me, low carb makes all the difference. To be honest, when I eat stuff like bread, bananas, granola etc, I get alarm fatigue super easily and my averages and SDs go way up. Eating low carb (right now I’m aiming for about 50g a day) makes a tremendous difference and I go from cross that threshold back and forth each time I eat, to maybe hitting it once, twice a day max. I’ve recently re-committed to low carb. If I can keep it up, I can imagine lowering my high limit to 140, possibly lower. I don’t always stick to that diet, because of life (and I wouldn’t plan to so strictly that I couldn’t make exceptions for special occasions), but it’s super clear to me that low carb makes all the difference for me at least between having flat lines and wave-like blood sugars. Never would have known that without my CGM.
That said, it’s all about what doing what works for you! Including what you read and what you ignore on here. One thing I think that can be tough on here is the broader grouping of T1/LADA—I try to keep in mind a number of the T1s on here still produce insulin and are in a very different situation from those of us with acute-onset diabetes since childhood. Comparisons across those groups may not be accurate.
That’s been mostly my experience, too. I’ve come to accept that the doctors’ values and concerns are not completely congruent with mine. Once I accepted that reality and dealt with some annoyance and anger, I concluded that running my numbers in the range I could accept and live with was my concern, not the doctor’s.
Now I know doctors exist that can both be pragmatically cautious about lows without throwing their value of targeting healthy closer-to-normal BGs completely out the window. Unfortunately I’ve found their occurrence much less often than the those overly hypophobic. The medical practitioners that really irritate me are the ones that quickly conclude that a patient is at high risk of hypoglycemia based on A1c alone. They assume a BG variability not present in every person with D. I see this trait as cognitively lazy.
Most sensible people would consider that to be excellent control. I have in the past posted on other diabetes forums where it seems to be standard practice to include your recent HbA1c results in your signature and it turns into a competitive exercise (my Dad can beat up your Dad!).
My objective in life is not to beat the UK T1D all-comers record for the lowest HbA1c. I watch my CGM trace but I don’t want alarms going off all the time (unlike for low BG where there is a potential safety issue and I set it at 4.4.
but thanks for making me feel more normal.