So we were at a friend’s house last night and there was lots of junk food and cake, so I gave my daughter a hefty square wave bolus to last for 3 hours. She stayed nice and steady but was creeping up a bit at bed time around 10 pm, so I corrected her. Then around midnight her Dexcom said she was 15 (270) and climbing. So I did a poke and was surprised her meter said she was 24 (432!) ! I thought it was odd that she was so high, so I did another poke and sure enough got the same number. Meanwhile her Dexcom had leveled out still saying that she was around 15 (270), but I thought that the Dexcom just hadn’t caught up so I let the pump correct the high. Well, then she came down in a huge hurry and by 3:00 am went super low. (Yes… I’m tired today).
So it’s almost like that bg reading was just a strange spike and wasn’t really a true reading at all. But I’ve always trusted the meter over the Dexcom, as I should. But last night I wished that I corrected her based off the Dexcom rather than her meter, which is crazy. But perhaps I should just step her down at night just in case… meaning I should have only given her 2 units at midnight instead of 4 and then waited to see what would happen.
You could do another square/extended/combo (different pumps call it different) bolus. Bolus the 4 units with maybe 20% now and 80% over the next 4 hrs. Set an alarm for 2 hrs. Go to sleep. In 2 hrs check her and decide whether to cancel the remaining bolus or let it keep running.
I don’t think it is reasonable to use a CGM reading over a meter reading. If you question the CGM such that you feel it necessary to do a fingerstick and then you double check with another fingerstick then you really have no choice at that moment in time. You have to use the fingerstick number.
If I feel the need for a “double fingerstick” then I do the second fingerstick on the other hand. If they both come up in the same ballpark then I have to assume that it is what it is.
Stephen Ponder, T1D and author of Sugar Surfing, uses the term “hollow” to describe some blood sugar levels. It’s an apt term since some numbers are easily persuaded to move in a favorable direction while others remain more stubborn.
In your scenario, I suspect that the Dexcom was not as accurate as the fingerstick device. (Were her fingers clean?) Based on your experience, however, it looks like the high was hollow since it over-responded to your correction. But it could have been stubborn, instead. The vagaries of diabetes, ugh! It’s simply a dynamic condition and, most importantly, you were there to catch the 3 a.m. low.
Another choice you could have made is to give 3 units to play it more conservative. But then you could’ve run into a stubborn high and add many hours to the hyperglycemia. Did the Dexcom wake you up?
Thanks Tim35 and Terry4 for the helpful advice. I like the term ‘hollow’ describing these highs because they don’t really seem real, but I did do two finger pokes different hands and the hands were clean. We’re run into it before at night, so I need to either do a square wave or give half and check later.
Thankfully the Dexcom does wake me up… but I’m also used to setting my alarm for all manner of times during the night and so last night was a combo of both.
What do you have your pump configured for the “Insulin Duration” (or whatever it is called on yours but the configuration parameter used to calculation the Insuling on Board - IOB).
You mentioned you bolused at 10PM and then bolused again at midnight. (Based on double fingerstick.) The pump would subtract the 10 PM IOB from the bolus required for the midnight BG correction but if the pump “Insulin Duration” is configured to a low value than the IOB would be calculated to be lower which would increase the midnight bolus which could end up with more insulin in her system then you expected which could result in a subsequent low.
If you think on other times that you have done a subsequent bolus within two hours of the first bolus without any food after the second bolus… (lol) Does there seem to be a pattern of going low after the second bolus which might indicate the IOB as calculated by the pump is perhaps not accurate?