Thanks Joe! We were told that one should be around +50 from where you started at mealtime at around 2 hours post meal. I just thought of that as a type of rule and didn’t equate that with meaning the mealtime bolus was accurate.
Yes, my understanding is that if high/out of range at the two to three post-meal hour mark, a correction might be a way to go, but better to wait to the 3 hour-ish mark as to not stack. The thing is he usually comes down a good bit in the fourth hour so I guess it’s a guessing game in the early going.
We fear that giving that half unit of insulin to bring the level down a bit will cause a low. That is weighed against staying at a bit of an elevated rate for a while instead. So sometimes it gets worrisome or frustrating watching the CGM and wondering is this too high, too low. Has he been elevated too long, etc.
I may have said this before as well, but the CGM pulled the curtains back on what happens between meals. Right now his alerts are set based on a 80-200 target range. I think the last Clarity report I generated showed he was 96 or 97% in range for the time period. I guess its just difficult to know where he should be most of the time. The current endo says she usually gives a fairly aggressive target of 100. She indicated at the time that most use 120 or 130, I guess.
@mawa316, Ok, time to lighten up. Remember our friend SWAG. < < < GRIN > > >
You have been caught in the “do I zig or zag”. How about a third option. How about you and your son do some physical activity in the 2-4 hour post meal window. The activity will stir the pot and move the insulin in the body as well as rev up the muscles to ‘eat’ a little sugar.
My idea of activity is an attempt to provide a third option.
So, we’re back to no lantus and 1/2 doses at mealtime since son has been running low.
Like I said before, when changes like this occur I’m always analyzing the G6 output… My son ate breakfast this morning at 8:40 AM with a BS level of 96.He reached a rounded over ‘peak’ at 168. Two hours after eating he was 129. Now, closing in on lunch in about :40, he’s running at 117. This is without any snack in between. My concern at this time is the leveling off before the next meal… what is a level that would be considered too high and a good time to go back on the Lantus. Last time, we want back on the .5u Lantus when he started going +200 with pretty much every meal, but I don’t remember the lower or “cruising level” after the meal was handled with the bolus dose.
Oh, wait, I think he ran 125-130ish overnight and that is when we went back on the Lantus.
I’m just always worried, as I guess everyone is with running too high for too long or higher than recommended (same for lows as well).
Hi and welcome back! You all have been doing a great job getting adjusted, and you’re making good use of the CGM readings. You’re used to looking at patterns, and that would be wise here as well. The readings you’re seeing might be “outliers” due to activity levels, maybe carb counting was a little off, or other possibilities - it happens to all of us and we correct as needed as the occasion arises. Your doctor will advise you of you need to make changes to his regular regimen, and will probably want a few days worth of records first. But by all means contact them sooner if you feel the need is it makes you more comfortable.
See that’s the thing that concerns me, “outliers”. I’m not sure in my example what the outliers would be. Typically, his BS has been pretty stable of stable for periods of time. When we make changes, they’re often good (at least for a time) across meals, bedtime, sleep, etc.
I guess I’m concerned with what is two high or too low between his target range (80-200). Or is it just easier to go by the ‘anything between the lines is good’ and he should be about 50 points higher from where he started two hours after a meal rules.
Sometimes we see he may go into the 170’s or 180’s after a meal and stay there for an hour and half to two hours. My first instinct tells me that’s a bit high for too long.
Every time we address it with the Endo, granted we haven’t seen the new one that much, we just hear we are doing great. I guess I just have to be clearer with my questions next time.
“Doing great” is one of those vague comments that sounds nice (I use it frequently myself) but is annoyingly unspecific. When someone tells me I’m doing great I’m happy to hear it but later ask myself “Wait, what exactly did they mean?” So remember to ask your doctor to define what they mean so you can probe further.
Let me tell you a little story about me. I used to be fine until I hit 120. When I reached that number it was like flipping a switch and I would start dropping rapidly. 120 is a great number but I had to stay higher to keep from going low. There was a time when a good number wasn’t good enough to sustain me.
One of the things to consider is, when he’s at a certain number (on the lower end of the scale) is he starting to lose focus, “feel funny” (whatever that means for him), or does he need assistance with doing things? Some people may be quite fine at a particular number, while others start to feel a bit odd at the same one. I think as your doctor gets to know your son and learn more about his lifestyle and patterns (does he take a walk around the same time each day, or go whenever the mood strikes him for instance) the better they can guide you on a range to shoot for.
If you are concerned about how high his numbers are after eating ask your doctor what he should aim for and if taking his insulin a while before eating would help (doctor should recommend how far in advance).
@mawa316, Matt, I tried to check your son’s age from all of the posts on this thread. I did not see it. I may miss something in my thoughts about OUTLIERS. What are the things that can screw with CGM data? 1) emotions 2) growth spurts 3) puberty 4) stress 5) illness 6) other meds - even steady ones. 7) injury - even hidden from sports, playground, neigborhood.
Remember our old friend SWAG and apply it to all of the ideas above for chasing OUTLIERS
If you figure out the OUTLIERS, please let us know…
Hi @987jaj. Doyou mean that emotions, growth spurts, etc screw with (affect) the glucose levels, or the CGM data? The CGM should be picking up the levels that are in the body, but the levels themselves are affected by all sorts of things. Just clarifying - thank you.
Hi @987jaj. Doyou mean that emotions, growth spurts, etc screw with (affect) the glucose levels, or the CGM data? The CGM should be picking up the levels that are in the body, but the levels themselves are affected by all sorts of things. Just clarifying - thank you.
@mawa316, Time for one piece of quick humor. Daffynition: “At teenager is a person whose hormones have turned on and whose brain as turned off.” Covertly, he may be finding girls. <<<<<< GRIN >>>>>
So here is the thing I’m most concerned with right now. At times, and it seems a little more frequently lately, my son will spike and stay elevated for 2+ hours. I attached a pic of the areas I’m concerned about.
I believe I mentioned this earlier our Endo, who everyone seems to adore, has us on a ‘scale’. She presents it like she does the math for us so we don’t have to worry about it, but I’m getting the algorithm at our next visit.
Anyway, we are sort of waffling back and forth between scales with a ratio of .5u:25 and .5u:30 or 1u:50 and 1u:60. There isn’t too much difference between the two, but sometimes there is a .5u dosage difference. When he runs high like that, we’ll use the 1:50, lower we’ll switch to the 1:60. Sometimes he’s stable on one for about a week, but I guess there’s no rhyme or reason as to what’s going on sometimes. The best guess adage seems appropriate.
I just constantly worry whenever he goes out of range and what that is doing to his long term health. The Endo says there will be occasional highs, how many is too many or how high is too high to be happening with any frequency? We’ll find all of that out at our next appointment in December and I’ll probably send in to have his Clarity data checked, but just wanted to get a feeling from the community.
When should I really be concerned with the trends I see?
@mawa316. Matt, dropping down to the Clarity info. You should be able to log in and see the Clarity data online from your home computer.
Back to the two hour elevations, the question I would have is “What did he eat?” If he were on a pump and ate pizza, there would be an extended bolus of insulin given by the pump. In the case you are giving us the fat is slowing the insulin working. Someone better than be can fully explain it.
I wanted to give you a start about a direction to look. Keep the faith.
I used to run reports and send them to my doctor via their patient portal if I couldn’t wait for a visit for them to do a download. Now I share my account with the office so they can pull me up as they need to. It’s much more convenient and they can choose the report/s they need.
That image is from our Clarity info pulled online. And yes, we have all of that set up with our doctor as well.
As far as what he eats, he pretty much eats the same thing all the time. When he does eat something like pizza, we do see the extended elevation with another about 1.5 to 2 hours after eating. I believe I was told that in this thread and to maybe take half dose at mealtime and 1/2 a bit later when eating pizza, which we have not yet tried. But, I digress.
Like I said, he pretty much eats the same things, but do know food and many other things can play a factor. I guess my main concern is not why the BS is steady high sometimes, but when I should be concerned about that. Is that something that comes with the territory or is it something I should raise alarms with the Endo as soon as I see a few instances of it? Like I said, we will be checking with the doctor too.
@mawa316, Matt, I think you are getting close to the hair pulling again. You have mastered a large amount of information, integrated it to the way your son’s body responds, and continued to ask the hard questions. In my feeble opinion, you have come along way and should be proud (I believe Dorie, Joe, & Dennis will agree)!
I have a (possible repeat) story about food. I was at a conference and ate the same evening meal at the same restaurant with the same carbs, and I was on a pump. I used the menu carb count (usually needs to be fact checked) and pumped the same amount of insulin each meal. After compiling my body’s reaction 3 or so hours after each meal, I was HIGH on one, LOW on another, & the 3rd was on target. I don’t remember what the order was. However, the take away is, figure, calculate, and plan, diabetes will still leave you guessing…
Check with the doctor and be prepared for any type of answer. Point to ponder, is this the evidence you need to discuss with the doctor to go on a “closed loop” pump system like the Control-IQ from Tandem?
Hmmm, what I’m seeing does make a push for a pump I guess.
So in my minimal understanding of a closed loop system, things are adjusted on the fly to combat BS spikes, rises, falls?
One thing I worry about is the CGM in the system being accurate. Sometimes, its way off, like when a sensor is started or it seems the same with a new transmitter for a few days as well.
First of all I have to second what @987jaj said about the amazing progress you’ve made!
Regarding the issues you’ve had with the CGM, if you haven’t done so yet you might check to see if the inaccurate readings happen with particular locations (yet more patterns to check, sorry).
I have been using Dexcom with Control IQ since early summer. It corrects quite nicely so long as the background settings - basal rate, correction factor, insulin duration etc. are accurate. Personally I think it’s a good idea to learn how to use a pump manually first, without the bells and whistles, so you can learn how to make your own corrections and how your body responds. In the unlikely event that you don’t get your sensors and have to use fingersticks for a while, you won’t be in the woods.
That is a good idea - move to manual pump first. My son, at least at this point in his T1D journey is not to keen on the tubing of a pump. I would think when he’s ready, he would like to try something like the Omni Pod first. I don’t believe that works in any loop system, but it might open him up to the possibilities down the road.
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