I’m going to be trialing dexcom CGMS on my tslim soon. I’m excited and nervous at the same time since I had a really bad experience with the medtronic CGMS, hopefully i have better luck with the dexcom/tslim combo.
I was wondering whether there are any tips that you can share with me to allow me to make the most use out of my CGMS experience and get the most reliability. By tips I mean things not necessarily documented by dexcom or tandem but just happened to be used by other pumpers out there.
For example, I remember when I was on the medtronic CGMS, people recommended putting in the sensor the night before starting the sensor and letting it settle, it was claimed that this presented more accurate readings. Is this also applicable to dexcom?
Another thing I remember was always start your sensor when your BG is in range - so I had to line it up with my meal so that the sensor start was two hours after I’ve had something to eat. Is this also applicable to dexcom?
The best thing I learned was to load T:Connect app on phone. It gives most details real time, and easier to find than drilling down into pump menus.
It shows the cgm trend line, current bg, IOB, and bolus /basal adjustments as they are made by CIQ. Can scroll down on screen for more details.
I don’t put sensors in overnite, and find G6 to be accurate soon after start up.
I find that putting in a new sensor a few hours. Fore I make the switch is usually enough time, however you don’t need to calibrate so the wonderful thing about the dexcom is that you can install a new sensor when you go to bed.
The 2 hours pass and it starts giving data. You don’t need to get up to calibrate like on the Medtronic.
When I wake up I’ll do a finger stick and it is pretty much always right on target. But that’s because I’m pretty flat and fasting while I sleep. It’s the perfect time to install one.
The tip I have for the tandem is to lower your sensitivity setting a lot like half of what it was on your Medtronic.
Because the pump is a bit laggy making corrections, the sensitivity setting makes it react faster and for me it does very well after a month of playing with the settings.
I will also correct manually because it’s a habit.
Right now I’m experimenting with sleep mode all the time.
This means I have to make all my corrections manually, but I really don’t need to most of the time.
Basal corrections in sleep mode usually take care of it.
So I’m at the point where I could go under 5% a1c, which was really a pipe dream just a year ago
That’s why I moved to sleep mode. To allow it to go a little lower. I really wish I could set my own parameters
Beyond that. Right now it is predicting my A1C will be 5.5.
Since I generally run .5 Under that in reality, I’ll see what happens. Really though I don’t care anything under 6 is exceptional in my book. I don’t want to risk lows just to get a super low a1c however it’s kind of fun to see these numbers that I never was able to achieve before.
Sleep mode lowers the high limit to 120, but keeps lower at “predicting” 112.5.
My experience was that it starts basal reduction around 115, and sends me up to 140 by the time it raises basal. Often see 15-20 minutes 0 basal.
So key is what basal rate would keep you from triggering predictive 112.5, and thus prevents having anything close to 4.9 (bg 94) for most of the night (or day, as some people use sleep 24x7).
From tandem:
When a Sleep Activity is enabled, the treatment values are lower and narrower since there are fewer variables that affect glucose values during sleep, for example you are not eating or exercising.
When Control-IQ technology predicts a glucose value less than or equal to 112.5 mg/dL, it will start to decrease basal insulin delivery and will stop basal insulin delivery if the predicted glucose value will be less than or equal to 70 mg/dL 30 minutes in the future.
If Control-IQ technology predicts that the glucose value will be at or over 120 mg/dL, basal insulin delivery will be increased. Note that when a Sleep Activity is enabled, Control-IQ technology will not deliver Automatic Correction Boluses.
Control iq is sort of suspended when in sleep mode.
It will not give boluses but it will effect changes in basal.
When I sleep my sugar generally evens out at about 95.
This is where your sensitivity settings make a difference.
If you lower your sensitivity, the pump will attempt to bring you down more aggressively and will not suspend until you are predicted under 70 or so, although it will lower it.
You can experiment on your own.
Leave everything the same and lower your sensitivity by 50 percent.
You will see a lower overnight level Be careful though because if you do it too much you will go low. So maybe you can start 20 percent and see how it goes.
When I lowered mine from 30 to 16 it brought my averages down. I was averaging 120 at night and now I average 95
However if you use sleep mode off and control iq on days it might tend to over correct your meals, so there is a balancing act
Right now I stay in sleep mode all the time I make my own corrections. My daily average is in the 90s, where it was in the 130s when I had my sensitivity higher.
I will try more tweaking, but so far the basal decrease causes it to suspend most times instead of flattening out in 90s. Good to hear you get those results.
Probably doesn’t help that I’m a nighttime snacker !!
Thanks all. Good to hear you are getting good control with it.
Do you find it impacts the sensor if:
You start the sensor when your sugar is out of range
Your sugar is out of range when the 2 hour start up finishes.
Isn’t it still expected that you do correct manually? How else will your sugar come down? By this time its too late to rely on an automatic adjustment of basal as it will take about an hour before that takes effect.
Oh and there are so many apps, what’s the difference between tconnect and dexcoms clarity app? Only clarity seems to be promoted in Australia, tconnect isn’t available. Do they do the same thing?
Well if you run the control iq it will do automatic bolus to keep you in range. However I tend to correct before the pump does.
So I set it to sleep mode all the time. And I need to make manual corrections, however with my sleep mode, it does basal corrections more aggressively and I need fewer corrections anyway. Add that to a lower sensitivity and I get good consistent results a bit lower than the settings prefer.
However if I miscalculate a meal and I go high it tends to over correct that and I go a bit low.
It’s a work in progress I feel like I am close to determining my sweet spot.
The difference between the 2 apps is that the connect also logs in and shows your insulin both basal and bolus. While clarity only shows the glucose concentration
The first day on the G6 is hit or miss. Some people find the accuracy spot on, and others find any number of hours to be wonky. You won’t know until you try. I would recommend NOT pre-soaking (premature insertion) your first sensor, just to evaluate your personal need for it. Even those that do suffer irregular readings report excellent accuracy after those first bad hours, so at WORST, you’ll lose a day of data. If you are one that fares better with a pre-soak, this will tell you how many hours you need. Personally, I have no need to pre-soak.
Second tip, dehydration really screws with the readings. You should be drinking your water anyway, but now you’ve got an extra reason to.
Previous sensors were negatively affected by acetaminophen and other medications. Supposedly that has been fixed with the G6. I still find that Theraflu is the G6’s kryptonite, though. I don’t know if you even know what that is, but in the US it’s a cold & flu medicine that comes in a packet to be mixed with hot water. It’s like flu tea. Since I also struggle with RA, a symptom of which is chronic cough, Theraflu has been a favorite to help me sleep, but I have to turn off the pump automation because everything goes haywire. Other cough/cold/flu medicines don’t do this… Just my favorite.
Australia doesn’t have Control-IQ yet, just it’s predecessor, Basal-IQ… So you don’t have to worry about the automatic insulin delivery yet. And honestly, I disagree heavily with @Timothy 's device settings advise. Control-IQ is amazing, but still in it’s first generation with some weaknesses… The major one being that it’s too light-handed at correcting for highs. Some people choose to “fix” this by lowering their correction factor. Except, this basically shoots the system in the foot, rendering it incapable of preventing lows. Personally, I think it’s best to program an ACCURATE correction factor (which may still require tweaking from Medtronic settings), and exploit other options to make things more aggressive. But like I said, that’s not your concern right now. For now, your pump will suspend your basal if it predicts you will go low in the next 30 minutes, depending solely on the information you give it via the correction factor and the rate at which your G6 tells it your glucose is falling. The only real shortcoming of this is that it will resume insulin as soon as your glucose starts to rise, even if it’s just a +1 mg/dl.(sorry, I don’t know what such a tiny number looks like in mmol) If you find that Basal-IQ isn’t preventing your lows, which can’t be explained by just a ridiculous over-bolus - Basal-IQ can only do so much… Then RAISE your correction factor If you find it’s suspending insulin too soon, then lower it.
Is anyone able to comment on the above? My appointment to go on the CGMS is at midday with my DE, which means if I eat before the appointment, my sugar is going to be high when the sensor is inserted. Not sure whether this will impact the accuracy later on - I found with Medtronic it did so just want to check what’s the go on the dexcom.
If I eat after the appointment, I run the risk of being low when the start up finishes … and again this impacted my readings on the Medtronic, will it on the dexcom?
Looks like either way I’m not in a good spot with my BG . I hope the dexcom isn’t as picky as the Medtronic sensors.
I don’t pay attention to timing insert with mealtime, and don’t experience those problems.
But you could do sensor insert, but not start it, if you plan to eat soon. Then couple hours after meal, do the start sensor.
Thanks it’s probably a non issue then. Its been on the back of my mind because it was pedantic with the Medtronic sensors and timing was everything because of the need to calibrate.
I generally put in a new sensor at bedtime. I’m usually steady at that point. Then the warm up happens while I’m sleeping and I wake up with 6 hours of flat line sugars and generally it’s dead on the money compared to finger stick.
If you start at a certain time then 10 days later you will start at the same time so it’s best to figure out the best time for you and Go with that
I’m not usually one to comment on food choices, 'cause I eat whatever the heck I want (within our own weird, made-from-scratch, homesteading lifestyle choices)… But why does eating mean you have to be high? Surely you have SOMETHING in your repertoire you can bolus appropriately for? Something low to moderate carb?
I know you’re going into the Dexcom with ill will, given your previous experience with the Medtronic sensors. Please try to set yourself up for the best experience. The G6 is amazingly accurate, but like all glucometers, comes with a margin of error. It is designed to be MOST accurate within the common diabetic target range. You’ll have the best first experience if your in range when the sensor warmup period ends.
I don’t believe there’s any published data on this… but I’ve noticed, and others have voiced a similar opinion, that my sensor life is diminished if my sugars get away from me. I don’t think the first day necessarily matters, but more like overall behavior. My personal theory is that the big spikes up and down eat up more reagent than if you can maintain a flatter trend line. Others have said they see better life when their average is lower. Maybe it’s the same thing, maybe not. Anyway, if your aim is to restart sensors, definitely try to go get your trend in line.
Good question . I actually don’t know, it may be something that I was told by my first endo or DE when I was first diagnosed 20 years ago and it just stuck with me.
Generally after a meal, my sugar goes out of range (over 10 mmol -15mmol which is 180-270mg) comes back down two hours later. I rarely measure my sugars within the two hours after eating (because I was told by my medical team not to) and not being on cgms it’s hard to say whether it’s really stayed up there. But when I measure my sugar 2 hours after eating it’s typically between 8mmol - 12mmol (145mg -215mg). So in my head I always think it goes high. And my previous Medtronic cgms also confirmed this somewhat. This is somewhat high but i find that if my bolus is any stronger such that is goes closer to 6mmol (100mg), Ill likely end up in hypo state later. My food is generally low gi, options like wholemeal rather than plain bread or rice so it’s not like I’m eating crazy with meat pies or burgers. If my sugar is doing this when I’m eating healthy, I can’t imagine how much exponentially is the rise when I eat out.
So it will be interesting to see how my sugars travel when I’m on dexcom.
It might be “normal”, but it’s definitely not optimal. I was in that boat last year before starting on the G6. I had no idea the crazy roller coaster my meals took me on. Accurate data is really helpful when it comes to learning to avoid those spikes.
Personally, I would lean towards a lower carb breakfast that day. I find I care a lot more about the choices I make when there’s a record stalking me! I’m not sure what typical aussie breakfast fare is, but I’d recommend something like scrambled eggs with veggies and cheese.
. I hope the dexcom isn’t as picky as the Medtronic sensors.