Thanks, Rick! The 120 high alarm is only a device to warn us of those spikes so we can catch them timely. 12 is such a volatile age for a girl, and I hear it will get worse. Actually, from 3am to 3pm is a very, very stable time for her, and if she did not eat she would be relatively flat, with evenings from 6pm until usually 1am but sometimes later extremely unpredictable. This is the norm for a lot of girls in the teen years. I believe when she is fully grown, a lot of this will cease and, if it doesn’t, I expect to have either the artificial pancreas, implantable cgms, smart insulin, islet transplantation without immunosuppressants… something. She is very lucky her Mom also is now working nights, so she is covered in this way seven days a week, for the most part. As an example, her basal rate from 6pm to 12pm is extremely high for her weight and she gets 1.95 to 2 units an hour. During some of these spikes, she has used up to 3.25 units an hour, then abruptly drops back to her overnight basal of .95. It is extremely nerve-wracking. Endo says it is not uncommon. Believe me, she is not going to take such great care on her own, so I’m hoping for improvements in therapy.
I never got “faster action” remotely like Dad and Daughter’s experience. For me, Apidra has been only slightly than Novo at start up; the peaks and tails are almost identical. If I did react that quickly, then I would use it as they are using it-- another rapid tool, suitable for micro-management use. :))
If she doesn’t mind the Dexcom nags, then 120 could work as you say. But there’s a big risk in using an extremely low alarm, and it’s a design defect:
Going DOWN, Dexcom provides both the alarm which you choose and an “emergency”, can’t shut it off, nag-you-until-you-fix-it-or-the-battery-dies alarm at 55 mg/dL.
But going UP, Dexcom has only ONE alarm. So, if it goes off at 120 mg/dL, after every single meal, that’s “good” if it made you look at a sharp and unexpected rise. But here’s the problem: If you KEEP going up, and the “correction”" dose which you chose to do never causes you to get under 120, then it it stays quiet: Just one alarm, as she floats up to 160, then back down to 130 from the “correction” takes effect, but if it starts to rise again, you won’t get any notification – not at 160, 200, 250, 300.
That’s the risk. If she never makes it back below the “high alarm” line, she’ll never hear another one.
Wow, this is EXTREMELY dangerous. I will print this out for Sis. Dexcom Rep. told us we really would go crazy with the Dex alarming all the time and convinced us to set higher alarms and just look at the screen as often as we need to. We set the low alarm to 80 and the high alarm to 160. Dex startup was today and was not at all traumatic for it. Piece of cake and we are comfortable with insertion. Don’t like that little plastic thing you have to twist off; will twist it off beforehand; Rep showed us how to put fingers underneath and snap sensor in. Dex calibrated really well; BS readings 104 and 111; Dex read 107. Perfect! However she ate donut spontaneously when Sis bought coffee, did not prebolus. Dex gave us a low alarm at 80 arrow pointing down; gave her a glucose tab; then 71 with arrow pointing down, so we checked. Fingerstick said 160ish. Fifteen minutes later she caught up to Dex. But I could never dose without checking. Most likely Dex will be more accurate when there is not food and boluses active; i.e., overnight. I am shocked at her BS response to food; shocked beyond belief! We have done one hour checks and on Minimed I did not always notice such a high climb. We are going to have to prebolus by at least 15 minutes, possibly 20. As I mentioned on the home page, love, love, love the Dex. P.S. She has been eating and dosing because we got home late and she would not eat at the mall. Dex is alarming at 160 and she is 220; now she was 124 with 3 units on board; I gave 20 grams watermelon, will keep checking, but it keeps beeping low. I will check once more, but think this sensor is still a bit off.
just a quick reminder of points already made elsewhere:
(1) Dexcom will NEVER match an increasing bG until about 1/2 hour after the rising bG ends. If she treated the low bG with an uncovered donut, Dexcom absolutely will not show ANY signs of that donut for over twenty minutes-- Dexcom readings are always WAY behind during any train wreck of flying-high, covered-too-late bG.
(2) A new Sensor is much less reliable and “stable” than a 3-day-old Sensor.
(3) If you want it to present quality readings at 80 bG AND 160 bG, you can’t do all of your calibrations at 110. (You need two points to establish a line, and it’s more accurate if they’re further apart.) But never, ever, during increasing bG.
(4) And don’t ever enter calibration data below 70 mg/dL. It’s much more accurate to use readings in the 80-90 area as the “low” calibration readings (along with a few data points from considerably higher readings), and let it just calculate estimates for deeper lows from that data.
(5) Usually, overnight is NOT the most reliable period. This is because blood and ISF “pool” during sleep, and the area local to the Sensor site can become “stale” in comparison to the rest of the body. False lows, and under-reported Highs, are the usual result of the problem, but it can also read too. DO NOT calibrate to “correct” such an error: if you calibrate against stale, dysfunctional ISF, the whole calibration curve goes wacky.
If you’ve absolutely GOT TO get the readings cleaned up, “right away”, then do this instead: Have her get up, walk around the house for a few minutes, then wait 10 minutes more, then finger-stick and calibrate. This creates good blood flow first, then adds time for molecular density differences (i.e. GLUCOSE LEVELS) between ISF and blood near the Sensor site to become more normalized.
Sorry, Rick, I am bumping you back up into the “Expert” category, LOL. We called Dexcom tech support yesterday afternoon and she knew none of this, just told us to recalibrate. Dex was off night before last, so niece put it in her purse and walked away from it. After she got back from camp, we called Dex Rep, followed her advice and recalibrated. The fingerstick numbers and sensor numbers were VERY close, within 11 points, except for a few hours after dinner. Now it would lose her at points, but sensor did catch up to her BS at points even during that after dinner period. Was so accurate that at 4am, I decided time for sleep and went by the Dexcom reading of 96 one arrow down. I gave her 6 grams of juice, which should bring her BS up to 125 and unfortunately fell asleep before rechecking. She was 181 fingerstick at 8am, 170ish on the Dex. This is not her pattern, though she had times when she will go up in the morning from 4 thru. It is usually short lived. We have to hook up the Radio Shack wireless mike and in that case I should wake up. For school she can carry Dex in her small Coach bag which she takes with her everywhere. Pockets on jeans are too shallow so I sewed a jeans pocket with velcro that I saved down on the inside of her shorts and it works well. She does have bulges in her pockets between pump, Dex and Lifesavers. We left the low alarm on vibrate and turned off the high alarm (since she does not want to be bothered while acting). I told her if it beeped and she can’t pull it out to eat sugar. She’s okay with this. She has been between 100 and 150 from 12 noon until 3pm, when she was released from camp. Breakfast, she came down quickly, as she is in a rush and will only eat a yogurt before camp for breakfast. It is an acting camp, so they do dance moves, but off and on and are not running around like maniacs. Love, Love, Love the
Dexcom. As soon as Dex is integrated with a pump, I think she will really love it too. I like having a separate receiver, so I don’t accidentally wake her up grabbing for the pump. She does not wake up usually for fingersticks, but I look at Dex at least every half hour, even 15 minutes sometimes. Put receiver on the dresser near the door beside her bed. She was completely unaware I was even checking. I do not expect such accuracy all the time, but even if it works this well a good deal of the time, I’m sold.
Rick, one more question on getting a good calibration for the high levels. She absolutely does and always has, spiked to 200, 250 after eating. If we prebolus, she may spike to 180, but DIA is four a a half hours, so you can see where that’s going. Down. We are always feeding insulin around here. We will seek to get a low calibration point around 80 to 100. Should we seek to get the high calibration point around 200, not 160? This would be problematic because those are postprandial spikes and in flux. If I get the “high” calibration at hour 2 after eating, where it could be 200 at times, that is not a stable 200. So how do I get high readings? I certainly can’t get them every day. I can get them at some point during a three day period. What should I do re getting the proper high calibration point? P.S. Sis did calibrate the 180 this morning.
“But going UP, Dexcom has only ONE alarm. So, if it goes off at 120 mg/dL, after every single meal, that’s “good” if it made you look at a sharp and unexpected rise. But here’s the problem: If you KEEP going up, and the “correction”” dose which you chose to do never causes you to get under 120, then it it stays quiet: Just one alarm, as she floats up to 160, then back down to 130 from the “correction” takes effect, but if it starts to rise again, you won’t get any notification – not at 160, 200, 250, 300."
??? I thought Dex’ snooze/re-alerts feature would allow tracking whether a correction dose has achieved your target??? Snooze it for 1 hour and Dex should re-alert that you are still above 120.
Yes, I did think this too. But Dexcom tech support told me point blank NOT to set the high alarm at 140 if she very often goes above 140 because the alarms are too annoying and they would be going off all the time. Regarding calibrating the Dex, you want a lower reading near 80 or 100 and you want a high reading near 200 if she does normally have 200 or above numbers. If you normally do not rise above 140, then that is what you should set your high calibration at. Regarding alarms, we set it to 160 so we can have a “heads up” on highs after dinner and especially overnight, we want to catch the highs early. However, DN is not used to the alarms yet and is getting annoyed so we turned low alarm to vibrate and turned off the high when she is away from us. She eats at noon so does a fingerstick then and we pick her up early afternoon. She almost always has good numbers until 6 p.m. I just put the Dex near her at home and go check when I need to for now. At bedtime, when I need to hear the alarms, I’ll turn it back on.
Don you may be right-- I’ve not yet tried using that feature at all.
Well, if it does have re-alert feature, the danger is in over-alerting and over-annoying. I could see Jan setting the high alert at 160 with a 2 hour re-alert at night, maybe 1 hour during day. The manual says you can set the re-alert as soon as 30 minutes later but that is not enough time for a correction bolus to work and probably just going to annoy her niece.
Jan, the last two posts are “nested” too deep for further replies.
Some Dexcom support people know as much as I do. BUT, they can’t actually “bring up” any suggestions which the FDA hasn’t approved. Independent end-users, like me, have vastly more freedom to state opinions.
For jeans, and maybe shorts too, I recommend that she forget about using pockets: The new-style Dexcom clip works really great on any fashionable belt; you don’t have to keep digging it out and stuffing it back. And far more important for a young teen: the clip avoids ruining a sexy profile with ugly pocket “bulges”.
You could try calibrating highs the curve BEGINS to level off, approaching a peak value shown on the Dexcom-- bG has ALREADY peaked, and the “bit lower” meter measurement might be a decently balanced match for the “still not all the way up to max” ISF-based Dexcom value. I don’t do this, of course: for me, Dexcom and bG are extremely close during periods of moderately falling bG, and I don’t have the kind of wild spikes which you’re dealing with.
I still think that the long DIA would be much better addressed by modifying the meal content. You haven’t found an insulin formula which can handle those rapid onset, carb-heavy meals, The insulin is insufficient after one hour, AND it keeps biting her in the a** 3 hours later. It sounds to me like the best way to get off this “roller coaster” is to change the meals, rather than play increasingly risky games with longer and longer pre-bolus timing attempts.
Just my opinion, of course.
To answer the alarm question, on the Dex 7 Plus you can set the alarms to go off every half hour for the highs. But it only vibrates, then two short beeps, so easy to miss. Need the wireless mike setup to hear.
She’s pretty good about limiting herself food wise, if she is high, and there is a lot of junk food she does not touch. But she loves carbs, loves veggies and fruits and does not really like meat. Breakfast and lunch, she eats 30, 40 and under. Afternoon snack, 50 or 60, it is the dinner meal which is troublesome. I may have to experiment and try to keep it closer to 50, maybe give her her dessert snack later on. She loves pasta; conincidentally, if I give her that gluten free Quinoa pasta (which we do all the time now) she drops like a rock. Gave her 20 extra grams of fruit and pasta and she was still dropping. Once I figure out this one, she will be able to eat a lot of pasta, which she loves. P.S. We have noted this with Quinoa and have always given 20 extra grams with a little fruit up front, plus checked at one and a half hour mark, then covered part of the insulin. But without the cgms, we did not know she was dropping to 55 and then coming back up. That was really a big surprise.