How do you use your alerts?

Hi guys, So I went to my CDE yesterday and she wasn't happy with how I use my alerts. I've been responding to my alerts as they are happening, so if I have an alert that my BS's are trending up, i'd set a temp. basal anywhere from 125-200% of my basal. She didn't like that. Sometimes i'd still have active insulin and i didn't want to over shoot my correction. She perfers that I wait until the end of the day to evaluate my trends and change my basal's and/or my carb/insulin ratio then. I'm curius to see how everyone else use their information.

Ps. She never told me what to do with my alerts prior.

Thanks for any suggestions.


I do what you do – I fix stuff as they happen. I don’t understand why she would want you to wait. That defeats the whole purpose of setting alarms. Your CDE would probably freak my settings because I have my high alarm set for 120 to get as much notice as possible!

She felt that she couldn’t tell what my “real” basal/ carb/insulin needs were…She felt that i was just attending the syptom and not fixing the problem…im guessing the problem would be wrg basal and ratio…but i feel that if im on my way to a high number, id want to prevent it…

Have you ever done any basal testing? That will at least let you know if your basals are correct. I agree with you that I would want to prevent it and try to make the changes to what you are doing that way. If your basals are off, your carb ratios will be off also, but those are easier to figure out once you know you have the basal down. I am not a CDE but I wouldn’t want someone telling me that I need to run around high all day!

Right, I think ima do what she’s telling me for like a month or so. Give her the info and then after that, make my mind up on how i’ll deal with it. She wants me to fax her once a week with the info…She’s a lil micro manager. Thanks for ur suggestions, i was just confused. I thought the purpose was to prevent high blood sugars…still curious what others do…

Hopefully, more people will chime in with what they do. Good luck with this and keep us updated how you are doing!

I can understand your endo to some degree. I often see highs or lows that are unexpected, but occur at that time of day just one time. The next day I am sometimes back on track at that same time, even if I ate the same food and exercised at the same times of day. If I had changed my ratios and/or basals on the spot, after only one high or low, it could be a mistake. I wait until the next day to see if the high or low occurs again at that time. About half the time it does, so I make my adjustments then.

Richard, do you correct the high though? I think that is what Lex is asking. I agree that I wait to change any basals or other ratios because sometimes it is a fluke but I do make a correction if I am going high.

I definitely don’t wait until the end of the day to evaluate my trends. However, I am also not quick to change my basal rate and/or my carb/insulin ratio. I agree with Kelly that a correct basal rate is very important. My BG used to drop in the evening. Over many weeks I gradually adjusted my basal rate so that my BG stays flat when I don’t eat. In theory a bolus should perfectly offset the food intake. A correction is an indicator of a mistake. When I have to correct I always think about how I can avoid the same mistake in the future. My goal is to avoid the need for corrections, not to get better at corrections. I have never used temp basal for corrections. Instead I take an extra bolus. Temp basal delays the correction.

Oh yes Kelly, I correct a high sometimes before it has gone very high, if I find out soon enough with my CGM.

What the CDE said makes perfect sense in that I think it makes sense to first get a picture of how well your current settings are doing overall. I don't see anything wrong with taking a few days to evaluate the big picture first. If you are always reacting short term or using a lot of temp basals it's sometimes hard to see what needs changing. I find that in the long run a couple days of doing "nothing" so to speak better defines the underlying problem much clearer and therefore gets you to better settings to work off of much much faster. I back off on corrections and temp basals anytime I am doing pump setting evaluations. It works very well for me.

But once my basic settings are nailed the best I can get them then it makes no sense not to correct on the fly as needed. The CGMS isn't going to do much good if you never react to the numbers either. This is how I use my CGMS most of the time. When testing my settings it's only a few days here and there or if something changes.

Basically a long winded way to say that I think there's a place for both strategies.

If you are having to correct that often, you probably have incorrect numbers/ratios set for basil or bolus. Either follow the directions of your Endo so she can help you get them set correctly, or if you want to take more control if it yourself and not depend on the Endo,get the book "Pumping Insulin" and learn how to test, set, verify your own numbers and ratios and carefully follow the directions in the book. If you don't have your Basil numbers set correctly, nothing else is going to work. If you get your Basil set correctly, and you count carbs right and have your Bolus ratios correct, you should seldom need a correction dose and should seldom go low or high. You may need different ratios and basil rates for different times of day, and if your level of activity change considerably (like you sit at a desk all week but walk two miles through Costco on Saturdays) then you may need different sets of numbers for different days.

I have three different basil settings for morning, afternoon, evening-overnight and three different sets of bolus ratios for bkfst, lunch, dinner. I figured mine out using the instructions in the book "Pumping Insulin" and my Endo tweaked them (mostly she changed the start/end times for the rates I had calculated and tested).

Of course, your mileage may vary...