Glucose Distribution

Since I got my dex I was looking for a way to condense the flood of data into one number that would tell me how I was doing. Now I have found a measure that I am content with, even that it is not just one number. The Glucose Distribution Chart tells me the % time spent per bg range. I am only interested in the % time spent above 130. This week my numbers were
131-160: 11%
161-190: 1%
190-220: 1%
The week before it was
131-160: 9%
161-190: 2%
I would like to improve. Knowing what a reasonable goal is would help me a lot.

Hmm… Well, I guess the standard recommendations say that we should be back within normal range an hour or two after eating. Assuming 3 meals/day, that translates to 3 - 6 hours/day above range, which is about 12.5% to 25% of the hours in a day. Based on those numbers, it looks like you’re doing great. You could use similar mathematics with different numbers to calculate a number more finely-tuned to your personal goals.

Wow! I am extremely impressed. How did you achieve not having any postprandials higher than 160 for so much of the time? Do you restrict carbs? Way to go!

Jan, I play a basic version of the game: no pump, no MDI, just one shot when I wake up and another one when I go to bed. The only diabetes-related decisions that I have to make are “When should I eat?” and “How much should I eat?”. I define a good decision as one that keeps me in the target bg range. The dex allows me to fine-tune my timing and portion size. Do I restrict carbs? Yes, I do. Before I eat I ask myself “How much can I eat without exceeding the target bg range?”. As you see from my numbers, I don’t always succeed. Food from the cafeteria is always unpredictable. Even for the exact same food eaten at the exact same time my body has drastically different reactions. This is why it was so hard for me to detect a pattern before I had the dex. Now I know that there is no reliable pattern. I no longer predict. I just react to the numbers on my dex.

Helmut, I actually looked back at your profile to see if you were Type 1 or Type 2. Very impressed with your postprandial control. Cannot obtain that for my niece. She spikes less with Dexcom, but still in the 160 to 180 range, two hours after eating and I consider that a success. Obviously, she will be even higher at the one hour mark. Then we feed the insulin as Novolog takes four and a half to five hours to leave her system. When you feed the insulin on board, she may then go back up slightly. Apidra will be necessary for us to get those numbers down; we did a short trial of one week and that was not enough time for us to figure out new basals/bolus correction and sensitivity factors — I believe all of these will change, maybe radically. We did not have Dexcom when testing Apidra either. I think she will need a lot more basal with it; lower correction factor. I can only dream of such control. Glad to see that it IS possible.

Jan, today for me it is all about portion control. As you know from my profile I go way back to the time when bg strip were not yet invented. I used 70/30 Humilin and it took forever to get a high down with an extra shot. When Humalog became available a new and better world opened up for me. All of a sudden I was able to bring highs down much faster. I overdosed and when the bg came down like a ton of bricks I drank orange juice to accomplish a soft landing. All of a sudden I felt I could eat as much as I wanted. I just had to compensate with the right amount of Humalog. I fooled myself into thinking that it actually worked. In reality I rode a roller-coaster. My A1C was OK because highs and lows canceled each other out. By A1C standards I did fine. I knew that it was wrong all along. Only recently when I started reading the forums I learned about the importance of variability. I am at a age where I prefer to worry about control rather than complications. My A1C did not reveal that my variability was out of control. Fooling the ‘Good Doctor’ only goes so far.

My expectation is that if I eat half then my bg will only go up by half. Nobody is holding the gun to my head to clean the plate. It is my decision. On the CWD forum mothers often state that they tolerate high bg for their kids because they don’t want them to think about diabetes all the time. I believe in a simple assertion: Once a person is diagnosed with diabetes the person has to think about diabetes. That is no longer a choice. The only choice is whether the person wants to think about control starting early in life or about complications (like an amputated foot) later in life. Obviously I am biased.

These days my goal is not to use any Humalog at all. Of course, I am not religious about that and I do what I have to do to keep my bg in check. By using Humalog less often I was able to lose some weight because I noticed that my weight seems to be proportional to my insulin intake (since I try to keep my bg constant).

All
I have also been pondering how to extract useful results from the Dexcom data. If you have the DM2 S/W available you might be interested in a spreadsheet I developed which calculates an A1C value from downloaded Sensor or Meter values. It’s a bit complex to use but seems to be fairly accurate, compared to my routine laboratory A1C results, and you can run it anytime. I’ll be interested in any feedback from anyone who gets it working for them.
7150-BGspreadsheetMaster.xls (23 KB)

VERY interesting. Now, a 12 year old or six year old or two year old has to eat a certain amount of carbs for brain development (130 a day) and just to grow. The reason she goes high after eating a 60 gram meal is that her Novolog is really not “fast acting” at all FOR HER. On the cgms, her blood sugars don’t come down until 1 hour 20 minutes after eating. That is when I see the down arrow. So I decided to beat the clock so to speak. Bolused for her sixty grams, gave the rice, meat and veggies. Twenty grams was for fruit. Knowing the way the Novolog worked, at the one hour mark give the fruit (fruit takes approximately 20 minutes to digest, or so I thought). Well she dropped faster, two arrows going down and was 39 when the 80 low alarm hit. It is the insulin that does not match well with food digestion. Takes four hours plus for Novolog to leave the system and stop taking BS down. That’s not much better than Regular, is it? Mothers of children know that they MUST eat healthily. They have no choice but to tolerate high blood sugars, because their kids must eat. Insulin rarely matches food digestion for her. Rarely. Conversely, I can give her a cup serving of ice cream and she never goes over 140 and never drops too low either, just comes right back into range. Icecream at every meal? She’s a healthy eater and would rather have fruit, which raises her substantially. Hoping Apidra will work. But as an adult, yes, there are many things possible.

I am getting better at the game. The last couple of days I was 0% of the time above 130. I still have an endo appointment in November with the goal of acquiring an OmniPod. I am very much on the fence about getting a pump. I read about all the problems that people are having with pumps and rarely do I find an account of anybody doing better with a pump than me without. I know that I am driven by fear and I am afraid of change. My wife says: “What is the downside? If you don’t like the pump, go back to shots!”. I wish I could stay in my comfort zone and my comfort zone would keep growing. Unfortunately my comfort zone only seems to grow when I step out of it.

Hi Helmut,

Your 130 max BG goal is right in line with the maximum BG spikes of a non-diabetic.

There is a study where a group of non-diabetics wore a CGM and it showed the minutes per day in various BG ranges, including after meals.

  • for BG > 160, the minutes per day was 1
  • for BG > 140 - 160, the minutes per day was 10.5

This means less than 1% of the day at a BG of 140 or more. I see where you had 0% at BG 130 or more for a few days, so you are doing well.