Tandem T-slim and Dexcom G6

Medicare finally approved the Dexcom G6 and I use it with my Tandem T-slim pump. I was really looking forward to the insulin suspend mode and last night it got a work out. The problem is probably me but the scenario I am about to relate is a constant issue.

I had dinner and used the extended bolus so I would not go high later. Everything was fine until 10:00 pm when I got an urgent low alarm, my pump suspended and I treated the low with glucose tabs and lowered my basal rate. The pump functioned as intended and restarted when my BG was out of the danger zone. I received the same alarm twice more. I knew it would take more than Glucose Tabs to keep from going low again. I ate half a graham cracker and a half glass of 2% Milk. Thirty minutes later I received a high glucose alarm. I took a correction bolus and an hour later my BG nose dived again.

I have mentioned on here before that there is, with me anyway, a very fine line between treating a low and going high, and treating a high and going low.

I would love to find the ideal snack to get me out of the low danger zone and not go high. Yesterday, was the first full day with the G6 and it is so much more sensitive than the G5. I am total hypoglycemic unaware so this will give me the peace of mind I was hoping for. No doubt my pump ratios are less than ideal and I am working on it.

I would love to hear how you handle lows and if it keeps you from going high. Thanks for any information you send my way.

Smarties… dextrose as primary ingredient, and 6 carbs per tube.

I generally use glucose tablets because the amount of carbohydrate per tablet is predictable, and they contain glucose, which raises BG faster than any other carbohydrate. Some hard candies are also sweetened with glucose (dextrose) and have predictable portions. They’ll work just as well as glucose tablets and many people use them.

When I find myself overshooting and going high it’s generally because my BG is dropping quickly and I panic. I take a few tablets and if I don’t see an immediate response I keep taking more. I need to remind myself that ‘more doesn’t mean faster’. If I remain patient and wait 5 minutes after taking a dose, things almost always start turning around as judged by the rate of decrease slowing dramatically or reversing to an upward trajectory. If not, I take another dose right away. Generally speaking I can avoid going high with this approach.

I started using Basal-IQ a few months ago and I love it! I’m amazed how effective suspending basal is at addressing minor lows.

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I take 4 ounces of juice and wait for 15 minutes when BG is low (confirmed with meter). G6 may give a false low. When BG is high, I take a walk for 30+ minutes. You will notice BG rise slow down after 15 minutes. It is most effective after 45 minutes of walk. If 2 hours after meal, BG is high, I take a 1 unit Bolus shot.

It sounds does sound like your basal rates are set too high and maybe even your correction factor. Until you get those sorted out you will most likely be on the glucose roller coaster. Glucose tablets should be able to handle any low that isn’t caused by a too high basal rate. How long had it been since the extended bolus for dinner had ended? Maybe you should set your low alarm to somewhere in the 80’s instead of lower so that you have more time to take action to prevent a harder to treat low.


Firenza

    October 21

It sounds does sound like your basal rates are set too high and maybe even your correction factor. Until you get those sorted out you will most likely be on the glucose roller coaster. Glucose tablets should be able to handle any low that isn’t caused by a too high basal rate. How long had it been since the extended bolus for dinner had ended? Maybe you should set your low alarm to somewhere in the 80’s instead of lower so that you have more time to take action to prevent a harder to treat low.


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Thanks to each of you. I, like you, initially treat a low with glucose tablets and it does turn around quickly.

I have been told, and it has been my experience that glucose tabs is only a short term fix. I have been taught that a more substantial snack is needed to maintain a blood sugar in a normal range. Without it my sugar will nosedive again.

What I am searching for is a combination of foods that will maintain my sugar in a normal range for a longer period of time. The snacks I have been taught to use like, peanut butter and crackers, graham crackers and milk, etc. always make it shoot to over 200 in 30-minutes time. That starts the roller coaster and can wreck a whole day or night.

I may need to work with a dietician. I did find some meal suggestions online and am going to try implementing the ideas found there. It advises protein, complex carbs and creating a small mini-meal even in the middle of the night.

I am going to check with DMS where my supplies come from. I understand they have CDE’s to help. I think we all know the type of help we need but finding that help is difficult.

Any helps you send my way is appreciated.

This depends on what is causing you to drop. If you hadn’t eaten anything or taken any short-acting recently, your basal might be too high, so a glucose tab may not be enough. If you just over-bolused for a meal, once you get it back up where it should be, you might not need anything other than that small amount of glucose.

Since you have a CGM, you can see exactly what happens. I usually only ever treat a low with a glucose tab (or two) or applesauce.

Consider the law of small inputs - if you eat fewer carbs, you need less insulin, and therefore you will likely have smaller swings. (This comes from Dr. Bernstein but I am absolutely not advocating for his crazy-small amounts of carbs.)

Also maybe try some fasting to ensure your basals are set correctly.

I have been using the Tandem for about a year now and my problem is when I use the extended bolus function. When I do my pizza bolus, if I leave the IQ feature on, and I start going low while eating, it shuts off the extended. I didn’t realize that at first and couldn’t figure out why I was going high later in the night. So, I now have to shut off the IQ feature when I do pizza and than have to remember to turn it back on.
And if I am trying to keep the blood sugars up, I find peanut butter with anything helps keep things level. And of course I love peanut butter.

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@Sally7’s suggestion of peanut butter is a great easy trick to stable BG’s after a low. There may only be a few carbs in a spoonful of peanut butter but the high fat content and protein will make it digest slowly over several hours thereby keeping BG’s in range. I also like the Simply Nutty bars from Trader Joe’s since they are easily portable and only have 14g of carb with 7g of fiber it makes them really long lasting without a huge spike (and they taste good).

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I have to set a reminder on my phone to turn Basal IQ back on after I’ve turned it off… very annoying when it interrupts my extended bolus, ha!

Fun size snickers is my favorite. Has some protein and fat, will keep me from going low again later. I always carry Glucose tabs in my pocket, if going out or walking, also take a snickers with me. Much better than eating CHALK.

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Can you post the data from the CGM? Do you have detailed records about when/what you ate corresponding to the numbers? Records should also show how much insulin you took. That will help. Are you certain that your basal insulin rates are correct? How confident in those are you?

If your having a lot of trouble, then its time for very detailed analysis and good records. Perhaps 2 weeks of detailed records.

Peanut M&Ms are my go-to low treatment. My doc daid if I have to have diabetes, I ought to be able to have something I like to treat lows. The peanut M&Ms have the candy shell for carbs and the high-fat peanut to smooth out the BG curve.

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An apple juice box! For me it takes me out of lo zone and doesn’t take me too high. Works every time and liquid goes into system quickly PLUS good nutrition!

I use those too, especially the little bags fit in pocket, much better in warm/hot weather.

Yeah, Smarties, the cheapest (almost) pure glucose anywhere. And reliable dose, 7 g per tube.

Another piece of advice: don’t treat the high after a low. There 4 counter-regulatory hormones that raise the blood sugar when you have a low (rebound). That means 1) your blood sugar will probably go higher than expected based on the dose of your hypo treatment. And 2) it can run high until the hormones stop, upto 48 hrs later. But they might stop in an hour.

Treating a rebound puts you at risk of crashing because you have insulin on board when the hormones stop. That will look like the drop like you described. If the hormones keep going long enough, your insulin may bring you blood sugar down nicely and you may think that you’ve successfully treat the rebound. Then it goes up again for no apparent reason. At this point you might not realize you are still dealing with that first low you had a day, or more, ago. Taking insulin, will again put you at risk of crashing when the hormones stop. And that can trigger another counter regulatory cycle. The best thing to do is to ride out that high after a hypo.

I have done EVERYTHING I described here. Even knowing this, I’ve been on that roller coaster for many days before I clue into what’s going on and have to dope slap myself. I think some, maybe a significant number of cases of “brittle” diabetes are caused by mistreating hypos.

That is why they say when you are setting your basals, not to base it on a high if you have had a hypo in the previous 24 hrs. Before I transitioned to a pump 30 years ago, I went through a time when I my bGs were very unstable on MDI. I found a new doctor, and the first thing he did after a review, much to surprise, was to ask me what I thought we should do. I answered that I need to get those highs under control so I need to up of my NPH injections, maybe add more regular, or something. He surprised me again by saying the first I should do is to cut my insulin by 20% across the board. He then pointed out the lows in between almost every high, and explained how rebound works. He said the first step is get my bGs stable, even if they are consistently high. At that point we can make changes to ease my sugars down without causing any hypos.

Hope this helps!

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I loved your story about being told you need less insulin not more to get rid of the highs! I was of the same mindset for years! I would just keep increasing the basal to get rid of the highs and not realizing I was just taking way too much insulin.
I also did a complete reset of all basal rates. We calculated how much basal I should need based on weight and work I did. We just went with the same rate for the complete 24 hours except for my work shift as I work a pretty physical job. And surprisingly, I was taking way too much. And even now many years later, I am still holding around that same rate and only have a day time rate and an overnight rate.
This taking too much was another reason I was carrying around that extra weight. I was eating to feed the insulin. When the insulin levels came down, I stopped eating to fix the lows and lost some weight. My biggest problem was learning that I now needed to dose if I was snacking. Before my basal was so high, I could eat and not worry about. So having to dose before a snack also helped me stop eating because I had to decide if it was worth the effort. Having to test, calculate and bolus? Not worth it!

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I enter the BG into my pump and run the carbs up to find how many carbs to take. (negative insulin for low BG = carb dose and net insulin is zero.) I fudge (pun not intended) the carbs for how fast or slow BG is falling.