This is my first time to post here. I have been reading a lot of the posts though. I hope you can help. My wife is the diabetic in the house and has kidney failure. We have recently acquired a pump and sensor.
When she gets a low signal at night, she would reset it (Esc..Act) and test the BG and get a snack of some sort. After that she would "send" the reading and Basal to the pump and it would inject more insuline and about 20 minutes later the alarm would indicate another low.
What is the right procedure?
I suggested that she does not "tell" the pump that she had a snack and set the "snooze" time more than 20 minutes to give the sensor time to register the "new" sugar levels.
May I ask if there's a reason why your wife is covering the carbs from the snack with insulin? If her blood sugar is low, then she needs the sugar to bring it up.
Also, "snack" usually means food, while lows should really be treated with juice, glucose tablets, or something else that's a very simple sugar.
When the alarm sounds the second time, is her blood sugar still low? Generally, when a low is treated it takes about 15 minutes to come back up. If it's still low, then she should treat it with more sugar (unless it takes her longer than 15 minutes to come up, in which case it's probably fine to wait). If her blood sugar isn't still low, then the sensor needs time to "catch up". The sensor measures sugar in interstitial fluid, which lags behind actual blood glucose by about 20 minutes. If that's usually the case, then yes, the snooze time should be reset to something longer than 20 minutes.
I don't have a pump or CGM, so I don't have this problem. But I would do as you suggest. I think you need to think of food intake (which needs to be bolused for) different from a carb correction (which should not be bolused for). The idea is to eat only as much carb as you need to get your BG back to normal. It is certainly not a good idea to overeat so that more insulin is needed since that starts the ping-pong blood sugar ball going. So assuming the amount of carb eaten is the correct amount to get your BG back to normal, you should not enter that carb in your pump to be bolused for.
The carb that you eat to treat a low is not a "food intake" that should be bolused for. It is a sign that you already over-bolused and is being taken to correct your BG to get back to normal. It is also a sign that you should figure out why you over-bolused to begin with - maybe the carb ratio is wrong, etc.
And also as you suggest, setting CGM snooze time for more than 20 minutes should work better. Consider that CGM is reading your BG from about 20 minutes ago, and it takes up to 20 minutes for the carb that was eaten to really show up in your blood - so it can take up to 40 minutes before you would see BG back to normal on the CGM.
Thanks for the reply (and welcome) She would usually just drink something that contains sugar such as coke or juice. But then insists on covering the carbs with insulin. This just lowers the sugar again (I think).
The answer is then: Take the sugar drink and extend the snooze time slightly to about 30 minutes and do not cover the carb intake just yet?
She should definitely not cover the carbs with insulin--she needs those carbs in her blood stream.
Covering the carbs, though, wouldn't cause the alarm to go off immediately, though--that would probably take an hour or two (or three). I don't take insulin, but even a half hour would make more sense than 20 minutes after the first alarm went off.
When is your wife getting the lows at night...after eating, in the middle of the night, etc. Timing of lows can sometimes help to determine whether it is a basal or bolus issue...if she is getting lows 3 or 4 hours or later after eating, her basal rates might be set a little too high. It can take a little time on a pump to get your settings stabilized. And even then with diabetes things are constantly changing. I have to tweak my basal rates periodically with the weather.
Also depending on when she's getting these lows, her I/C ratio might be set a little to high...or if she is blousing before eating and seeing her BG levels drop immediately it could be a problem with delayed gastric emptying...if that was the case then doing a square wave bolus helps considerably. I almost always use that feature since I have gastroparesis.
Hi Christy She usually gets the lows after midnight between 01:00 and 03:00. We have reduced the bolus from midnight to 07:00 to 0.4 units insuline.
We have started to implement the suggestions of the "family" here and it is going a lot better already (a lot less frustrations).
I think you may need to play with the sensor's settings. I have my low limit set at 81 and my predictive low set at 20 minutes. While 81 is not hypo, I have found through trial and error that when my sensor drops to 81, my BG is usually 65-75. I had to play around to arrive at these numbers. If you set your low limit too low then with the time delay you will be too low. If your predictive alert is too high, then you will get false alarms and if you set it too low then you will already be hypo by the time the predictive alarm goes off.
I like the 20 minute alarm between low limit readings, I think it is a great safety feature. If I am workiing on a task and get an alert on my pump I will sometimes ignore it if I think I am dropping slowly or flatlining and likely in the 70s. 20 minutes later I get a reminder to re-assess.
Calibrating the pump whith a low BG is questionable. I assume she treats right after the low BG and this causes her BG to quickly rise. The calibration may be innacurate due to the quickly fluctuating BG. I would also suggest the 15 carb: 15 minute rule for treating a BG. I keep lifesavers right by my bedside. a lifesaver is 2.5 carbs, so If I am low I can pop 6 lifesavers for 15 carbs.
The low is set at about the same point as yours. (4.5 mmol/l) and we changed the snooze time to 40 minutes. This ensures that she is awake enough to help herself and the sugar is taken up before the next "alarm". I see we still have al lot to learn. This forum/site makes things so much easier. Thanks to all.
