Hey all, just wondering how often you download your numbers, or just take a hard look at them and tweak your pump settings?
My problems is that it often takes me weeks to realize that my daughter’s numbers have been creeping up, or that boluses or corrections are not working. I feel like I should be sitting down and analyzing numbers at least monthly, especially since my daughter seems to go through growth spurts (she’s 10). But is monthly enough?
She wears a Dexcom but it seems that I just get used to seeing higher numbers and use it to chase highs. Sigh… it’s crazy what you can get used too.
It ends up being about once a month. No matter the program-- Dexcom Clarity or Tidepool-- I always get the message that the program could find no pattern in my BG meter numbers OR CGM data. Which is REALLY helpful (snark)!
It’s sort of ongoing for me. Every morning I look over my Dex line for the night, and if over half a week or a week I see a definite pattern that I can’t attribute to food/activity/stress/illness, then I’ll make a change. It’s harder to discern patterns during the day, of course, because of variations in meals, activity and stress, but I’d say I upload every week or two and check for trends and problem areas.
Bit of ongoingly, bit of once a week/fortnight.
Great advice I read somewhere (probably here!) is to look at the data with a question, rather than just ‘tada here is SO much data’.
For example, I’m currently working with my evening levels. So I’m ongoingly looking at how I’m trending what my meal habits are…then when I look at the data for a week/fortnight and I’ll ask myself ‘is there anything clear happening at dinner around bolus/time I eat/bolus choice’ etc.
I get overwhelmed too quickly trying to make everything work all at the same time. This helps me take some pressure off ‘fixing’ it all in one fell swoop (that’d be nice though’).
I look at my Dexcom graph every morning and evening, and I download and look at data about once a week or more often if necessary.
I make adjustments daily. My blood sugar varies daily, so I use things like temporary basal rates or temporarily reduced ratios often (most days). And then once a week or sometimes more I need to make major changes to basals or ratios. I try to catch them early, but because things vary so much anyway, it’s hard.
I can usually tell there’s some major problem when, like today, my blood sugar isn’t in range even once except for about 15 white dots on my CGM that are there while my BG happened to be passing through. It’ll take me a few days or half a week to figure out what needs to change to keep things mostly in range again. That change will make things easier for a few days or maybe a week and temporary tweaks (temp basals and “sugar surfing” will make staying mostly in range easier), and then perhaps in a few days or a week things will go completely out of whack again and I’ll have to make another major change.
I also find it interesting that Clarity doesn’t show more patterns. I know there is a pattern if most mornings, I get an alarm between 3 and 5 am. Hate getting ripped from a deep sleep.
I usually pull all reports every two weeks. I love using the daily reports and reviewing food/exercise choices to see what worked and what didn’t. Also with my written log can see if pre-bolus was long enough or not long enough. I use all the reports and love the hourly statistics report. I can really see if the basal is working correctly.
I can go as long as a week somethimes without touching anything beyond meal boluses. Other times I get into a mode where I have to boost basal for night and then lower for days. Then there is a third mode where I suddenly change and have to lower or raise basals up to 3 times during the night. My insulin use varies over a 2 to 1 range when this happens but the extremes only last a day or two.
So I am often making several adjustments daily. I look at the charts about weekly mostly just to adjust my formulas for basal vs time of day or best carb factor to use with each basal rate. I have a spreadsheet for this but keep 6 full setups in the Tslim pump covering basals from 16 to 28 most of the time.
I look at my Dexcom display every day, especially first thing in the morning to see how my night went. I upload to Clarity every day and continuously monitor time-in-range (TIR), percent hypo, variability per standard deviation, and average blood glucose (BG).
I also use Nightscout and it automatically uploads so I can see up-to-the-minute BG, TIR, basal rates, as well as pump site and CGM sensor ages.
I am more apt to make pump changes based on these reports. I monitor and change settings much more frequently than in the past. I too-often stuck with settings well beyond their usefulness.
I find monitoring daily has sharpened my appreciation for blood sugar performance and provided me with an increased competence and confidence in making good treatment decisions. Some people may think this level of attention is too much but the dividends I get make my whole life better. I find merely watching certain measures creates in me an almost subconscious disposition to make them better. That’s how I tick; others differ, I’m sure.
Personally I had to get into the habit of uploading at least once a week and then might make tweaks after trying it out for a week or two. Depending on your daughter’s age and activity level and schedule changes you might have to slowly make small changes.
I upload my devices (pump + CGM) every second week. I use the AGP (Ambulatory Glucose Profile) to look for patterns. I use Diasend for this and it’s easy to spot where I need to do changes. I concentrate at only one thing or period of the day every second week to avoid getting confused.
From day to day I use temp basals heavily and superbolus often based on experience and CGM. I have pre-programmed 7 flat basalrates so I easily can switch between them. Flat basal works most of the time and I started using flat basals after reading Stephen Ponders “Sugar Surfing”. If my CGM-trends several mornings in a row indicates it, I find I have to up my basal a notch from 2 to 7 am, otherwise flat basal seems to work.
For a long time, I logged and analyzed Caleb’s numbers daily. I wanted to understand everything, including how different foods impacted his bg.
Now that Caleb is older, review is as needed. Things can move along pretty steadily for a while and out of range numbers have more to do with circumstance - exertion, parties, unusual food, than changing insulin needs. When trouble spots pop up, they are hard to miss. So when they are persistent is when we drill down. If nothing pops up, then it’s a review with clarity periodically - could be weekly, or more.
When I first started using dexcom, and soon after experimented with lower carb, and pre-bolusing, I downloaded devices and logged lots of details in a notebook. But now, years later I only review or download when things need tweaking again, or there is a change in my routines.
I am happy staying where my current numbers are, but certainly would log and review more often if that changed.
