At the hospital, he was given his insulin just before eating (bad food service, different story). We just kept doing that after returning home, but I’ve read that insulin should ideally be given 15 minutes before eating. Is that the way to go?
@mawa316 like everything diabetes, no rule works all the time. I go 15 minutes before if I have no insulin on board, and if I am not dropping before a meal, and if the meal I am eating is fast to medium fast carbs. If I am dropping before a meal for example, I may give my meal insulin 30 minutes after. If I am eating very slow carbs such as pizza or ice cream I have a different strategy.
When I feel like eating Halloween candy I take insulin and wait to start dropping and then eat candy.
The way you learn is with testing and/or CGM data and trial and error. Also, whatever works well for you may not work well for others.
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Thanks Joe! We also have to get the fast/medium/slow acting carbs down as well.
Hope all are well and staying safe!
We’re prepping for the Dexcom and we downloaded the sample apps they have. They indicated that there are times when you’ll see the blood sugar level without a trend arrow or the other way around and I guess you should check with a finger stick at that point. For the Dexcom users out there, how often does this occur with the G6?
No trend arrow means steady (not changing) blood sugar. The G6, if started correctly, doesn’t need calibration.
Not according to the sample apps. If the level is stable, there is an arrow pointing to the right. So, I guess it should always have both a number and trend arrow. There are times, again according to the demo, where you might have one or the other but not both.
@mawa316 Fair enough. Sorry to mislead. My last CGM was no arrows no trend.
Directly from DexCom: no arrow means it hasn’t calculated a trend yet. Here is the text
The trend arrows tell you what direction your blood sugar is going. When these arrows are not being displayed it means that the receiver is not able to determine what direction or how fast your glucose is rising or falling at this time. A common time where this may happen is when a reading just came back after an antenna icon, question marks, or when your blood sugar is changing rapidly enough where it cannot track it.
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Hi @mawa316 and welcome back! It’s been a while which I hope means you are becoming more confident and comfortable at least relatively speaking; although of course we are always here if you need us.
I started in the G6 with Basal IQ several weeks ago and switched to Control IQ recently. It’s not necessary to progress that way but I did. Anyway, keep in mind - so long as the pump and sensor are in range (20’) and aren’t obstructed (most often for me that’s because I lie down on it, but I do have an alarm set to let me know in either case), you will be getting updated readings every 5 minutes with either system, so you can see how things are going at any time, although the change in the graph might be minor. Control IQ will adjust insulin to compensate for lows and highs, although I find I do still need to get a snack when I’m on the lower end of the scale - I’m adjusting my basal rates to help with that.
So talk with your doctor about making any adjustments when you see those arrows. The system may resolve them with the insulin adjustment, so don’t panic.
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So two things… First, we’re going to try the NovoPen Echo, which has the ability to deliver 1/2 units. My son really isn’t all that enthused about a pump, but may at some point try the Omnipod. Anyone out there use the Echo? Like/Dislike? I guess I should have asked those questions before we ordered.
Next, for the most part, my son’s blood sugar level is fairly stable, with a low every once in a while. His last low was on the 16th I think. Anyway, it seems like his insulin still works on bringing his level down in the last hour. Sometimes when we check at 2-2 1/2 hours its still on the higher side, sometimes even at 3 hours. At the 4 hour or next meal mark he’s usually OK if he has a snack. I’m just wondering, and I may have asked this before so forgive me and I know this is different for everyone, but is the norm 3 meals and snacks, with a bedtime snack. He usually eats Breakfast, mid morning snack, Lunch, mid afternoon snack, Dinner, then a bed time snack.
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Yes. This is the most common.
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So, in another thread it was mentioned that if you have good blood glucose control, you should be at no greater risk with COVID-19. I still struggle, I guess, as to what is good glucose control. Maybe I should ask, what is a summary or example of someone with poor glucose control?
@mawa316 this is subject to interpretation. I use normal blood sugar of about 70-100 mg/dl. If you are always in there well that’s PERFECT blood sugar control. No one has perfect blood sugar control.
If you are consistently less than 120 before meals and you keep you after meal spikes below 200 and you aren’t having crushing lows or overnight lows I’d say you have AWESOME blood sugar control.
Good, to me, is an average of 140 with the typical lows and highs, maybe with an A1c of less than 7%. I’d say that was “Good to really good” blood sugar control. That’s what was meant. I think this is about where you need to be so you aren’t going to suffer early complications and issues
Then higher averages and a1c and you are at higher and higher risk of (not absolutely going to have- just higher risk of) complications, slower healing, circulation, stubborn infections, probs and other regalia. The things that wear you out are higher numbers over long periods of time. not just one thing but one thing very often. Do not get crazy over 400 mg/dl if you do what you need to do to turn it around. Ok?
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So my son started using his Dexcom G6 today and I guess it will take some getting used to. His reading with the Accu-Check Guide Me have been fairly consistent, but just before dinner time the Dexcom showed 64 and dropping. It was time for his meal so we double checked with the meter and he was 84 at that time. about 15 minutes later the CGM was dipping into the 50’s I believe, but our meter read 77, which is on the lower side for him. I wasn’t aware that the CGM is a little behind the blood glucose reading so that is going to take him some getting used to.
Maybe we should have calibrated or when is a good time to do that? Our educator said that with the G6, you should not have to calibrate with every sensor change, but when is the right time? Should we do that in between meals if the readings are a ways apart?
Hi @mawa316 calibrating a CGM is the teal tricky bit of operating one. G6 doesn’t need it as long as you don’t lose the label. I would say the very best time for calibration is when you take a fasting blood sugar, say right before lunch or dinner, during when there has been no special activity or after a very fatty meal for several hours. You want your blood sugar rock steady and then you can calibrate it with a finger stick. Calibrating a CGM when you’re blood sugar is changing over time is usually disastrous. Cheers good luck 
Matt @mawa316, why mess up a perfectly good device like the Dexcom G6 by unnecessary calibration? Keep in mind that BG Meters provide BLOOD glucose via a finger-stick, which depending on technique and several other factors, is prone to deliver inaccurate readings; his G6 is estimating BODY glucose by analyzing interstitial fluid. Two different animals.
Calibrating the G6, unless directed, could interfere with the intended operation . One of the features of the G6 is “predictive low” warning - throwing in random calibrations confuses the G6 and defeats its purpose. There is nothing wrong with doing an occasional blood glucose check and comparing values - but almost always, these blood checks should not be used to calibrate. The most accurate time to do a comparison check, is at least 4 hours after any insulin infusion/injection, and at least four hours after a meal, and not following any real-active period.
As a comfort-practice, it might be good for you to do a finger-stick at the time of a laboratory blood-draw and compare the results - also, compare the CGM reading for that minute with the laboratory plasma glucose value.
I guess we went the calibration route because the CGM said 65 and dropping fast, but his finger stick was at 85. It was right before dinner so it sounded like a good time, even though its not recommended.
It’s not that I want to ‘mess up a perfectly good device’. It’s more we just didn’t know any better.
I’m still not grasping the difference with what CGM monitors. When we eventually move away from the finger pricks and if the CGM lags behind by 15 to 20 minutes, what good is it if the CGM is showing 65 and dropping like a stone, coupled with the fact that if there is a lag, his true blood sugar could be in the 40s. It doesn’t seem like its reflective of true glucose levels.
Or I guess the CGM provides the correct interstitial fluid glucose level, but which is more important, that or blood glucose.
Or, are they just two completely different animals that can’t be compared in any way.
I’m just not grasping the benefits of the CGM, aside from less finger pricks yet. I’m not saying the CGM is bad, I just don’t get it.
Hi @mawa316 no worries. A CGM in its current form cannot measure actual blood sugar so it measures a correlating component of interstitial fluid. All it means is it reads something else and the thing that it can read is similar to blood sugar.
The interstitial fluid tends to lag actual blood sugar so typically if you blood sugar is dropping fast, the CGM usually reads higher than actual blood sugar. Other things like dehydration and squishing the interstitial fluid (compression error) can cause wider errors.
The CGM has an accuracy similar to your blood sugar meter, so in the case of G6 it’s better to not calibrate because of the lag and the number on your meter has an accuracy as well (+/- 10%) That being said, if you need to calibrate you can but do it when nothing is changing.
So the CGM allows you to see the number continuously- the benefit is being able to actually see the trace all night long rather than interpolate a 9Pm then an 8 am finger sticks and guess what happened in between. It gives you the whole picture not just 2 dots. That’s the benefit.
Hi @mawa316! It’s been a while and you and your son have come a long way since your first post - congratulations!
While my CGM is an important and necessary tool I also listen to what my body is telling me. So if my CGM reads 85 by I’m feeling confused, of balance or demonstrating other signs of a low, I’ll get something to eat. Now here’s the thing: let’s say a person is used to running in the 200s (I know this isn’t your son - just an example) and is learning to tighten control. They may feel like they’re low at say 150. That number shouldn’t be dangerous, their body needs to adjust to the new numbers. On the other hand, readings under 80 can be dangerous. So if the person is dropping rapidly per the CGM, it would be good to get a snack.
I did the online training - and quiz - to get my G6, but I still had some questions. My Dexcom rep - who also uses Control IQ - was very helpful. They or your diabetes nurse educator (DNE) should be able to help you better understand what the CGM measures vs a BG meter and why there are differences.
By the way, I’ve never used anything but my fingers for hehe sticks but some meters are made for alternate site testing (back of the arm, I think). I think site site can yield different results from the fingersticks which have been used fire decades. Also some meters need to be calibrated periodically. They used to come with a control solution but you may need to buy that separately now.
Our educator did explain the differences between what is measured and why the lag. I guess it just takes some getting used to it and trusting in the CGM itself. It’s just a new scare I guess.
My concern was just with the lag and lows. If the meter reads 80, but the CGM says 65 and dropping, does that mean he can assume his blood blood, not fluid glucose is dropping as well and its a good time for a snack.
He ate his breakfast at 9 this morning, looks like his level (fluid as per CGM) peaked about 1/2 hour later then started dropping to a low at around 10:30. A little early for his snack (was usually having a small snack around the 2 1/2 hour mark), but it brought his level up and stabilized in range. I wonder if his insulin needs to be reduced a bit. A call to the endo team will answer that. Or, things are going as planned, we’ll see.
Oh and I guess another important piece of information is that my son can’t really feel highs and lows yet. The one thing we did notice is that when he’s going on the lower side of his range, he starts to get a little cranky.
Diabetes can make you time conscious, especially if you’ve had it for decades and grew up with a pretty regimented schedule. As a child I always had lunch at 11 (at least when I was home) and dinner at 6. I still sick to those time frames pretty much out of habit. But if I feel the need to eat earlier than normal I do - last night dinner was between 4:30 and 5. Use time as a guideline but don’t feel locked in. As you know our bodies do their own thing.
In the event of a low or an expected one, I prefer to err on the side of caution and have a snack.
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