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Dexcom settings/alerts at school

Discussion in 'Parents of Children with Type 1' started by cm4kelly, Feb 16, 2013.

  1. cm4kelly

    cm4kelly Approved members

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    Excited about getting my Dex4 next week. Looking at the tutortials - I was wondering - for smaller kids - my son is 6 - what is your high number setting for alerts? Obviously a 200 would help for tighter control, but I worry about the alerts going off a lot at school. Would you set it at 250?

    What does everyone else do and how do you deal with alerts at school?
     
  2. BittysMom

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    My daughter is in first grade. I forget what I initially tried as the high... But I've since raised it substantially at school because it was needlessly interrupting her. Now I set it at 300 so it won't go off unless she has a nasty breakfast spike or a site issue etc. This works for us because she has a snack a 10am, lunch at 12, snack at 2. So there are many opportunities to correct whatever high she may be having ie: no need for the high alarm really.

    Her low I started at 90 but what was happening was that it would go off 10 minutes before meal time and they would have her go to the nurse for a check and then again at lunch... I've since lowered it to 80 or 85 depending on the day. I love the low alarm for after-lunch playground time. She's come in for a check on more than one occasion due to it alarming.
     
  3. cm4kelly

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    And fingersticks at school . . .

    That is what I was thinking too - a higher number than 200 for alarms.

    My son has about the same schedule - does he still do regular fingersticks before lunch, etc. - so does the nurse just go by the number on the dex? I was thinking you would probably still use the regular meter during school.

    Excited about the low alarm for playground time. That will really help us. He already comes in on his own when he "feel funny" which has helped us catch some lows.
     
  4. lmf1122

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    DD is 10 now, but has been using a CGM since was was 6 and in 1st grade.

    At home, I set low alarm at 70 and high alarm at 140.

    For school, I change the low alarm to 80 and the high alarm to 300. I used to turn off the high alarm at school because she often spikes after breakfast and the Dexcom 7+ would often read higher than her actual BG. Then one day, her site went bad and she was 300+ all afternoon and we didn't realize it until she went to the nurse at the end of the day. Now we set it at 300 so we can catch any site problems sooner.

    Before lunch she does an actual finger prick, but before gym and recess she just looks at her Dexcom to see if BG is OK before activity.
     
  5. BittysMom

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    The nurse always does fingersticks and doses according to them. It's the trending arrows that are a great help in deciding how many tabs/ low treatment to give, especially when there is IOB.

    Also, I have the alarm set to go off for double arrows down. It doesn't happen often for us and it saved our butt the other day at school. :cwds:
     
  6. selketine

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    As long as she is getting some regular BG checks in the day (like for lunch) then I'd set the high alarm fairly high or leave it off during the school day at first. I'd probably leave the high off the first week until you see how high it typically goes.

    If she is going high after breakfast - its not going to do any good to alert at those highs at school because she has too much IOB to give a correction. You can download the data or look back on the receiver later to see what happened.

    You want her and everyone else to learn to pay attention to the LOW alarm - that is the important one. If it keeps beeping high I think it just desensitizes everyone to the beeping - even your own kid who will just acknowledge it to shut it up!
     
  7. hawkeyegirl

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    We do not have the Dex, but we have high alarms off at school, and they switch to 160 when he gets home from school and 140 at night.
     
  8. Darryl

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    When my dd in 3rd grade through 8th grade, the alerts were set to 80/100 so there was an alarm pretty much every hour, and everyone involved (staff and students) recognized that this alarm was to keep her safe and healthy. She maintained an A1Cin the 5.5% range through all of these years with no hypo's at school. Now in high school she prefers to not have alarms (and the Dex alarms are kind of useless for her anyway because she can't set the high alarm below 120), so she turns off the alarms and checks the CGM reading every hour or so and corrects throughout the day. I would ask yourself, what is more important, minimizing alarms, or minimizing health risks?
     
  9. BittysMom

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    Darryl, even with Apidra, how are you able to correct on a dime like that? Sorry to hijack the thread...
     
  10. selketine

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    Oh I think Darryl's approach is worth a new thread.:p

    I can understand Darryl's view of the child's health vs. minimizing alarms. However for us, the high alarm if it comes usually comes so soon after the meal that we can't give a correction. I think it is fine to be notified of that - on the other hand some people have given up on a CGMS all together because of nagging high alarms.

    When starting out on a cgms the first time, I think having the high alarm off in the day at school (especially for a young child) keeps the focus on the most pressing issue (lows). Even William - who has used a cgms daily for years now will press the button without looking at it sometimes if it beeps. Fortunately the Dex can be set for a different tone for a high vs. a low alarm so this isn't a problem (I think this is better on the G4 than it was on 7+).

    This child is 6 years old - so any beeps probably will require some adult attention. He might also be apprehensive of the beeps at first (thinking it means something bad).

    As you get used to the cgms, then add in the alarms you find helpful - and pay attention to the snooze times which for a high can be set for a short period - up to hours.
     
  11. Darryl

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    If BG is going up, she takes more insulin (taking into account IOB of course), if it's going down she eats. If the trend is consistent through the day she might also set a temp basal lower or higher. There really isn't much more too it than that. They key is to set tight limits in the first place. If alarms are 80/100 (or 80/120 in the case of the unfortunate Dexcom limitation), then if BG goes a little out of range, say 101, she takes a very small bolus, like 0.1u. If BG is 79, she eats a couple of carbs. So these corrections are generally not big, not enough to worry about.

    If you set set wide limits, say like 200 for a high alarm, the relative ease of our approach may not be apparent, it would be like telling someone to drive a car while telling them that they're not allowed to steer until they've veered 4 lanes in the wrong direction - in which case they will steer hand and have to worry about overcorrecting.

    Even with our approach there are of course times that BG goes way out of range, but once these are corrected we focus again on keeping BG in the nondiabetic range, and as long as we do this as often as possible we have good control and A1C's. Setting alarms outside of 80/100 IMO makes everything harder in the first place, it sets you up for the rollercoaster of overcorrections. If you try it, just remember that a high alarm of 100 means a very small correction.
     
  12. Darryl

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    Right, after a meal the high alarm can be ignored. It takes just a second to silence an alarm.
     
  13. mysweetwill

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    I am so intrigued by this, particularly since it is only recently that my son's correction factor has been reduced enough that we can actually correct a number slightly out of range. (His correction actor is now 150 - a far cry from the 350 he was less than a year ago).

    However, corrections for him are almost always negated during the day by IOB. On an ordinary day he usually eats something, whether a meal or snack within the three hours of his active insulin time. So unless his BG is super high he would not get a correction due to IOB. Im thinking this is where your daughter uses temp basals. Or perhaps her active insulin time is shorter? Or she doesnt eat as often?

    Maybe my questions are better suited for a new thread, but I have been thinking this through since I read your post and it has me wondering...
     
  14. Darryl

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    Her active insulin time is 90 minutes max since she switched to Apidra some years ago, so that definitely makes it easier. But even at 1 hour it's pretty obvious if more correction is needed. Like if she's 101 going up and boluses 0.2u, then 1 hour later she's 130 going up, it does not matter that there is still a little IOB because clearly she needed more in the first place and BG is still rising. Sometimes you have to think along those lines, not go strictly by the theoretical IOB. And if you have not tried Apidra and you insurance will cover it, I'd recommend trying it.

    She uses temp basals if there is a repeated problem, like two consecutive boluses that aren't enough, or going low twice after eating.
     
  15. mysweetwill

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    Thanks Darryl, this is helpful and gives me some ideas to thnk about. I appreciate it.
     
  16. BittysMom

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    Thank you for taking the time to reply because you put into words what I hadn't had the chance to and did it much better than I would have :) Same exact thoughts were over here.
     
  17. BittysMom

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    Thank you. I run in to this often where I can tell the IOB isn't going to do the job.
     
  18. khannen

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    My daughter is currently in 3rd grade. In Kdgn, we set the high to 225 during school hours. Since then, her high alarm is set at 180. Low has always been 80. Once it has alarmed with a high, we have it set to wait 2 hours before alarming again. It really hasn't caused many issues at school.
     
  19. SarahKelly

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    We've been thinking about this part to with the CGM at school and I am going to turn the high off for the first week or two to see how we need to adjust basals then I am going to have it set for the same levels as at home. I just don't want to forget to turn them back on after being at school and I know I would.
    For us we keep his low at 80 and his high is at 200. For his age with his correction factor (of 300 still!) it seems more worth our time to have the high set at 200 and not lower.
     
  20. Logansmom

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    Hi. Logan is 6 (just turned 6) and has a G4. He has a high alarm of 200, low of 80. The school is trained to jump on the low alarm but use the high alarm as a guide depending on time of day. We are actually changing that high alarm to 170 so we can catch it quicker. He calibrates it on his own and silences it if it's before 9:30. The school isn't allowed to bolus him before 930 unless they contact us as any high is usually the breakfast spike and I don't want them stacking insulin. He doesn't beep much for highs, more so for lows and it's nice that they are able to keep him more in range by giving him just a little something.

    The high alarm has saved us many times. I wouldn't shut it off.

    Now when we had medtronic, that's another story. They always used to complain about the false alerts but we don't have those with our G4.
     

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