What are your High and Low Alerts?

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Permalink Reply by ederhi on July 22, 2009 at 9:47am

May I ask Rickst29 , who is a great expert in my opinion. He helped me a lot about 1 year ago, when I startet with Dexcom.
You set the alerts at 140 / 80 . What is your HbA1C ? . I reached HbA1C 5,6 - 5,7 by setting at 160/60 , being most of the time below 140 . Can I still improve it ?? (having a very severe diabetes : type I since more than 20 years , hypoglycaemia-unawareness etc., no pump ).

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Permalink Reply by Rickst29 on July 22, 2009 at 3:56pm

Hi, Ederhi.

Alarm settings like mine will get your attention quicker when you're "hanging around" moderately high readings of 140-160. But, unless you do fairly extreme diet changes to make your response to meals ultra-smooth, it's just a bunch of nags-- you WILL go higher, for at least a little while, post-prandial.

If you're willing to get all "OCD" about timing everything within your meals, making them very slow and complex, then you can almost certainly gain a few tenths of A1C. But the benefits aren't large, even in that case (probably just a few more tenths downwards). And setting off the alarm so often can the drive people around you absolutely crazy....

You're doing great already. My A1Cs are about the same, not better than yours. I have to keep my low alarm much higher, because my lows come on really fast and hard, with devastating effects on brain function. (I start grabbing sugar tabs at any reading below 80, and that's a normal bG for people without my long, terrible history.) If you CAN go all the way down to 60 mg/dL without becoming "falling down stupid", I love your settings. Keep 'em!

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Permalink Reply by ederhi on July 23, 2009 at 2:13am

Hi Rickst29,
thank you for your honest reply. I guess we are fellow sufferer, as I really know what you are talking about lows (my wife found me lots of times unconscious - before Dexcom - , it is a wonder that I am still alive) . Inspite of being in great danger with bloodsugar under 70 , I never start a meal > 80 mg%. I have to take just up to 20 g KH per meal - about 8 to 10 snacks a day. And I have to check Dexcom with 3 or 4 blood sugar readings per day, especially before sleeping. And you have to have a bed-fellow, who can rescue you if getting unconscious. Being alone in a hotel I set the low-alarm at 80 aswell. You convinced me: I changed my alerts to 140/60 (day) and 160/60 (night). With setting 140/80 I would get lots of alerts every night - I guess you will have a night without alerts just once a week. If you are a snorer, you have to take a examination for sleeping-apnoe / hypopnoe. I am no snorer , even though I have a little (!) apnoe (demanding no therapy so far), that wake me up about 50 to 100 times (!) a night without noticing it. Every diabetic like us has to do this check, as the frequent (!) apnoe worsen your profile. So I really hate any additional disturbances at night by alerts.

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Permalink Reply by Jan on July 23, 2009 at 9:12am

We have had a little experience (less than a month) with Dex now. What I thought we could do (based on one parent on CWDs stellar results), we cannot do. Neither Dexcom nor Minimed is accurate enough all the time to dose from, and her readings may be a little more inaccurate than many. Now we set DN's high alarm to 180 with a one-hour snooze and the low alarm, we set to 80 usually. At night, before going to sleep, we take note of how Dex is comparing to fingersticks. If Dex has been reading 20 or 30 points higher than the fingerstick, we leave the low alarm at 80 for the night. If Dex is reading lower, we adjust the low alarm higher, such as 100.

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Permalink Reply by Helmut on July 23, 2009 at 4:03pm

My high alert is 120 and low is 80. At night I turn the low alarm off because I don't like to be woken up. If the 55 alarm goes off at night I drink half a glass of orange juice. My reason for having the low alarm at 80 and not lower is that I need time to react to a falling BG. If the fall is fast I might be at 70 already when the 80 alarm goes off because of the delay. Even if I eat food with a high GI right away the BG will fall further and I might bottom out at 60. That is close enough to the brink for me. I started out with the low alarm at 70 and found it to be unmanageable. The 120 alarm only tells me that I ate too much. I know then that the next time I have to eat less of the same food. The way I measure my 'success' is different. I look at mean BG, SD and % of time spent above 140. For the past week my numbers are mean BG=101, SD=23, 6% spent above 140.

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Permalink Reply by ederhi on July 25, 2009 at 3:24am

Helmut, you will definitely have lots of alerts at night ( with 120 / 80 ). The alarms will be at 120 and at 80 ! If you do not have alerts, you must be a medical wonder ! Turning off the alarm at night is the most stupid you can do. But actually you are doing the same as I do : your low-alarm is 55, my is 60 , no big differance. I like to be woken up when I get higher than 160 (trend will be going to 180 and more at dawn) - so I can shoot a little bit of insulin to prevent it. At daytime you must not eat much when being at 70 , but you have to eat 10 - 20 g KH and 5 (-10) g Glucose with water (!!) first, if you do not like to go down to 50 .

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Permalink Reply by Helmut on July 25, 2009 at 11:01am

Ederhi, thanks for your response. By turning my low alarm off I end up with alarms at 120/55. In an attempt to separate fact from fiction I consulted the dex download data about my alarm frequency. There is no nice summary about alarms so I had to look at the data day by day. What a revelation! I thought nights are all the same but they are not. At least not for me. I don't see any reliable pattern. 6 out of 7 nights I am below 80 at some point in time. I get about 2 low alarms at 55 and 2 high alarms at 120 per week (nights only). Interestingly enough I never bottomed out between 55 and 60. Thus I will change my low alarm from 55 to 60. I like the idea of catching the low a little earlier.

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Permalink Reply by ederhi on July 26, 2009 at 3:23am

Helmut, we absolutely agree in our setting-philosophy. If you just get 2 alarms at night per week with setting 120 (high at night) , Your diabetes must be very young or gentle. I hardly can believe it, your HbA1C must be far under 6,0 % or you are doing wrong at day-time. My last HbA1C was 5,6 , but I would get much more wake ups at night with setting 120 . For me it is nor relevation that every night is different, as each alkokol, stress, sport etc changes blood sugar even after 12 hours . So you can take it easy - I would do the same setting in your case..

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Permalink Reply by Helmut on July 26, 2009 at 9:11am

Ederhi, I got the dex 6 weeks ago and did not have a HbA1C test since. It would be nice to see a lower number than before. I would be happy with anything under 6. My major goal is a lower variability. My last HbA1C was 5.8 but my bg was all over the place, definitely not as often in the target range as now.

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