What are your High and Low Alerts?

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Permalink Reply by Luca Bertagnolio on June 8, 2009 at 10:47pm

It really depends on how strict you want to be with yourself taking a little shot of insulin when you see the numbers going thru the roof... :-)

I have been using the Seven+ for just about two months, and noticed that the defaults of 200-80 were a little too lax for what I could do, so I moved them to 160-70 and am very happy about it. I need to be around 50 to really start to feel "low" and thus I am experimenting a bit with a lower low setting, while 160 gives me enough room to play before I need to correct with some additional insulin. I don't use a pump.

My last HbA1C before I started with the Seven+ was 7.0% so I was doing relatively OK, did some blood tests after barely 1 1/2 months on the Seven+ and was already down to 6.4%, so I expect wonders in a couple months, when I'll do another round of blood tests.

Maybe that 220 is a little too high... try to get more "feeling" for the device and see if you can stay lower than that figure, but without stressing out. I'd rather have a slightly higher HbA1C and not be stressed out, than the opposite!

Ciao, Luca

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Permalink Reply by Carolyn Deans on June 9, 2009 at 1:09am

Yeah, I have my high alert set pretty low. I often change it several times during the day (btw 120 and 160), depending on what I'm doing. If I just ate lunch and am expecting to rise somewhat, I might put it at a higher number. However, if I'm sitting at my desk doing nothing and not expecting to see a rise, I'll set it very low.

Because my alerts are so low, I spend a considerable amount of time "out of range". However, since I have the Seven Plus, I can set it to remind me every 30 minutes while I am still high. I prefer to know as soon as I start to get high and be reminded frequently while I'm still a bit above where I want to be.

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Permalink Reply by Jan on June 10, 2009 at 12:18pm

Hi. We used to use Minimed and had the high alarm set at 180 with a 2 hour snooze. It was always way off and if MM sensor read 180, it was usually 220 or higher by then. We then turned off the second alarm for two hours and she was usuallly back lower than 180 by then.... or another alarm. When we set her up on Dex 7 Plus, I want the alarm at 160 but will have to make it higher if at school. If Dex reads lower than 160, fine. If it reads higher, I'll make it 150 or 140. I would do what you feel comfortable with. You can always lower it again, later on. P.S. Would like to catch the high early, because in our case if she is high, it will take hous to come down. Would like to see if we can get a head start on the high.

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Permalink Reply by Renegadez on June 11, 2009 at 4:06pm

I had not thought of changing it up and down but thats a great idea and I do think 220 is to high but when i started I was running way 250 to 375 so things are coming in line which is how I know I made the right choice with the Dexy & Opod combination Thanks RenZ

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Permalink Reply by Rickst29 on June 15, 2009 at 12:31am

140 "high", 80 "low" for me.

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Permalink Reply by Jan on June 21, 2009 at 3:39pm

Rick, I consider you one of the experts in cgms use. On the CWD forums there is an amazing parent who keeps his daughter's BS in a nondiabetic range (with the exception of postprandial spikes, which he appears to have her go no higher than 160, for the most part). In order to do this, he sets her low target at 80 and her high target at 100. He has a fantastic (if onerous) system in place. He has trained his daughter well and she does not appear to mind his system. He, basically, avoids inaccuracy in Minimed's Guardian cgms (as you know, these devices are off during quickly changing BS, or when out of a certain blood sugar range), by keeping and correcting in a very tight range, thus avoiding incorrect BGs from the sensor. He finds it easier, in the long run, to stop the roller-coaster before it even gets started. Your thoughts? My sister wants to start her range at 80-120. This would be fine, but is there any way to avoid constant beeps post-prandial? P.S. Dexcom Rep cancelled and we have a tentative startup date next Friday. She is going to summer camp at the end of June and will not want to have alarms going off repeatedly at camp (or at school). But we can keep a tight range at home. I would like to try the 80-100 range overnight as that is the range I would like her in while sleeping (we are up until at least 3am, checking BS and will continue to do so).

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Permalink Reply by Jan on July 5, 2009 at 6:16am

P.S. Disregard the above post. I asked the question before we had actually inserted the Dexcom. The high alarm at 120 is too low for us at the moment. For us, Dex more accurate than the Minimed so don't have to set the high alarm a lot lower (MM used to read 50, 100 points off on the highs and 30 points above the lows for her). Unless BS is rapidly changing, Dex is usually within 20 points of her fingersticks maximum.

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Permalink Reply by Suzanne on July 5, 2009 at 8:52am

Right now my low is set for 70 and my high for 200.

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Permalink Reply by nilufer on July 14, 2009 at 1:41am

I have it at 70-180. I barely go over 150 after a meal these days...though sometimes in the morning I might hit a 180 after breakfast...though that is more related to the coffee (my only vice these days) than anything else as in an hour time I will be back to 90-120 area, so I do not even correct for that.

At night I turn my high off and check in the morning if there have been any abnormalities, I only have my low on for the night as that is what really scares me.

Further I saw that Carolyn wrote that she spends a considerable time out of range. Though Dexcom has the functionality to set the ranges differently when you have downloaded everything so though you might have set yourself for 80-200 you could view your graph for before breakfast at the range of 70-108 and change it for mid morning etc.

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Permalink Reply by Stacey on July 14, 2009 at 1:12pm

Right now, 55 and 240...hopefully I'll be bringing that 240 down soon :)

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Permalink Reply by Tony Linz on July 16, 2009 at 7:32pm

I have my alerts set at 80 and 200. I have only been using the dex for two weeks. I have had 3 or 4 nights when my low alert has went off in the middle of the night. I get up and test. Typically, Dex has been about 20 points lower than my monitor however I would rather it wake me then not. Possibly down the road I may lower the bottom to 70 or so.

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Permalink Reply by Rickst29 on July 17, 2009 at 12:09pm

Hey, Tony: Have you entered a calibration reading to teach it that low readings (with and without alarms) are pretty consistently showing lower than reality?

Don't just follow the "once per 12 hours" nags from the receiver to do calibrations. If you're having bG readings in the 80-100 range, which Dexcom showing consistently higher, go ahead and put them in-- that will really help to adjust the calibration. If you only enter bG numbers with higher values (110, 120, 150....) the "curve" for lower readings is based on guesswork. It's much better to give Dexcom GENUINE data points to work with, if you want the lower readings to be close. (And for most of us, accuracy on lows is much more important than accuracy on highs.)

Even if you're down at 70 mg/dL, and about to eat a couple of Glucose tabs to "play it safe", go ahead and put it in-- then eat the tabs. Dex will match your calibration up with the next reading (less than 5 minutes away), and those sugar tabs won't contribute to major "distortion" of the measurements for about 10-12 minutes.

But, I feel that meter bG readings much below 70 mg/dL probably shouldn't be used-- the accuracy inside Dexcom's Sensor falls off to much at these low readings, and excessive variability in those "raw data" at low bG seems to hurt the accuracy of calibration, rather than help it.

You're entering values via the menu, right? Even if you are using the old "Ultra-2" meter, DO NOT EVER use the download cable. The accuracy advantage which the 7-plus has over the old seven, mostly, is inside changes to the calibration software-- and from what I've seen, the "put more weight on the RECENT readings" improvement is disabled when you use the cable. A non-fatal software mistake, I suspect. The best way to avoid it is to throw the download cable away, never use it.

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