Who gets you here?

I'm jumping over from the CGMS discussion group where I started a discussion about Flatlining--with small ups and downs between the normal range.

I would love to know, who gets you to this flatline?

Do you rely on your doctors' suggestions?

Or do you use your own experience and self-knowledge to make those adjustments?

How much adjusting [or correcting] do you do [in a day, week, month, etc]?

How long did it take you to get to that point--if that's what you do?

I've been diabetic 22 years.

I've only had the pump for about 6 years and the CGMS for 1 year.

And I'm just curious.



I am self-reliant. I use my CGM like a video game console. I watch what happens when I eat or bolus. That’s it.

Bethanne, I used the Dexcom CGM for the first 9 months of this year, and found the discussions in the Dexcom Users Group. The help I received there enabled me to improve my control so much that I was having flatlines a few days each week. My new insurance policy may not cover my Dexcom. That is why I am stalling, and not using it for now.

+1 to the video game notion! After I eat, it’s like I’m trying to dock the Star Destroyer, slowly watching it pull in to the Death Star or whatever?

I suppose I got me to the flatline. My mom tried to give me a shot some 25 years back and was so shaky that I never let her do it again.

Dont really rely on the Dr. too much. I do like the validation they give me on my ideas though. Over the last 25 years only my Ophthalmologist and my old GP have really been good Drs.

Im like Helmut, I look a lot (ever 1/2 or so then sometimes more) and adjust often with small doses. per meal i dose during and after then check a few times to see if I need a new picture for the flatliners! =^D

It took 25 years of horrid control and then about 6 months after this discussion --> LINK. Then almost instant change on my new way of eating. 4 months ago my A1C was 7.6. Last month it was 5.8. End of this month I expect 5.5 or less hopefully.

Thanks for posting this discussion Bethanne. I look forward to seeing some of your trends up here as well!

Do you correct using the CGM or do you test to confirm the reading? The MM people say never to correct based on the CGM, and it’s been significantly off enough times that I believe them. On the other hand, if it’s reading high, and I know I really should be high because of just eating, I am tempted to make a small correction based on the CGM. Who knows, I might get myself in trouble some time, though.

i do a combination of both, but mostly I will test to make sure.
depends on when I last calibrated and how I feel…
I have done some head slapping with followup testing and realized my CGM was off.
But in general I find the CGM to be pretty accurate.

Liability is the issue when MM says, never correct without a fingerstick.
It’s a catch 22 for all these companies. Suggesting the fingerstick implies that the product isn’t great, yet not suggesting it could leave them with lawsuits. Which is unfortunate and more a sign of the times than anything else, if you ask me. :slight_smile:

I agree about the trouble. I owe bolus because I get a bit antsy when I think Im going up. Ive had to make a conscious decision to not correct and let myself have a small PP as opposed to being OCD and needing to flatline.

I used the MM CGM for about a year and hated it. I think it was a huge waste of money on a product that wasnt ready for market. I stopped using it towards the end of the year. I couldnt handle the misinformation e.g., fingersticking 50mg/dl off. Additionally, the sets caused me discomfort. I stopped it all for 2 years, then recently acquired a Dexcom which I can count on within about 5-10mg which is the 5 minute lag in most cases. I can bolus off of the Dex comfortably. I do fingerstick 10-12 times a day still.

In your case, I might finger stick twice 10-15 min apart to see if your BG is on target with the CGMS trend, then do your small adjustment bolus and test again in 15 min. The caveat is that is all a half hour process and a high carb meal may shoot you up 50-75+ mg in a half hour. For me, I know the insulin is 20 minutes behind my BG. So If I see an up trend I may bolus .5 (=15mg/dl for me) and wait 15-20 to see if there is any effect. Thats after my calc-ed meal insulin.

Glad you made it over here. I have always known what my control should be but TuD has helped me refine and tighten things up. My Doc has been amazed at what I have been doing!

I will adjust things myself and if there is something I just can’t get quite right I will ask my Doc. I really take from may places.

I will make minor corrections based on the CGM, but if I need some major changes I go to the finger stick.

I am another one to say me but also help from the DOC. I quit asking for help from doctor’s years ago. I have gastroparesis and doctors did nothing to help. Even though they knew I had gastroparesis, they treated me more like I must be eating nothing but junk all day because my BS was so out of whack. When I started talking to other diabetics online and learned that even people with normal stomachs split up meal time insulin for foods that take longer to digest, that made a huge difference in my control. I rely on my Dexcom but I also double-check a lot with my meter.

I was diagnosed Jan 1984 and did not really have any problems until the gastroparesis really hit in 2003. That was also the same year that I was put on once a day Lantus – between those two things, my BS was bouncing from 30 to 300 every day. It was late 2007 until I started reading online so it basically took about 5 years for me to get things back to where they should be. One of the first things I did was dump the Lantus for Levemir and that helped a lot. Then I started breaking up meal time insulin. By spring of 2008, I started on Apidra and because it gets out of my system faster, it is easier to stack insulin for both splitting mealtime insulin & corrections. I also joined Danny’s TAG group and that has also helped a lot.

I have foods that I use a square bolus for… Like pizza. High fat meals. I like the square bolus. :smiley:

My low carb diet would suck without it! =^) I actually square every meal.

I find the 3 integral parts of my control are CGMS, square / multi boluses, and diet (with a bit of exercise).

Also, I second Danny’s recontamination for TAGers.

Getting to where I currently am, “good” control is all relative, has been a combination of following good advice, incremental changes, and kick-■■■ technology driving those changes. I rely on the technology, exercise, and diet. I make all my own adjustments accordingly, but I’m always checking back with my endo at our regular three month appointpents to have another set of eyes watching my numbers to see if there are any potential problems.

The CGM is great because we can get real time, or close to real time anyway, feedback on how changes in our diet and exercise affect our BGs. I initially got the Dex because I was having lot’s of lows, especially associated with my exercise program. After using it for a few weeks and working through my issues, I figured out real quick that a pump would give me a lot more control over my basal rate under various conditions . After working with the Omnipod and Dex for a month, I figured out that a lot of my meal dosing issues could also be dealt with using extended boluses, etc. All along, i’ve been gradually tightening the range on my Dex alarms.

It’s definitely a work in progress, but the key word is progress. This group, like every other group, has been great with helpful tips advice. This group is fabtastic, though, because it’s the first time I’ve been able to actually see and read about how others are using their CGMs to tighten their control. Ironlically though, it’s when we talk about our excusions and get good advice on dealing with those that really really helps.

I love that about the pump as well…

the ability to progressively tighten the control. Part of that is why I ended up being a bit put off and freaked out with my new doctor’s idea of “good” control. But because I’d just come off a pregnancy, I felt like I needed to be extra cautious and take some advice. I’ve been pregnant before but not with the CGMS. Still, I was wary when he set my target range at 100-120. It wasn’t a big deal until I needed to bolus and it was correcting, actually minusing insulin because my sugar was 90. I cringed when I saw that and then added that correction back in. PLUS, it wouldn’t add insulin until I was over 120, and to me that seemed too late. But I was/am trying to be good, right?

In three weeks, my graphs still look like a roller coaster. And he thinks they look good. I know i have to be patient, but I think during a transition like this, changes would be necessary. I expected more… but it’s been too obvious that he is only looking at average numbers. that was his line this week. “The average numbers look good.” The highs and few lows don’t matter. But they matter to me. And i’m the one who counts. :slight_smile:

the attachment is my latest carelink upload. you can see why i’m a little disappointed. :frowning:

is there a way to just attach a picture??? do I have to have a link?
5560-carelinkdec.jpg (173 KB)

You can upload a picture or provide a link. I think if your picture is too big they will make it an attachment as opposed to embedding it. When you are at the dialog box for pictures, click on options, then resize it to 600-800 or so.

It looks like your peaks are post meals most often. Does that sound accurate? seems like 8am, 2pm, and 10am are the uptrend times.

i agree. :slight_smile: I’ve changed my target ranges. Tomorrow I will look at the last few days adn decide if a bolus shift will work. I’m guessing it will, but I also want to get back into better eating habits. Hopefully that will help, too.

the overnight is bugging me, but it’s also not very consistent, making it harder to nail down any changes. shrug A progression, for sure.

Yes for sure. Take your time and dont make to many changes at once. You wont know whats going on if you do. I might try to keep the meals consistent, if not just the proportions. That will make it easier to see whats happening. Keep us posted.

I do all my own management, from day 2 on the pump, almost 4 years ago, and over 3 years with the Abbot Freestyle Navigator