CGM causing anxiety


(jjmnav) #21

T1D for 30 years, Dexcom for 4. I still find myself over-correcting primarily when heading low. Taking smaller corrections and allowing half an hour or more to see results is difficult when we are hoping for immediate results.


(t1don) #22

amy - this is tough talk, and some things come off tougher in writing than in person, but please trust me and listen as I care - let it go. cgm has changed my life. I am shots, symlin, and cgm. last a1c was = 6.5, the best of my life. you cannot live without this thing. DONT over correct. use it for trends and let it guide you as to the effects of stress, different foods, etc. trust it. cgm is our best friend. I will pray for you on the rosary, don’t stress please…


(amy) #23

Thank you for your thoughts. I am always grateful to the diabetes online community! I’m working on letting it go, some days are better than others. And I’m glad the CGM has made such a difference in your life, but for me, it’s less about improving my A1C as I haven’t had one above a 7 in nearly 20 years. For me, the CGM is more like a reinforcement…something that offers additional support. I hope I can accept the support without the stress!


(pamcklein) #24

Hi Amy, I do the same thing - - chase my numbers. I did this more when I first got my CGM (Dexcom G4) than I do now.
For me, part of the problem was the settings my endo had put into my pump. I wasn’t getting the right amount of insulin. I’ve adjusted my settings with the help of a different endo, and now trust that my pump will give me the correct dose needed. Thus, I am less likely to over bolus when I see the up arrows. I’ve also learned to check my “insulin on board” before I bolus. Sometimes, like when I’ve calculated my carbs wrong, I still need to give myself an extra bolus, but I don’t feel I’m chasing the numbers like I was.
I really just wanted to add that I’ve done this too. As you can see here, you’re not alone! :slight_smile:

Pam K
T1D 53+ years


(Dennis J. Dacey, PWD) #25

Really good advice Pam @pamcklein. We can have all the really awesome tools with all the bells and whistles [like the heavy duty test tubes from 53+++++ years ago for OUR testing] but is they are not properly adjusted and tuned they are worse than just shooting [up] in the dark.
In my opinion, one of the first thing a pump user must learn is how [and why] to set basal rates and bolus ratios - unless the endo is with you 24 hours every day. Yes, it takes work because our bodies are constantly changing, especially with the change of seasons. Our personal “validation” of basal rates is essential as is sensitivity rate[s] and bolus ratios.
As an example for me, basal rate “validation” for over-night is eating a normal evening meal and then “fasting” until afternoon the following day - monitoring frequently, recording results and, if out of range [>100 or <140 mg/dl] eating a measured amount or administering a micro-bolus. That is just a sample of how I manage.


(Shari) #26

Dennis, I thought maybe I was looking at a typo when you said ‘get your HbA1c back up where it should be’. I have never heard of a doctor encouraging a 6.5 rather than 6.1. Is there a reason for this? Really curious.


(Dennis J. Dacey, PWD) #27

Hi Shari @s1mccann, there wasn’t a typo.
For many years I maintained an HbA1c in the range of 5.9 to 6.1. every three months, with only two out of that range, a 6.4 amd a 5.7. This was after the test “standard” was changed from 6.5 to 6.0. In the early to mid 1970’s I was part of the study developing glycosylated hemoglobin [npw the HbA1c] testing and scoring; this was well before the advent of home digital glucose meters.

Now why two different endocrinologists have strongly urged me to loosen up and target the 6.5; after using several types of insulin for 60+ years I’m ‘slipping’ and sometimes fail to notice my dropping BG - on two occasions EMS had to awaken me.


(Ryan) #28

My doctor also encouraged a higher A1c when I went to the low 6s and then under 6. The theory is that numbers that “good” will include too many occasions of being low or at risk of going low.

I am happy that time in range is gaining ground as a metric. An A1c of 6.0 with 90% time in range is a much safer situation than a 6.0 with 15% time with a low BS.

CGMs give us way so much data. It’s good to think of readings as information rather than a judgment. Every day brings a different challenge. We will be high. We will be low. It’s ok. The CGM lets us see trends to keep us safe.


(Shari) #29

Dennis, thanks for answering my question. I understand it now.


(P.) #30

Your “obsessiveness” is not the problem. The fact that the “-log” insulins take so long to act is the problem. Since I’ve been using Fiasp in my pump, I’ve stopped stacking. My blood sugars don’t go up as high and it takes less insulin to bring them down; therefore blood sugars don’t go as low, either.


(amy) #31

I don’t know about fiasco…I’ll have to research. Thanks!


(P.) #32

Fiasp is made by NovoNordisk and just became available in drugstores. Like Novolog, it is called insulin aspart, but it starts acting much faster than Novolog.​


(Cole) #33

This use to happen to me! :frowning: But over time I got used to the fact of it being in the high range. It will take some time getting used to it but once you do the GCM becomes a great tool for monitoring your Blood glucose.


(Janice) #34

I loved my Dexcom CGM until I had to give it up, insurance. I avoided the graph and just paid attention to my actual numbers. When my preset alarm went off I’d take care of the problem, no alarm no problem. I really miss mine, because I am totally unaware , no symptomology I am testing my blood every 2-3 hours 24/7 including at night, haven’t slept all night in about 4 years hoping to change this situation. .Don’t drive yourself nuts by anticipating the drop, when it happens deal with it, if it doesn’t happen your good… Back in the dark ages I cooked urine with copper and Sulphur, that was 1954, blood never entered the mind back then. Relax and enjoy life. Keep a positive attitude. Enjoy a great day. bye Jan


(Kirsten) #35

I would infer that your correction factors and insulin:carb ratios had to decrease now that you are on Fiasp. Is that correct? I spike & crash like a superball and have been wondering about what Fiasp is like to use versus Humalog. I have an endo appt next Friday and will ask her about trying it. But real-world feedback from actual users is very helpful too. Thanks!


(Jennifer) #36

My 14yo daughter just got the Dexcom a couple of weeks ago. At that point, she was about a month out from diagnosis, and was testing 4x/day, plus any time she felt high/low (so, about 10x/day).

The first day with the Dexcom was a wild, wild ride. Her BG readings went from stable within her goal range to high and then low and then high again. The anxiety proved too great, and she took it out.

Then, I read about how the Dexcom doesn’t test blood glucose, but interstitial glucose, so hydration status has a significant impact on its precision. So, she decided to give it another try, and we set some rules: we rely on the Dexcom only if it shows she is within her range, and feeling normal. If it shows she is low, then she uses her BG meter. If it shows she is high, then she drinks a cup of water, and uses her BG meter and calibrates (since giving corrections according to a false high sets the stage for a roller coaster ride). Also, since interstitial glucose lags 15-20 minutes behind blood glucose, we do not rely on the Dexcom for evaluating treatment of lows (we found that 15 min after eating 15g carbs, the Dexcom would still show she was plummeting, and she would over treat and go high).

Hopefully our experience helps add to the collective wisdom of using a cgm. :slightly_smiling_face:


(P.) #37

Yes. I’m using about 4-5 fewer total units in a day. I had just started using a pump about six months ago, so we were still figuring out all the settings, then for Fiasp we lowered the amounts of insulin according the formulas they use. I’m sorry to say I don’t know what the formulas are. We are still titrating the amounts very cautiously. I was bouncing much more before.


(Dennis J. Dacey, PWD) #38

@CureIt & @kirsten.
This is a Topic string entitled “CGM Causing Anxiety”.
Please create a new Topic Title for your discussions of pump settings and for Fiasp and carry on your conversations there. One of the basic rules of this site is to stay on the topic.


(Dennis J. Dacey, PWD) #39

Hello Jennifer @TXJenny.
It is not surprising to me that your daughter’s BGL is bouncing all over, given her age and her relatively recent diagnosis and introduction to artificial insulin. When you say “Dexcom” I’m presuming you are referring to the G5 glucose monitor [Dexcom manufactures several items].

The during the first 12 hours with the G5 [2 hours with G6] should not be used for dosing and even after the initial “warm up” it is wise to do a fingerstick check. When your daughter pulled out her sensor on the first day, she may have been “shooting the messenger” - after more than 60 years of calculating and dosing insulin I’ve finally learned to be patient and roll with the punches.
When your daughter recently experienced a “low” and had her 15gm. of carbohydrate, where was the arrow pointing on he GM receiver? I believe on the G5 the arrow pointing down means a predictive drop of more than 45 mg/dl in 15 minutes; 15 gm. would not be sufficient. One evening this month I dropped to 68, noticed that and consumed 24 gm. mixed carb. [OJ plus crackers and PB] and did another fingerstick 26 minutes later and was down to 46 mg/dl. I attributed the drop to a bike ride earlier in the day. Good diabetes management in my opinion is “art with a good amount of intuition and science”.
Stick with it Jennifer, encourage your daughter constructively and soon she will be giving me tips for my management.