Day 1 of Dexcom and lessons learned

[jpb286]

Well, I am almost at the conclusion of the first "day" of using my new Dexcom CGMS. (Well, okay, it didnt ask for the two BG readings until 130pm, so I guess 1/2 day anyway...)

For the first time in my life, I got to SEE the duration of insulin action. When it asked for my 2 BG's they were 202 and 216. Dexcom gave the first reading as 207. Excellent accuracy! :p

I "overbolused" slightly since it wasnt coming down a whole lot in a hour's time, and "dipped" down to 77, and the Dexcom alarmed me that the value was below 80. I checked and sure enough my BG was 65! The first low I treated in 18 years WITHOUT showing symptoms!!!

Well I lowered my basals again, since despite carb intake and eating a Chick-fil-A meal which I only bolused half, I was teetering around 80. What a great tool! :)

Here was my mistake. The data interpretation is only as good as the user. The levels went up to 100-120 and stayed there. Okay.... Then later this evening, the sensor alarmed at a level of 60. I test and the glucose was 89... hmmh.... so I (rather poorly) decided not to treat it. Well the sensor dropped to 50-ish and stayed there for about 20 minutes. I am still in the 70's-80's....

WELL... low and behold, I dropped down to a BG of 51, and the Dexcom alarmed "LOW" value (<55). Now I AM symptomatic (shaky).... If I had been a "good" diabetic (oh, who are we kidding, none of us are) I would have payed attention to the Dexcom trying to tell me it was "predicting" I would go low. Well it was dead on, and I was stupid for not listening to it.

So OBVIOUSLY I treated the low, and now I am back to normal again. Lesson learned. Trust(with some common sense and a grain of salt) the CGMS. It doesnt lie(unless it doesnt like you).

[rickst29]

except what the $^%&# is a "Chick-fil-A meal"?

Sounds even nastier on the consumer than it does on the chicken! :p

[jpb286]

except what the $^%&# is a "Chick-fil-A meal"?

Sounds even nastier on the consumer than it does on the chicken! :p

You must not get out much, Rick... :D

Day 2 was good, sensor was great, with in +/- 20mg/dl depending on whether I was climbing or dropping. I still cant get used to "treating" a low at 120 based on a curve, rather than the "shakes" at 40. What do you recommend on getting the adhesive to stick, it is peeling up on the topside, and I just slapped some 3M Transpore tape on there I stole off the ambulance(until I find a better adhesive).

[Rachel]

You must not get out much, Rick... :D

I still cant get used to "treating" a low at 120 based on a curve, rather than the "shakes" at 40.

How about if you think of the new way as "stopping" or "catching" a low - leaving you less (or no!) lows you need to "treat".

Glad to hear you are off to such a great start. Congrats!!!

[rmccully2000]

. What do you recommend on getting the adhesive to stick, it is peeling up on the topside, and I just slapped some 3M Transpore tape on there I stole off the ambulance(until I find a better adhesive).

I think Rick uses Mastisol but we use Skin Tac liquid and we put this on soon after insertion. I'm convinced (though I have no real proof :) ) that this greatly reduces/eliminates the water HIGHs associated with bathing and showering. We no longer cover the Sensor and it tracks like normal most of the time.
So glad you like it !
Becky, Mom to Mason, 7 Dexcom, Iport

[rickst29]

Thin q-tip application on both skin side and failing fabric side. You need to let it dry completely BEFORE you press the fabric back down on your skin, it's kinda like contact cement in this regard. Put on correctly, it'll last as long as the Sensor (for me, up to 3 weeks). But you might easily find yourself needing to apply it later to the sides, or bottom edge, if they peel up.

I don't tear up still-adhering fabric to get it all done at once, and don't know if that would be a "good idea" for an extremely active person. It would make removing the Sensor a lot harder-- right now, I just start from a side which ISN'T held with Mastisol and pull through the firmly stuck-down areas.

There's a lot of residue with this product. Ferndale makes a remover, but Smith+Nephew "Uni-Solve" is more than adequate. Their "Remove" formulation, with more Ether, is overkill.

[jpb286]

Day 5, and the Dexcom is still 100% accurate (+/- 20 mg/dl BG/ISF variance). I am still on my original sensor, and until I get the Mastisol/Detachol you will never guess what I am using to hold the tape down on the sensor......a GLUE STICK. :eek: Hey, I checked first, it said "Safe on Skin", and its working fine in the interim until I get the industrial-grade stuff....

I have had a couple of 10-15 minute periods where it couldnt receive data (not sure why, but I am near enough electronics stuff so, oh well....) but whenever it picked back up it was still extremely accurate. I have been able (thanks to the Dexcom) to get my basal rates 100% accurate, with an acceptable fluctuation of less than +/- 30mg/dl (per Pumping Insulin, Walsh et al.) and most of the time less than that.

This is about as big a milestone as home glucose testing. I really dont know how I managed my diabetes before I got this. Its unreal. I had no idea I had significant post-prandial spikes (almost to 300mg/dl) before I got the CGMS, no wonder my A1C was in the 9's. I hope to get a result in the 8's the end of this month, and in the 7's in another 2 months. We'll see.... the best is yet to come....

For anyone considering CGMS, I beg you, please try it out.... you wont regret it....

[coni]

What is the average of daily finger sticks pre CGM for you versus now?

[jpb286]

Probably about the same. About 6. Its just the ability to "confirm" what I am seeing on the CGM, rather than play "catch-up" with just fingersticks.

[rickst29]

This is about as big a milestone as home glucose testing. (I really don't know how I managed my diabetes before I got this. Its unreal.This was my reaction, too. I've gone from TWENTY pokes a day down to 4-6., from 10-12 Glucagons per year to ZERO. For me, it's a bigger advancement the the pump, and even a bigger advancement than the invention of "fast" insulin analogs!

Best thing since switching from pissing strips. BTW, I'm chuckling at your clever glue stick workaround :p

[jpb286]

This is about as big a milestone as home glucose testing. I really dont know how I managed my diabetes before I got this. Its unreal. I had no idea I had significant post-prandial spikes (almost to 300mg/dl) before I got the CGMS, no wonder my A1C was in the 9's. I hope to get a result in the 8's the end of this month, and in the 7's in another 2 months. We'll see.... the best is yet to come....

For anyone considering CGMS, I beg you, please try it out.... you wont regret it....

Well, I had my A1C done yesterday and I couldnt believe it..... 7.8! :D

[rickst29]

If my A1c came back "7.8", I wouldn't believe it either :mad: :mad:

But of course, you just started, nearly all of that reading is from your "pre-Dexcom" behavior. With the way you're watching it, your NEXT one is gonna be much lower-- almost certainly in the sixes, maybe the LOW sixes.

I'll hand you a virtual beer if your next one comes in 6.5 or better, OK :D :D

[Rachel]

Well, I had my A1C done yesterday and I couldnt believe it..... 7.8! :D

Fabulous, Paul! You've worked hard for this and it will only get even better.

And the best part is that by using the CGM and catching those lows before they happen, you won't lower the A1C falsely with a lot of lows.

Is your plan still to do these monthly? If so, my guess is that the next one will be a little better or hold steady (getting rid of those spikes but also the low lows), but that the one after that will be dreamy. Five (virtual) bucks if I am right?

[jpb286]

If my A1c came back "7.8", I wouldn't believe it either :mad:

But of course, you just started, nearly all of that reading is from your "pre-Dexcom" behavior. With the way you're watching it, your NEXT one is gonna be much lower-- almost certainly in the sixes, maybe the LOW sixes.

I'll hand you a virtual beer if your next one comes in 6.5 or better, OK :D :D

Well, I was "happy" at 7.8, because for having diabetes 18 years, and even being on a pump, my A1C has never been below "8", EVER. So all the more reason to celebrate. I agree, it simply "has to" get better. My next goal is 7.0, so if I can hit 6.5, we'll celebrate(and so will my kidneys) :)