Brian,
You should never have to eat your words because as you well know what is happening today might not be happening next week.
I volunteer for trials whenever I can and one of them was Dexcom and dosing from the Dexcom readings. When I was explained the trial protocol I didn’t do it. There are many people who dose off their dexcom and do very well with it. But this is YDMV. I don’t and feel like I never could do to the fact that 20 to 40 points is a huge difference. It really depends on you sensivitiy to insulin I think to whether it is safe to dose off those numbers. I’m currently at 1:100 so a little insulin goes a long way and I could be in a world of hurt if the meter and dexcom are off 40 points.
There are sensors that are right on and there are sensors that are not as good. Some sensors are good or right on for awhile than get crazy and than get back on target. Too much variability for me to dose. But like I said I know many who do it and do it well and safely.
My dexcom is my life saver and would not give it up. I love what it does for me and my family from a safety issue. I love my trending arrows. So if those arrows are heading straight down, insulin is probably in the mix, but if flat, I might let it ride to see what happens. More info is a good thing.
So enjoy the new numbers and now you won’t have to get up in the middle of the night for those checks or for me back in he day doing basal checks. Such freedom!
This is an incredibly important point!
I do dose off my Dexcom, but I’m a very insulin resistant T2 with a ratio that’s more 1:10 (Edited. sorry. It’s my insulin to carb ratio that is 1:4, ugh!), even at the best part of my day. An extra unit, or even 2, of Novolog won’t have me going low without at least an hour or more of potential warning that I’m drifting low.
When I consider that my Accu-Chek meter has its own +/-20 variability, which I’ve become more attuned to now that I’ve got the CGM and had occasion to check my finger-stick twice on those times its way off from my Dexcom (rather than just assuming my Dexcom is the one that is wrong), the variability of a well-calibrated sensor doesn’t bother me, as I realize that a single finger stick can be just as potentially inaccurate. It’s just frightening the amount of variance we’re expected to just accept!
Like other people in the thread, I’ve also had issues with Dex reporting false lows overnight, usually during the first couple days of a new sensor. I would say that about 85% of the time, I love my Dex and think it’s incredibly useful. The other 15% of the time, I absolute HATE it due to inaccuracy issues, including the overnight false low problem, as well as those periods where it’s giving me the ???. Luckily, during my first few weeks with it, my experience was almost 100% positive. If it hadn’t been, I don’t know that I would have stuck with it. Having had it for over two years, I’m now more willing to ride out the bad times than I might have been in the beginning.
Wow, is that ever an important point. I am a very insulin-sensitive T2. 1 unit of fast-acting insulin will drop me 80 points. Even a unit of R is good for 55 or 60. So a difference of 20 to 40 points would really matter.
[quote=“David_dns, post:45, topic:54361, full:true”]
Wow, is that ever an important point. I am a very insulin-sensitive T2. 1 unit of fast-acting insulin will drop me 80 points.[/quote]
Hmm, I always thought that would be the definition of an oxy-moron statement.
Meaning that I’ve always thought T2 was defined as insulin resistant and therefore required large doses to see a reaction, guess you really do learn something new every day.
BTW: I’m not implying in any way David_dns is a moron, but the statement seemed self-contradictory to me. Just want to be clear on that for others reading this thread.
I’ll also say the reason I never dosed based on the CGM is my high sensitivity (1:15 ratio insulin:carb and 1 unit of insulin drops me 60 - 70 points) made it what I consider to be dangerous and not worth the risk.
And I’ll third the sentiment that this is an EXTREMELY important point to consider when deciding to dose based on a CGM reading.
Wheelman
Well, it isn’t, so I guess you do.
T2 is a diagnosis of exclusion. It is diabetes not diagnosable as any other discrete form (T1, LADA, MODY, gestational, etc.). Like every other type of diabetes—or most diseases, come to that—it assumes different profiles in different individuals. For reasons too detailed to take up space with here, I now have very few working beta cells left; my most recent c-pep came in at 0.1. T2 is more complex and varied than many believe.
But, as I have said many times before, the whole type classification discussion is moot for me. At the end of the day I don’t care whether I am Type 1, Type 2, or Type 68. What I do care about is having normal blood sugars, and I will do whatever it takes to accomplish that. Whatever anyone thinks.
From where does this definition of type 2 diabetes originate? I’ve only seen it defined that way on this forum?
Well, from my doctor, for one.
But feel free to reject it and substitute whatever definition you prefer. I don’t care how anyone defines me. I care what my meter says.
Just finding it interesting… I do consider type 2 diabetes a condition of insulin resistance, as it’s defined pretty much everywhere… Seeing that you don’t display noteworthy insulin resistance makes me wonder what your natural baseline would have been like? Could you be naturally hypersensitive to insulin— to the point that a resistance disorder brings you to a level of what might seem close to normal sensitivity, but with it comes dysfunction? I just find it interesting…
But I agree entirely that definitions matter very little and the healthcare system tries way too hard to put each of us into a precise little box where often we don’t fit well… Just hadn’t seen the definition of “diagnosis of exclusion” as it pertains to type 2, though it seems to be often cited on this forum.
Highly unlikely inasmuch as I spent more than 15 years on a classic textbook recipe of oral meds, diet and exercise, which was highly effective in the beginning but became gradually less and less so with the passage of time. But like I said, the classification scheme is angels on the head of a pin as far as I am concerned. Its only real significance to me is its effect on insurance coverage.
I agree - unfortunately it’s used by insurance companies to deny coverage…
My official diagnosis is in my record as “Type 2 or unspecified Diabetes Mellitus” – The diagnosis itself specifies ambiguity.
I second the 85/15 claim. I want to mention another important side-effect: Before dex, I always felt that I did not have enough BG strips. I tested 12 times per day and missed many highs and lows because I could not test as often as I wanted. With dex, I only use about 7 BG strips per day without trying to conserve. I even use 2 BG strips for every calibration. It is a big relief for me that I can test as often as I want.
This is very unscientific and having only been diabetic since a surgery removed a tumor from my pancreas, I will say that I love my new G5. I had the same issues of doubt when I first became diabetic and since I do research for a living (and write standards!!) I was aghast at the ‘allowable’ inaccuracy of the meters…but once I acknowledged the fact that we have the luxury of carrying a little laboratory around with us, I accepted the fact that I was solely responsible for my comfort level with the accuracy of my meter. So, I 1) Bought an identical meter and tested with both, and 2) Always checked my blood with my meter whenever I got pricked at the endos office AND at blood draws (realizing of course they’d be different but I wanted to know by how much) and I have been encouraged by their consistency. I now have my first CGM readings u der my belt and am learning how to use them.
This forum is great and I just experienced some severe lows (40s) according to my CGM last night. My doctor said that my A1C was too low for my meter readings and, just as she feared, I am going hypo at night (and waking up with a headache!) so, that confirmation alone is worth it. Add that to the fact that I now see trends and this cgm thing is a gold mine! I wish I would have done it earlier.
I am a data geek, though, so this whole ‘my body is one big science experiment’ thing has been fascinating-challenging-frustrating. But, I am eternally grateful for the tools we have available to us and we CAN control this condition if we pay attention and HELP our bodies live with this . I am very strict with my carbs (but have found that I enjoy food more now because I can taste it better), I stay active to help my muscles absorb insulin (not crazy amount but enough to have energy-having a pup is a great help), and I truly feel healthier than I was before.
So, maybe try the CGM for a couple months and if you don’t see the value, you can just stop using it…at least you can say you tried.
For me, I’m hooked!!
Just my side of the story… let us know what you decide!
I couldn’t agree more about the value of a CGM to see what’s happening while you’re asleep (among many other excellent reasons for those of us who love all the data).
For overnight lows, my experience (on MDI) is that Levemir could be adjusted with 2x/day to even out night-time bg levels. I get even better results with Tresiba. If you’re on a pump obviously you can make whatever basal adjustments to get it right. Good luck!
Your points are perfectly valid and I think can be basically crystallized to the effect that moderate accuracy is clearly preferable to no metrics at all. I can’t take issue with that.
You’ll recall that I began by saying, “Stipulating for discussion purposes that cost isn’t a factor . . .”. In point of fact, it’s an absolute showstopper. The only way I will have a CGM is by paying for it out of pocket, and that just ain’t happening; not in this life.
Sigh.
I’m glad you’re having such a great experience with yours, however. Onward and upward. 
The Dexcom CAN be a little inaccurate in the first 12 hours (but not necessarily), so test.
Oh no! I am as so happy foe you that cost was not an issue-so sorry!
I couldn’t afford this for sure if I didn’t have proper insurance, but being type 1 maybe makes a difference too? I have lows randomly so we need to figure out what the what…
Keep testing and good luck!!
You all are so wonderfully helpful on this forum, thank you! AFA the meter being inaccurate for the first 12 hours, LOL, I’m counting on it. It tracked a slew of nighttime numbers in the 40s so I am hoping it was a mistake. If not I’ll be dialing my Lantus back a couple units. I am researching Lantus peaks right now…this condition sure keeps me on my toes!! I am starting to sense that I will never fully be in control. Not easy for a Type A to concede. 
I’m a T1, and I too am insulin sensitive. My scale is one unit will drop me 50 points and cover 10 grams of carb. So I use cartridges and an Echo pen which will calibrate in half units. This is very helpful for me.