Hi! I have been a T1 diabetic since 1986 and started my Medtronic pump in 2000. I am not a “good” diabetic. Maybe checked blood 1 time a day and would bolus 50% of the time. A1C in 8-9 range. I am getting older and have finally decided to get on a CGM. I love my new Dexom however I am relearning my pump and want to use all this information for my better good:-).
I am not sure how to best use all this new information or how to use other features in my pump. I am used to guessing my bolus, but now that I see that doesn’t really work I need to re-learn how to bolus. So my questions are:
What do you do with all your Dexom data? I only have the reciever, do you download the information and analyze it somehow?
Does anyone have a cheat sheet for food and bolusing? I know fat slows down digestion, but I don’t know the rules. I know it varies per person too, but general guidelines would be great. My husband made Spanish tortilla tonight which is potatoes, olive oil, and chorizo. I have no idea if this is high fat and I should do dual bolus or because of all the potatoes just do regular bolus? I did regular bolus and was in 120s for 2 hours but now 2.5 hours later I’m 170.
What about active insulin when I use the wizard on my pump and I am eating? Do you ignore it and put the full amount, or do what the bolus wizard says?
Sorry for all my questions! Any info is greatly appreciated! Also I just ordered the book pumping insulin as I read that it’s highly recommend. Thanks!!!
There are some great books on the topic. One in particular is Gary Sheiner’s, “Practical CGM” - You can take a look at that here: Practical CGM – by Gary Scheiner | Integrated Diabetes Services
Another book that demonstrates a good way to use the data is Dr. Stephen Ponder’s Sugar Surfing - Take a look here: http://www.sugarsurfing.com/
I look at the data all the time on my CGM, and I make small adjustments based on that information. I also review the reports every week or so and try and see what I’ve been doing better or worse than the previous time period, so I can make better long-term adjustments.
I also highly recommend Sugar surfing. I found that very helpful and reinforcing much of what I had learned on my own. But the book explains it well with many examples and pictures.
Pumping insulin will help you understand and fine tune your pump settings. Many people find they need different carb factors at different times of day.
Gary scheiner also has some good information on his website, and provides consultations (with fee) if interested.
If you search the term Flatliners on this site, you will find many posts of how people review their CGM data, and how they respond to make changes.
People with an aptitude for math and statistics see the numbers in diabetes as a helpful framework. Engaging with your CGM data will help you learn about average (mean), median, percentile, and blood glucose variability as expressed with standard deviation.
I never took a college class in statistics but diabetes has taught me a lot of practical knowledge.
I recommend that you learn to upload your CGM to Dexcom’s Clarity program. Do it every day. Find the 14-day standard day report and try to understand what the graph and the data icons mean. Once you learn the significance of the chart items, you will be well on your way using that chart to adjust your daily therapy.
Read this Clarity User Guide and practice displaying various reports. This data is a customized picture of your unique metabolism. Understand the numbers and charts and you can use it to get suggestions about what to do next.
Diabetes is a dynamic disease. The static formulas are highly useful but learning to roll with what diabetes throws at you every day is also important. Good luck. CGMs are one of the best things in diabetes technology.
I actually have a degree in psychology and had to take 2 statistics classes…the only math class I ever did really well in. Years ago, but will see my old knowledge comes in handy. I am also a recruiter of biostatisticians so I have some pros I can ask for some help if it gets too complicated. Thank you for this info, I’ll get the clarity program.
Thank you! I’ll get these books and start studying 
I have noticed it takes longer for my sugars to come down earlier in the day, I have noticed others on here have the same …I think I might be one of those that needs different carb factors. I’ll order sugar surfing and search flatliners. Thank you for the info!
I don’t know if there are any decent books on carb counting, but I got my start with a dietitian after diagnosis. Having and using a scale and measuring cups have also been very helpful.
If you prepare a lot of your food at home, you can control the quantity and quality of the food. Carb counting (at least for me) is about making my meals as modular and predictable as possible.
A good example of modular is taco salad. You make the seasoned meat, measure out the amount of tortilla chips, brown rice, and refried beans. Cover in cheese, put on the lettuce (almost always spinach), tomatoes and salsa and a dollop of garlic blue cheese dressing. Add a half piece of fruit and I have dinner.
I am usually aiming for 60g of carbs per meal, so I adjust the amounts to get very close to that number.
One thing that helps me do better with my BG numbers is pre-bolusing. If I’m 180, I will wait 15 minutes, 120 about 10, 90 maybe a minute. I adjust the time also depending on recent activity and whether I’m falling or rising and at what rate.
This is what I do, but you need to figure out your own targets based on the dreaded trial and error. It’s not rocket science, but it can be pretty close at times (and I don’t use a slide ruler)!
I feel like our timelines are very similar…dx’ed '87, pump in 01/02, laid back attitude towards my control until about a year ago, which resulted in A1Cs generally in the 8s. I first got a CGM about five years or so ago, but got a Dexcom a little over a year ago. Just being able to see what my bg was doing made a huge difference, because I started troubleshooting. I tried to make changes to my bolusing (I was never good at carb counting) to improve the spikes and aim for lower averages. Just from watching and not doing anything overly scientific, my A1C dropped from 8.2 to 6.6. Then, about six months in, I switched to a LCHF diet because I was finding I was frustrated with my inability to control the spikes better. Two A1Cs later, I was in the 5s.
So basically, there’s a whole lot you can do, but in the meantime, just watch the screen a lot and see if that leads you to make any minor changes to your behavior.
Good luck! I hope the Dexcom works wonders for you, too.
Thanks for sharing!
I did try the medtronic cgm about 5 years ago but hated it. Had tape and senor issues and it kept going off…I am glad my doc had me test the dextcom…huge difference. With both my pregnancies I came down to A1C in 5 and 6…but I was checking and bolusing a ton. I was nauseas the entere time so that helped with carbs. I am hoping with the cgm I can do it again but better. Thank you for the encouragement!