Glimpse the future

With the appearance of continuous glucose monitors (CGM), like the Dexcom G6 that don’t require daily fingerstick calibrations, many people have fallen out of the habit of using a fingerstick meter to manage their glucose levels. I’m testing a lot less frequently than I used to but there are situations where a confirming fingerstick saves me a lot more trouble than it creates.

I’ve been struggling some with a trend of lows around midnight, a few hours after I go to bed. These lows often require more than one glucose treatment. I think they are caused by basal rates set too high, something I now call a “basal low.” We all know the feeling of just wanting to handle this situation quickly so that we don’t fully wake up and then face trouble getting back to sleep.

Making the effort to do a fingerprick is the last thing you want to do. I often just eat a glucose tab and roll over. Unfortunately, these lows have been more persistent and 15 minutes later, the alarm is sounding again. I’ve learned from experience that I can cycle through the alarm, treat and another alarm cycle until I treat one too many times and my blood sugar goes high for the rest of the night.

Two nights ago, I was woken up with a low alarm (65 mg/dL), treated with one glucose tab and rolled over. Fifteen minutes later the urgent low 55 mg/dL alarm sounds. I then thought, ok, maybe I am indeed low and need another glucose tab or perhaps my first treatment just hasn’t metabolically registered yet.

Reluctantly, I dragged myself out of bed and stuck my finger – 90 mg/dL. So my suspicion was confirmed, I returned to bed without another glucose tab, no more alarms and I woke up in the morning at 93 mg/dL. I would have been so easy to eat another glucose tab (or two!) and return to sleep and bounce into hyperglycemia for the rest of the night.

In these situations, I think of a fingerstick as a way to look 15 minutes into the future. It’s not really the future but a CGM often lags a meter by 15 minutes.

I find this framing makes it easier for me to find the energy to do the fingerstick and make better informed decisions. Instead of feeling like I’m burdened with this additional task, I see it as an opportunity to see into the future and make a better call.

As humans, we have this incredible ability to reframe reality and instead of changing any of the facts in a situation, we can see it from a different perspective and make better decisions.

It’s a small thing that has helped me. I now see my fingerstick meter as a magical tool at times that can allow me to see 15 minutes into the future. It makes those difficult midnight decisions a little easier. Anyone else use this technique?

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I love this idea! A bit of a trick on one’s own self!

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Great post, and you just have to absolutely love compression lows at 2 AM. Thanks for posting this @Terry4

It’s not so much a trick you play on yourself as it is a way to gain a new perspective that actually creates another plausible version of reality.

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Well said! :slight_smile:

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Lol…I just want the easiest way to go back to sleep.

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I definitely do a fingerstick for persistent lows. Often, but not always, I’ll find myself back to normal when my CGM still says I’m low. At night, this actually allows me to go to sleep much faster than if I were thinking I was still low, so I don’t see it as a burden. :slight_smile:

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I can see my interruption of sleep example is a tough sell for most people; we all love our sleep and certainly need it for our health.

The larger point, however, still applies. As many of us have easily transitioned to using a CGM and accepting its values for moment-to-moment treatment decisions, if we’re going to add food, insulin, or even exercise in response to a CGM value, looking 15 minutes into the future with a fingerstick before acting can be time well spent.

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I always get up and test if I get repeated lows during the night. I trust a fingerstick much more than my CGM. My problem is that I often can’t get back to sleep again after the alarms and having to get up to test.

For some odd reason I have been having a lot of lows and have discovered that 1 unit of insulin will cover 50 carbs at dinner. I am not sure why my ratio has changed so much. Even after 61 yrs with this disease, it still is often a mystery to me.

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Excellent thought process!

How many blood tests (finger sticks) do you think you’ve done since you made the switch from G4 to G6?

I’ll be switching here soon from the G5 to the G6 and I have plenty of strips, but I don’t think they will be covered any longer once I do make the switch.

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I ordered and received 3 new G5 Transmitters the end of June and have enough sensors to last until the transmitters die (3-6 months depending on the batteries). I’m in the camp of not wanting to change to G6 because of cost if for no other reason.

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Meanwhile, I finger test regularly, because like others I can’t see 15-20 minutes into the future. 41 tests the past 7 days (6 per day). At least half of these are within an hour of getting up as I battle a changing dawn phenomenon each day.

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I think you can just attribute this to the nature of diabetes. My recent dive in BGs around midnight seemed to come out of nowhere and I’m still trying to figure it out. I think the important thing is to accept any new trends quickly and experiment with tactics to address it.

The simple analysis for lows is that we are getting too much insulin. The harder job is to try to figure out how much to reduce and when. That includes deciding how much to take off of the basal insulin and how much the bolus dose.

In my case, I’m getting a build-up of insulin on board during the pre-bedtime hours and I think that leads to a hypo-effect around midnight. I am going to make my evening meal (which I eat at least three hours before retiring) insulin dose more aggressive. I can’t believe that I’ve been working on this for a few weeks now. It seems like a relatively simple challenge but the solution has been evading me. I will persist!

My fingerstick rate of testing has remained unchanged during the G4 to G6 transition, about five tests average per day. Some days I don’t poke at all and other days might mean 10 checks. In order to feed BG data to Loop during the two-hour sensor warm-up period, I stick every 20 minutes. I also add meter checks when I know my sensor diverges from my actual BGs. I don’t think skimping on test strips for economic reasons is a good idea, but I think insurance companies ceasing strip coverage is reprehensible.

While I disagree that payors stop coverage due to paying for CGMs that do not require calibration, I will self-fund if need be. Strips can be purchased for about 20 cents each and I think $1/day for five strips is worth it for safety and health. I still get strip coverage under my Medicare Part D coverage; I think the Part B coverage has dried up for most people who use a no-calibration-required CGM like the G6.

I’d still be using the G4 if Dexcom didn’t cut me off from the data stream needed to run Loop. I know I could have changed to the G5 but sense that I won’t be too long until that option expires. Canada, of course, will operate with a different schedule.

You and me, both. This morning I had to throw two 4-unit Afrezza doses at a stubborn glucose level and finally was able to bring it down with a 15-minute rebounder session. Keep up the good fight, @Jimi63!

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I think my insulin/carb ratio improvement is most likely because I am starting my fourth year of following a plant based very low fat diet which is designed to lower insulin resistance. I can now eat more than 10 times the amount of carbs using the same amount of insulin as I did when eating 30 carbs daily.

I am also exercising after both breakfast and lunch. Instead of 1 hr after breakfast I am splitting the time. I think that is the biggest recent change I have made. I should probably lower my basal insulin, since I am running lower at night and waking up with a glucose level in the 60’s. I had no alarm go off last night and was able to sleep all night without waking.

I find eating the same amount of oatmeal and fruit every morning, and beans, quinoa, kale and a garbanzo bean cookie at lunch makes it so I don’t have to guess about my glucose levels. Dinner is the only meal I vary.

I wouldn’t have liked to eat this way when I was younger, but I find it very satisfying now.
My last A1c was 5.2. When I finally get to a lab again, I imagine my number will be lower.

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Seems like you have things well in hand, Marilyn. Your A1c certainly confirms that. Splitting your exercise to follow both meals seems like a good tactic.

It feels like a notable accomplishment when you can sleep through the night without waking. Life’s simple pleasures …

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I agree. I think you use the Contour Next? I have the Freestyle (not light) that I use with my OmniPod PDM (Personal Diabetes Manager). Once I run out of Freestyle strips or change from the OmniPod pump, I’ll most likely get the Contour Next.

No, I don’t but I’ve read many positive comments about that brand. I’ve been a long-term user of the Accu-Chek Aviva meter and strips.

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I had very similar problems with highs and lows after bedtime. Though I completely agree with using finger sticks as a backup, I finally resolved the problem after years of waiting, by getting the Tandem pump with Control IQ. I had previously found it almost impossible to adjust the basal rate for unpredicted changes during the night. Surprisingly, this pump almost always makes the needed adjustments

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Thank you for your post! This came at the perfect time for me because for the last almost two weeks I have been woken up by my CGM alarm. I have glucose by the bed so, same as you I take a correction then roll over only to be woken up again. My meter, that I still use because for another week I am on the G5, is downstairs so like you I have not wanted to bother.

I determined that my basal doses (twice daily) were too high so I have been gradually decreasing and then checking before bed. I have found, at least with my G5 experience, that sometimes the sensor goes off on a tangent and does not at all reflect reality so I have learned to check with a finger stick occasionally especially when my body sense does not match the sensor reading.

When I was relying on finger sticks only I kept a meter by the bed as well but with the CGM the strips might go beyond their usefulness if I am only using them on occasion instead of 10+ times a day. My wonder is, why? I eat a modified keto diet, am a habitual intermittent faster and snack only to keep from going low if I am. I had wondered if, with the immune strengthening regime I do, that maybe my reluctant pancreas is helping out again, albeit slowly.

Thanks again. I rarely chime in but I have benefitted immensely from all of you who have been living with diabetes for many years. I am one of the fortunate ones. I was diagnosed (LADA,Type1) 4 years ago when I was 62. And thanks to sites like this forum I knew to insist on the tests to prove that I was not producing insulin rather than believing my PCP who said that I was an ‘anomalous’ Type 2.

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Excellent contribution Terry. We have fallen on this technique too. We describe it as having two time zones and being able to predict the future and so better inform our response to the present! It really does make a difference compared to our past practice. We’ve also started to have a sixth sense of when we need to double-check the information. Not always, in fact quite infrequently but valuable when we do! Thanks again.

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When I was still using Medtronic sensors with the 670g (still using), I had so many sensor problems that I was prescribed 600 strips per 90 days. Now that I use a Dexcom G6, I use maybe 10 strips per week on average.

I find that I can’t quite trust even the Dexcom sensors, because they seem to give me consistently high readings. The sensor starts out 20-40% higher than the Contour Next, and then just stays there at the same elevated level (consistantly, for hours) unless I calibrate. Once calibrated, the Dexcom either falls in line for the rest of the 10 days, or slowly drifts back up after a few days.

I am reminded of the study that someone mentioned here a while back (can’t remember who) where it was found that your A1c result is skewed by how well your hemoglobin fuses sugar to itself. Two people with the same average glucose can be several points apart on test results (like 6.8 vs 6.5). I’m beginning to wonder if the same is true of blood glucose vs sensor glucose. Does the glucose migrate at the same rate from vessels to interstitial fluid, so one person needs to calibrate at least occasionally, while another doesn’t?