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CGM and testing blood sugar

Discussion in 'Parents of Children with Type 1' started by acoppus, Feb 8, 2012.

  1. acoppus

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    So we are in the process of completing paperwork for a CGM. I was just curious when you test blood sugar with the meter when you have a CGM. I am guessing you still test before every meal, and at least once a night?
     
  2. hawkeyegirl

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    We test whenever I would be inclined to treat a low or correct a high, based on the CGM number. So if the CGM shows him at a nice flat 100 before a meal, I probably won't test. If the CGM is giving me a low predicted alarm 45 minutes after a meal, I will test. I only test during the night if he alarms.

    At first, you'll probably test as much or more than you did before you got it. Over time, you'll learn when to trust it, and you'll test much smarter than you did before.
     
  3. jules12

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    For us, it took several months before we were comfortable with the cgms readings, settings, etc. He still always tests prior to eating meals and before bed. On a good bg day with cgms, he would test 4 times minimum. On days with sports, or as the cgms is ending or calibrations are off, he can still test 8-10 times. For us, it was more about catching lows and seeing the overall picture than it was about reducing finger sticks.

    We test with the meter to calibrate the cgms 1) upon waking up before breakfast, 2) before dinner, and 3) before I go to bed usually after my son is asleep.
     
  4. Darryl

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    My daughter tests at 7 AM, 5 PM, and 10 PM. Additionally if there is a concern about accuracy.
     
  5. acoppus

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    Thanks for the responses everyone. My biggest goal with the CGM is to avoid overcorrecting, both highs and lows. It seems sometimes we see a low number and treat it, but then he goes too high--so apparently that low was rising on his own. And sometimes he goes too low after a correction for a high, so that high was coming down also.
     
  6. hdm42

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    I will treat a low on the CGM, especially if he's feeling it, but I won't correct a high without a fingerstick to confirm. We still test before meals and I test him before I go to bed.
     
  7. Mimi

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    We started CGM in October and are still testing just as much if not more than before. :( *sigh*

    I'm hoping as we get more comfortable to reduce the number of actual tests. I'm not yet comfortable treating a low from the CGM alone.

    I have not tested overnight a few times, just gone in and checked the CGM. However, since I absolutely cannot hear the alarms, I'm still getting up every night.
     
  8. Jacob'sDad

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    As long as we're on this subject: 15 minutes ago it was time for Jacob to calibrate. BG is 62. CGM says 61. He says he doesn't want to calibrate because his BG is too low and would rather wait for it to come up. His BG is flat. The graph shows that.

    I think he should have calibrated because all the calibration would have done is told the CGM that it was right.

    So instead we will wait until BG comes up. But it might not be as stable then. It could be on the rise. Isn't it better to calibrate a low, stable number that is within 1 point, then to calibrate with an in range number that is not as stable? Especially after eating?

    Hey, this is like a really good question isn't it?;):D
     
  9. acoppus

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    Mimi, I will be right there with you testing at night. I wear hearing aids, and know I will never hear the alarms either. We are seeing if we can scrape the money together for the MySentry:rolleyes:
     
  10. PixieStix

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    DS generally checks with the meter before breakfast, lunch, dinner & bedtime. He usually calibrates the CGM with the morning, pre-dinner and bedtime numbers unless BG is not stable. I do wake at 3am and may do a fingerstick if for some reason I am doubting the CGM. He does correct off the CGM unless a particual sensor has seemed off.

    Jacob's Dad--unless DS was symptomatic at that stable 62, I would have definitely calibrated and then had him eat a snack once it updated. I am wondering if you are waiting for the "Meter BG" alert to do the calibrations? If so, think about adding a 3rd midday calibration to his routine, that way you are forced to chose between treating the low or calibrating it so the CGM readings continue.
     
  11. Gracie'sMom

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    We still check before each meal and at bedtime. We actually check much more with the CGM because it opened our eyes to how unstable her BG's really are, especially at night. The alarms are hard to hear, especially at night when she's under her covers, and we use a baby monitor. We always do a finger-stick in the middle of the night one time to confirm the reading (most of our erratic readings are at night because she often lays on her sensor). The rest of the night we rely on the sensor if it's been accurate, but we do not treat highs ever from the CGM. Lows we will treat from the sensor often.
     
  12. emm142

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    In that case I generally wouldn't calibrate, because I would want to treat the 62, and I don't want to calibrate at the same time as eating glucose because once I do that my BG will not be steady anymore. So I'd probably have waited half an hour or so until my BG was stable at a higher number. If you're comfortable letting the 62 ride for 15 minutes without treatment, which I am not for myself (because I have a nasty habit of dropping a lot further :p), then I think you'd be better to calibrate at a stable 62 than an unstable higher number. It's just for low-safety reasons that I would rather treat first.
     
  13. Lovemyboys

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    We probably test just as much as when we didn't have a cgm. If we have a sensor that's not working properly then we test more. We test around 13 times a day. We never give a correction based on the cgm alone, we always test first. Thats just our household policy because a false high and a little insulin could be really bad for him, his ISF is 400. Same with lows except if we know it's accurate and he's just drifting downward well give him 2 carbs or so.

    That said, we love our cgm and it tells us a lot more about his bgs that the meter alone does.
     
  14. cdninct

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    Jacob's Dad: This is the sort of question that confounds me regularly. Some days, numbers are nice and stable, and I can take my pick of times to calibrate. Other days, his BG is in constant motion because we are chasing highs and lows around. While I agree with Emma that I would treat the 62 and therefore not use it for calibration, I am a lot less confident with what to do with a 225, for example--calibrate, knowing that the number may well throw the CGM off, or postpone by 4 hours and hope that he evens out where I want him to be before the dreaded "METER BG NOW" warning? Sometimes, there seems to be no good answer.

    OP: We are only 2 months in, and on a good day we might test 6 times (compared to 9-10 before). On a bad day, though, testing 23 times is common. As for overtreating and undertreating, it is definitely nice to see the trend, but since we find that the CGM always lags behind real time by about a half hour, it is still a bit of a guessing game some times.
     
  15. Jacob'sDad

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    In hindsight I definitely should have calibrated with the 62. I did not treat it because Jacob has really fast digestion, particularly if he hasn't eaten a meal in awhile. What I did do is told him to bolus after he ate dinner. It didn't work. His BG went way up and stayed there for awhile. We ended up with "meter BG" for at least three hours and eventually I calibrated with something in the mid 200s. Then the thing was off and it took a couple more calibrations to fix it.

    I could have done what Emma said and just gave him some carbs to bring him up. Of course he said he was STARVING and wanted to eat RIGHT NOW. I should have calibrated with 62.
     
  16. hawkeyegirl

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    If the sensor isn't brand new, you can throw a not-so-great cal in there without throwing things off too much. Or, if there's an arrow, I'll do the BG check, and estimate based on the rate of change what he'll be at 15 minutes from then and cal with that number. That really works surprisingly well.
     
  17. cdninct

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    I have wondered if that would work. Thanks for the confirmation.
     
  18. mom2ejca

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    I've calibrated and treated a low at the same time. It seems like there's enough lag time between treating the low and the time it takes to see that reflected in the interstitial fluid that it has very little impact on sensor accuracy, for my child, anyway, YDMV.

    That kind of calibration might throw off a sensor in the first day, but usually the next calibration will get it back on track.

    To the op: We check a minimum of 3x per day, before breakfast, around 4pm, and usually between 10pm and midnight. We do give corrections based on CGM, but confirm anything over 200 with a fingerstick and also test anytime she feels low. We would also check more often to confirm sensor accuracy after a questionable calibration, for a new sensor or anytime something's wonky:)

    BUT, for the first several months of CGM'ing we probably checked more often. As we became more comfortable, we slowly moved to less checks. I purposefully avoided correcting off the CGM until my daughter had a solid understanding of how the CGM works, when she needs to do a confirming fingerstick, etc.
     

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