How do you take insulin dose when you’re at a reasonable BS level or a bit high but your Dexcom is showing it falling. You’re about to eat dinner. What do you base your insulin dose on?
If I’m not trusting the sensor (rare), I’ll test and decide. that’s just being prudent. Sometimes I get lazy and base all my treatment on my sensor (thanks to it’s usual, but not “always” accuracy). Everyone has different trust issues. Once in a while I wished I’d done a finger-stick, because the sensor told me I was higher than actual, and therefore I took too much insulin, which means I have to eat additional carbs, and I’ve been dieting! Lots of fruit, veggies, fish, chicken, meat, and very little processed goodies. So when I have to eat to get my bgs back up, it’s an aggravation.
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But what number do you use? Let’s say, I’m at 128 when I test and my dexcom is saying 130 with an arrow straight down? Do I eat and bolus for a 128? or a 110 because my arrow is saying I’m crashing and where the heck is it crashing to?? I’m trying to lose a few pounds but you’re right, trying to exercise and them having to down sugar because I’m crashing gets so freaking frustrating.
The meter reading is your actual blood sugar. The trend Arrow of the Dexcom is still based on 15 minutes ago, approximately. If you waited just a few more minutes you might find that the trend Arrow changes. If it were me I would go with the meter reading to make my insulin decisions
There are many times when a downward trend from taking insulin will flatten out or it might even go up. In other words you can’t be certain that the downwood sloping graph means you are for sure going to drop into the hypoglycemic range. It means you might but it doesn’t mean that’s a hundred percent guaranteed. Both scenarios can happen
Thanks, I know, it makes it very confusing. If I wasn’t able to see the trend I would just go with the meter reading. I sometimes think that too much information makes life more difficult! 
More information can complicate things, for sure. It’s rarely straight forward. The situation you are describing is one you may just have to trust your gut on. There are so many variables at play - if you know why there’s a down arrow, like IOB or intense activity, I would definitely finger stick and probably under bolus a judgemental amount of carbs. But that’s based on experience specific to Caleb. I wish there were more precise guidelines, but for us, we have to eyeball things. More times than not, we get in the ballpark.
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Thanks, that’s basically what I do. I’ve wondered what others do. So I guys I’m on the right track!
Lorraine Parent of a Type 1
January 20 |
More information can complicate things, for sure. It’s rarely straight forward. The situation you are describing is one you may just have to trust your gut on. There are so many variables at play - if you know why there’s a down arrow, like IOB or intense activity, I would definitely finger stick and probably under bolus a judgemental amount of carbs. But that’s based on experience specific to Caleb. I wish there were more precise guidelines, but for us, we have to eyeball things. More times than not, we get in the ballpark. Visit Topic or reply to this email to respond.
In Reply To
barbraann
January 20 |
Thanks, I know, it makes it very confusing. If I wasn’t able to see the trend I would just go with the meter reading. I sometimes think that too much information makes life more difficult! 
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Lots of factors to consider, as others have mentioned. In this scenario, meter reading takes precedence. I’d generally look at my IOB, subtract the IOB (if any) from my bolus. I’d then eat immediately instead of pre-bolusing, eating the carb-by bits of my meal first to level that pending drop.
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Note: The first icon is the double up arrow in G4, I think.
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For me, I call 50 points = 1 unit. 100 points = 2 units. (This is probably different for you.)
I think this map is showing that if I have only a moderate fall, like this:
Then, I might consider pretending that my BG is fifty points lower than it actually is, so 1 unit less meal bolus.
If its a double arrow down, indicating a severe drop, like:
Then, I might consider taking 2 units less of meal bolus.
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One thing that helps along with the trend arrows on Dexcom is to look at the actual graph. You will notice over time that you can tell a lot about what is about to happen using the arrow and the graph. For instance it may show an arrow straight down my daughter may have been coming down straight for a little while, but if you look at the graph the dots are starting to round off even though Dex is still pointing straight down. This helps me a lot when I am treating a low and having to be patient to not overtreat, I watch the graph and even though Dex still thinks it is coming down I can always tell when it is leveling and about to come back up. I hope this wasn’t too confusing and it does take some time to learn, but I found when using them together it can help a lot especially in situations like you described with dinner time.
I think you also have to take into account what you might be eating. I’m learning this as I go. If I’m taking in a large amount of fast acting simple carbohydrates then I would just bolus and go knowing that my bg is going to spike and my Novolog takes about 20-30 min. to reach it’s effectiveness. If it’s a meal with lots of protein or fat I typically wait until I start eating or halfway through my meal to take the bolus.
What do you all think?
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Where the dots go, the arrows will follow. It’s like an advanced peak where the arrows are headed. Sometimes I will even do a fingerstick to gather more confidence about where I’m headed. I think of the fingerstick like a peak into the future even though I know it is simply a peak into the present since the Dex dots and arrows live 15 minutes or so in the past.
I usually dose the same amount of insulin with a,up or down depending on arrows. My big take away is the amount of time I’m waiting on the pre bolus. Two arrows down, I don’t wait, 2 arrows up I can be waiting 45 minutes. Everyday is just not her experiment in the making. And what worked today might not work tomorrow.
Completely agree.
Good description.
I believe what is going on is that the Dexcom “Arrow” uses the last three recorded cgm values (ie - dots) for the Arrow display.
When we (humans - lol) visually look at the graph (and particularly when it is hitting the curve at the top or bottom) and we see the last TWO data points changing, we (or at least I) tend to discount the earlier readings and assume (particularly if we are expecting and waiting on the curve) that the BG has peaked and is curving up/down.
End result being that on the top or bottom of the curve, the Arrow will often times visually appear to be wrong. Give it another 5 minutes however (ie - another cgm data point) and the Arrow should now be in better alignment with the graph.
The book and website Sugar Surfing calls that curve the bend. Watching for “the bend” is a key thing I learned from that. I found the book very helpful in learning how to respond to the CGM trends and bends.
The author is Stephen Ponder.
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