I'm curious to hear what others do regarding setting up the BG target goals for the bolus wizard. I have a very erratic schedule and don't eat any of my meals at the same time every day. When I first got my new pump, I set up bg goals, but I really don't know what I'm doing and I find myself frequently going low (not really low, but a lot in the 60's range.) I'm also confused by the fact that the wizard allows for a target RANGE...and I don't understand that part either.
My A1c's have been running in the low 6's (6.2-6.4%) and that's good, but I did have a serious low the other day that I didn't recognize (46) and only discovered it when I tested before eating lunch. My hypo awareness had been excellent until recently, and I'm wondering if those frequent slight lows could be affecting it.
You targets only come into play for correction insulin...your pump assumes that your carb count and settings are perfect it only makes adjustments to correction insulin if your BG entry is above or below your target. If you do not eat on a regular schedule having post meal targets will make it necessary to adjust your bolus recommendations, and this may also be the case if you only have one target set in your pump. Having a higher post meal target will soften your correction insulin if you bolus again when you still have active insulin.
My targets:
Low 70mg/dL
High140mg/dL
Bedtime 110-130
Before meals is 90-110 After meals is 120-140 (two hours) this setting rarely comes into play because I do not use my bolus wizard between meals because I almost never snack.
If you're more comfortable with a single number for the "range" for the bolus wizard just make the high and low the same number. The Animas Ping and the late lamented Deltec Cozmo use a single number. I use 95 for my target although my CDE at the Joslin said that I shouldn't use anything under 100 which was the target my endo suggested.
I'm willing to take a fair number of trips into the 60s. If you want to avoid those, you might use a correction target of 110 or 120.
Which is a problem for those of us who tend to go low early and therefore, need to "back correct". If I don't back correct up to 95 when I'm 80, I have a very good chance of finding myself at 50 early on.
But it also means that if you set your pump to target 70-180 mg/dl and then "correct" a 180 mg/dl, you won't actually get any correction. I think you need to interpret the "target range" as the range over which no corrections is actually needed.
The pump is not magic...you have to set your insulin sensitivity factor and I:C ratios correctly for the bolus wizard to have any hope of working. If you are frequently going low, it may be that these factors need tuning (perhaps by time of day) , not just your target.
If you don't understand what ISF and I:C ratios do or how to self-check and tune them, then you may need to work with your pump trainer, CDE , or read a book like "Think like a Pancreas " or "Pumping Insulin".
Without correct ratios, you wont hit a target no matter where you have it set.
Recently, I lowered my target BG to 90.... I am aiming to get an A1C below 6, but before I lowered the BG target, I made sure that I was not overshooting the target and had fairly stable control with the ISF, I:C and basal rates I was using.
I'm thinking maybe I should just manually correct. I've tested my basal and bolus rates, and they're both fine. The problem for me is that I don't have any kind of schedule, so I eat at different times, often eating out. I'm also VERY exercise-sensitive, so if I end up doing more physical exercise than normal (even trying on clothes can make me go low), then I have to snack, which of course means my bg is probably going to be higher before the next meal than it usually is.
Maybe the better question is...how often can you have mild lows (in the 60's) before you start losing hypo awareness? I had severe hypo unawareness back when I was on NPH and Regular, and don't want to go there again. That 46 with no symptoms really scared me!
i have been on the pump for 11+yrs now, and this is the first year that my I:C ratio has needed to be changed, i found this out by doing and eating the same thing every day for 1 week. i noticed patterns. it was important to know that i change my eating schedual around my life and not around my insulin, but despite this "freedom" i get from the WIZARD feature, i was constantly going low every day at lunchtime whether i ate of not. so my endo changed my I:C from one setting to three, and now it seems to be working much better. i still have a lot of tweeking to do, though; i am now post menopausal for 2yrs now, and with the hormonal changes, so do my blood sugars. i am confident that my endo and i will figure it out.
