Do any of you lower your basal rates onm your pump if you know your blood sugar is dropping. I have a cgm and if it indicates dropping blood sugar at a rate of 3mm per minute with a blood sugar of 130 or less, I wonder if suspenmding the pump for 30 or so, or setting a temn basal rate of 50 for some period of time would work to avoid taking those awful glucose tabs.
I think a temporary short term suspension or lowering of the basal rate is a reasonable tactic to help avoid some lows. Keep in mind, however, that your BG reflects insulin delivered about two hours ago. Any changes like a temp or suspended basal won't take full effect for two hours. If your anticipated low is one that will ultimately last more than an hour, then this tactic will be useful.
The big drawback with this tactic is mostly one of poor timing. Responding with a suspended or lowered basal could end up setting you up for a ride on the glucose roller coaster.
If you have a pattern (I like to use three days, with lows occurring at about the same time of day.) then adjusting your basal profile is a very effective way to deal with low BGs. You also need to consider the accuracy of your insulin to carb ratio and how well you count your carbs.
I don't like eating glucose tabs either, but for short notice lows, I don't feel you have much choice.
I don't like the glucose tabs either because I find they are too hard so can be more difficult to eat when I'm low or dropping fast. I use sweetarts instead - they work faster for me than glucose tabs and I find them easier to eat and not so chalky tasting. The sweetarts work well for me to keep me from over-treating.
I will set a lower temp basal rate when I'm having a stubborn series of low numbers, especially when I'm at work or need to get in the car soon. I'll try bumping it up with sweetarts and eat something small with protein, then set a -5% or -10% basal rate for an hour or so to try to "un-stick" the low.
I cut basals, if I go much below 50% for longer than 30 minutes or so, it seems to produce spikes (counterspikes?) pretty readily.
I would do a BG meter test to confirm, since when there is a fast rise/fall, the CGMS is usually less accurate. I would consider the IOB and 'food on board', and activity level, in addition to the CGMS and BG reading to determine if using a temp basal is needed.
For example if your CGMS says 130, your meter BG might be 180 or 80, which would result in a different decision. Or it might be 120-140 and you might want to try the temp basal. But if you also have high IOB and peaking, I'd go for a small carb snack if I don't think I have enough 'food on board'. High IOB could be bringing BG down faster than temp basal will have an impact.
There can be accuracy issues w/ the CGMs but, in practice, once I've gotten a feel for it, I think that it's pretty reliable for many applications and that I will know if it's 80 or 180 based on IOB, FoodOB, stressOB, exerciseOB, etc.
I don't eat a lot for breakfast, cleaning up DP in the AM, etc. and the IOB is gone well before lunch so, if it gets to be 10:30 and is at like 72, I'll kill the basal for 1/2 hour in case it is thinking about going lower before lunch, to avoid the test/ 50/ eating conundrum at lunchtime.
How often are you double arrow down ?? That's what the OP asked about, and in that case I would always check with a meter BG.
Seeing a 72 straight arrow, no IOB and no food on board at 10:30 is a different situation. Your meter BG could be 60-90, and 50% basal would have the same effect - keep you from going lower, and possibly cause you to rise a bit.
I hardly ever double arrow down, like maybe 3x since 2010, when I got the CGM? Not during the week ever. The Medtronic CGM doesn't have the same arrow setup as the Dexcom either.
I am really conservative w/ my diet during the week. It doesn't point flat but I switch to the 3 hour setting and scroll back to see what the rate of change is and the basal adjustments seem to be very effective to nudge BG up if it's low but not plummetting.
The TBR feature can not compensate for acute lows. Glucose tabs will guarantee that you will get the carbs as quick as possible. This will help to not get used to low BG numbers. If you in contrast try to ride the low out with a lower TBR then the low will persist over a long period of time. This is the best ingredience to develop hypo unawareness in my opinion. Because of the awful taste it is unlikely that you will overtreat the low. With experience you will learn the exact number of tabs needed to get back into the normal range - not higher or lower. Taste is debatable but I think there are better tasting glucose tabs on the market - like Dextro Energy for example.
I would not think a basal drift like I'm talking about would quite be an "acute" low. With a CGM, I can see times where it's 85-77-69, which I would consider "acute" but 70-70-69-69 is more what I'm talking about using a temp basal. This also always depends on the tactical situation. If lunch is coming up, I can get it back to 71, where I'd like to be for lunch with a bolus but sugar will push it up to 90 or so. I try to come in low for meals so the spike ends up at 120 (70+50) rather than 140 (90+50). I can usually pull this off 5 days/ week @ work and bank some decent numbers to offset any wider ranging numbers over the weekend.
It is interesting that 71 is so different for you than 65. The meter and cgms are technically not capable to distinguish these two numbers with reliable robustness. But you have high confidence in these numbers. Would I ride out 70-70-69-69? Well, definitely not. For me NovoLog is such a potent insulin. I really need a good starting point to inject it safely. Thus I would eat one glucose tab on the 70, eat the meal and inject my insulin afterwards. It is fantastic that this tight management works well for you.
70 is sort of the dividing line but, given the potential errors in the testing gear, etc., I will tolerate the upper 60s in certain situations. It also depends on the timing. If I'm going running or shopping or some other down type of activity, I'd push the low harder but, if I'm lunching in 1/2 hour or so, the basal will catch it. It's sort of an always trying to beat the last test/ reading/ whatever. I also don't like to eat much of anything if there's an impending calibration, as I want it to be flat. Lower is better than changing rapidly for that I think...
I know that at 10:30, a slight drift isn't going to do much so I can just sit tight until I eat at 11:00ish. If it's lower, I eat the carrots first, as they have a shade more sugar than the broccoli. The sandwich is last, for dessert!! Hee hee. I'm sure a psychologist would have a field day determining how nutso I am but SD currently 23 due to some turbulence, trip to Disneyworld, etc. In January, I had like 3 weeks in the 14-17 range, which was new to me but felt pretty good.