Do you always do a finger stick before meals? Or do you use your cgm instead?

although my G5 CGM is very reliable and for the most part accurate, i always use my BG meter to test before i bolus. i rarely have to calibrate my cgm, b/c it is most often in range. and, i suppose that it is basically the same range +/- % as my meter. example: this afternoon i wanted to bolus for my lunch. my cgm read 97 with a straight arrow across. my meter showed 130; but that seemed rather high. so, i tested again with my meter, but this time with my left hand finger, and the reading was 120. so i used the lower meter number for my carb/insulin bolus (Medtronic Wizard function)

what has been your experience with this? i like to rely upon my cgm to see trends and to recognize lows and highs and reactions to different foods. yet, before a meal, i will rely upon my meter (which, i must admit, is not the most reliable meter on the market…but Medicare pays for it and its strips 100%)

all suggestions and experiences appreciated.

I use my meter most of the time too. Occasionally, at social situations, I’ll bolus off my CGM, but I try to only do this when I’m really confident in my readings.

which cgm do you use? i am on the Dexcom. i find that when i am in the lower BG range, my #s are most accurate. if my #s are in the higher range >180, my cgm is less reliable.

I was just listening to one of our videos w gary scheiner from last year just before thanksgiving, and he mentions during it what he does
http://www.tudiabetes.org/video/tudiabetes-live-interview-with-gary-scheiner-cde-things-were-thankful-for/

but as usual, I think it’s best to check w your endo

I always bolus using my meter, except when I don’t. :wink: Like @acidrock23 - a lot depends on how confident I am with the CGM’s numbers. On the higher end, the fact that I get headaches over a certain point adds another level of “confidence” in that my headaches are more accurate than the CGM, so when there’s a “conflict,” I check with the meter.

I operate similar to @acidrock23 and @Thas. I favor the fingerstick but will rely on the CGM if it has been tracking well and/or I’m socially engaged. Even if I give less or more insulin than I need, it’s not going to be that far off and I can make surfing adjustments on the fly as I normally do. Delivering the perfect bolus up front is much less common fro me than making post meal adjustment carb or insulin nudging.

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I have been actually trying to force myself to NOT test at all before meals lately. I am essentially 100% of the time in-range before I eat— so in actuality I essentially never make any treatment decision based on my before-meal numbers… I’ve tested before every meal for several years now though, and have just lately come to realize that it hasn’t made a great deal of sense for me to continue doing it— I’ve done it thus far because they say that’s what you’re supposed to do… but I’m starting to think outside the box and treat my own unique condition more than just follow standardized guidance that doesn’t fit me well.

Though that’s on MDI and afrezza… I suppose the dynamic is different when blousing with a pump

For me, more value is had in testing after meals, because if my levels are elevated I actually do make treatment decisions based on that-- like whether to do an additional bolus…

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Sam, so w/out blousing before meals, you are confident that you won’t over-bolus and end up going hypo? i know that meters are “off” too, and that their accuracy is not always reliable, but still, doesn’t the blood sample give you the safest accuracy?

In my case it adds no value or safety because I always take the appropriate amount of bolus for the food I eat… And am never trying to figure out how much additional insulin to take to bring down my bg at the START of a meal---- because I’m always in my target range before I eat—

After I eat I can have significantly elevated, or conceivably even low bg if I took too much insulin, and there is value to me testing so I can take more insulin or eat more food----

But apparently im somewhat unique in that regard… I can essentially know without testing within +/- 15 points or so what my bg is without testing before a meal— it’s always 'normal’I

So yes, in my case and my case only I can say with certainty that at this point testing before each meal adds zero safety, precision, or confidence— but I’m not suggesting that this is appropriate for anyone except me.

Not necessarily always, but most of the time. Actually, lately I’ve felt extremely burned out and have slacked off on testing before eating (or treating a low) and other things, but I’m trying to get back on track with that.

how do you deal w/ the lows and/or high BGs w/out feeling like crap and roller coasting? aren’t you always going to be “chasing your tail?” it doesn’t take much time or work to test or simply look at your cgm (if you have one).

Oh, I think you misunderstood. I bolus off my CGM when I don’t test. I glance at my CGM all the time throughout the day and am constantly making adjustments based on those trends. I also still callibrate twice a day. For a while there I just wasn’t testing 4-6x a day before every meal/decision.

My blood sugar has become a lot more unstable, but that happened well before I stopped testing before each meal, and I think is partly why I’ve felt so burned out. It does make me feel like crap, but unfortunately I do not feel highs and lows very easily unless they are quite extreme, so I’m not someone who can just go off how I’m feeling to tell where my blood sugar is.

doesn’t looking at your cgm more frequently help you to spot the trends of whether you are going high or low? this way you can take action more quickly and stop the crashes and the spikes.

[quote]doesn’t looking at your cgm more frequently help you to spot the trends
of whether you are going high or low? this way you can take action more
quickly and stop the crashes and the spike[/quote]

It does, or at least did until the past couple of months. Lately, actions I take either totally over-react (i.e., I’ll treat a low as usual and then get double up arrows and end up with a high for the next several hours that doesn’t come down) or else have no effect (i.e., treating a 5.9 with down arrow as a low and still ending up dropping down to 2.5 mmol/L or so and having to treat twice more to come up).

I’ve been at this for 24 years and it’s never been easy, but the Dexcom and a lot of work up-front in adjusting all my pump settings and observing what food did and working on insulin timing seemed to solve things, or so I thought. I’m working on re-testing all of my rates and ratios, because I suspect those all shifted somehow. And maybe I’m changing settings too often due to hormonal shifts, or at least those on this site have suggested so, but then none of them have been women, and women I talk to (who have A1c results in the 5s) actually suggest that I be more aggressive in adjusting pump settings during “those times” than I am right now.

Very rarely will I bolus based off of my CGM. Sometimes, if I’m eating something after I’ve eaten a meal I will. I never treat lows based on the CGM, it isn’t safe for me since so few carbs can bring me up. If my CGM says I’m 40 but I’m actually 55 (still within the accuracy range) I’m going to go high if I treat for 40.

Most times I will test before meals. I will on occasion correct based off of my cgm sometimes if I am low or high… Don’t tell my endo. :stuck_out_tongue_winking_eye:

This was actually another consideration in why I decided to forgo insurance for steips and pay out-of-pocket—

So that I could actually do a realistic cost/benefit analysis and see how much I really should be testing— that type of evaluation is difficult to do accurately when the strips aren’t being paid for by the user—

i notice that even though i might be “in range” w/ my cgm and my meter, there can be a big difference between a BG of 60 on my cgm and an 80 BG from my meter. i, too, have to make a decision on my meter’'s reading. if i take two glucose tabs to treat a 60, i will spike if i am mistakenly treating an 80.

At the risk of being nominated for the “Worst D-Mom of the Year”, I’ll admit that we rarely finger stick except to calibrate twice daily because the Dexcom G5 has been that darned accurate. An A1C of 6.0 says we’re not doing too bad…

WOW on that A1c!!! maybe i should trust my dexcom a little more?? doesn’t sound like you’re the “worst mother of the year”.