And with those NOS Mullard EL84’s in the preamp stage you’re really ready to get out there and melt faces while delivering an admirably flat CGM trend line. Course it is a bit inconvenient to haul around, but that’s just part of the deal with Marshall equipment.
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Here in the UK we get free Roadies on the NHS (although you have to wait 6 months for an appointment). I assume Obamacare doesn’t cover this in the USA. Of course you could always go down the “Boutique Pump” route. In the hand-wired Dr B, the reservoir is a single 12AX7 with a capacity of 7 units, but you can mic it up to deliver enough insulin to give the entire O2 Arena a hypo.
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@DrBB, does your Dexcom have super accuracy? Have you achieved a flat line control for a 24 hour period? Even one instance of the CGM being very very different from the corresponding meter reading could lead to a bad high or low when depending on the 670G. I used to use a Dexcom 7+ years ago and my accuracy was dismal most of the time. I wonder if it would be much more accurate with the G4 sensor. So many false alarms that kept me awake at night when my meter readings were in my preferred range.
That’s very different from my experience with my Dexcom. It’s generally met or exceeded my expectations accuracy-wise. With a couple exceptions it has been within about 10 points of my glucometer reading, a lot times spot on, and generally within the glucometer’s range of error–not much different from the variance I see if I do two consecutive fingersticks. The thing that seems to throw it off the most consistently is hard exercise, particularly my a.m. and p.m. bike commute. I definitely have not had the kind of false alarms you’re describing though. Crying wolf like that would drive me crazy too (I did have that problem with “non delivery” alerts from my Snap pump and why do these devices always decide the time to freak out is between midnight and 5 am?). So far I haven’t had a single low-alert warning that wasn’t legit, and quite a number of them that caught me going low very unexpectedly. Which is not to say it’s accurate enough that I’d let it take over control of my pump (and it’s not clear to me that that’s exactly what the 670G is trying to achieve either, just to be clear). Those bike ride variances are too big, and I also get a significant bounce-back from my exercise lows–I’ve learned to wait 'em out quite a bit before treating them–so I wouldn’t want the pump to react too precipitously when it sees those numbers. Whereas the same low number would require a response if it was caused by a bolus miscalculation or something else. Maybe a genuine AP system would prevent all these kinds of hypos in the first place…? I don’t know how it would be able to distinguish between them otherwise.
To your other question: I don’t think I’ve achieved a real “flat line” day except as defined by the default range settings of the Dexcom itself, which are rather more lax than the target ranges I’ve set in my pump. I’m getting closer though, helped by some of the techniques I’ve learned about here.
Thanks for your reply! I have been T1 for 69 years, and there is some scar tissue that interferes with the absorption of my insulin. That causes me t have high BG’s until I have made a correction bolus. I called Dexcom and asked if scar tissue might cause the false readings I was getting. There was no definite reply, I was told that they do not recommend placing a Dexcom site in scar tissue. but they are not aware that scar tissue actually might cause false alarms. There are users in a Facebook Dexcom group who say they have better results if they stay away from scar tissue. Others say it does not interfere at all. My upper ab has permanent scarring, otherwise there is some here and there on other body parts.
Is there a universally excepted definition of “flat line”? When I low carb my bg’s don’t move “much”, but just how steady are you all deciding is “flat line”?
Hm, I don’t really know. I’m not personally obsessed with having a flatline in a strict sense–even non-diabetics’ BG can vary quite a bit throughout the day. But keeping it in-range as much as possible is important to me. I target 100-140.
No. And that’s an extreme we never intend to reach. I’m with DrBB, healthy non-diabetics trace rolling BG profiles. But the idea of reducing variability and producing “flatter” BG lines is what I think defines the term “flat line” in diabetes control.
If I can trace a 24-hour line that stays between 65-120 mg/dl then I consider that the ideal “flat-line.” Not really flat, but my ideal goal, nonetheless.
I have more of a “flat line” if I look at the CGM, than if I test frequently on a meter, as the Enlite doesn’t have quite the excursion movement that mimics the results from frequent bg readings on a meter. In the normal/close-to-normal range, the Enlite seems fairly representative of bg’s, but when bg’s climb quite high, the Enlite USUALLY doesn’t keep up with the real bg peaks. ergo, if I wanted to “compete” in flat line discussions, I’d want to go with my Enlite readings instead of bg readings. 
I’ve observed both “overshoot” and “undershoot” on my CGM. That greatly diminishes when my BG trace is less variable. Sometimes my CGM line looks better than my fingersticks, sometimes worse.
You placed quotes around compete in your comment. I participate in the TuD Flatliners Club. We don’t view our posts as competitive but in any measurements of human endeavor, competitive spirits can arise. We try to emphasize collaboration and encouragement. We often post some miserable failure traces. Failures probably teach more than success.
Learning is the overall goal. Showing up on a community like this can effectively leverage efforts. If you don’t already post to the Flatliners Club, I encourage you to participate.
There was a flatline group on the old TuD site, and some members showed amazing graphs in a tight interval like 80-120, for example. They were using the old Dexcom 7 or 7+. I was so jealous of their control, I dropped out of the group. I admired them, but could not compete. At my age I sometimes forget to bolus, and with scar tissue issues I have highs and lows out of my preferred range.
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Richard - Your only “real” competition is yourself. I consider making things better as the ultimate success. There is no perfection in diabetes. Your better performance today relative to your performance yesterday comprises the spirit of the flatliner group. We’re all in this predicament together! Please visit the Flatliner’s Club; you’re one of us.
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@Terry4 Out of curiosity, have you ever gone low with afrezza when there was still 30 minutes or so left? The way everyone makes it sound, afrezza will continue to work even if you eat 15 carbs or 50 carbs. My concern is that it would just “fight off” the glucose tabs that you’re actually taking to raise your BG and continue to lower it. Any thoughts?
I’m not clear what you mean by the “30 minutes or so left.” I’ll intepret that as 30 minutes left during its expected action period. Yes, I have gone low near or even after the end of Afrezza’s expected duration. The lows are not as low or hard charging as the ones from regular insulin.
I have no trouble treating with glucose tablets. It is not more persistant driving low than any other insulin. I think that depends on other factors.