About a week ago I took my nightly pills (beta blocker and antihistamine) with some almond milk instead of water. The next morning I woke up with a blood sugar of about 4.5 (81). Morning blood sugars are a HUGE struggle for me, probably the hardest thing to keep steady. Usually I am either high or low. Lately I'd been waking up around 10 (180) every morning. Anyway, I did it the next night and the same thing happened. So since then, every night I have about a cup of almond milk before bed, and every morning I've woken up perfectly except for yesterday when I woke up low.

Overall I get so confused about overnight readings because although I wake up to test several times per week, sometimes I am high and sometimes I am low (or have dropped a lot), and some mornings I wake up low while others I wake up high or in range. One of the biggest areas I think a CGM would be helpful for (the other being seeing what happens after I eat different foods).

Yesterday I was stuck around 10 (180) all afternoon and then after dinner I shot up to 15 (270). I was super annoyed so piled on the corrections. One thing I dislike about the Ping is that it is not NEARLY as good at preventing stacking of insulin as the Cozmo was. I don't know what it does differently, but I often notice it doesn't reduce bolus suggestions much at all even if there is a lot of insulin on board. Anyway, last night I sort of forgot about that, and I took almost 10u of insulin over a period of three hours (that's a lot for me).

I went to bed around 10:30, and around 3:30 I woke up for no reason and could not figure out why. I didn't feel low at all, but as usual I went to test.

I was 1.6 mmol/L (28 mg/dl)!!!

I had to test twice to see if I was really that low! According to the meter, I was. I ate four glucose tablets and less than 10 minutes later was 5.1 (91). So then I thought maybe I hadn't really been that low after all. I ate some cheese and a glass of almond milk, just in case, but I was sure I'd be high this morning because it looked to me like I was already rebounding!

Nope. This morning I woke up at 6.8 (122). Crazy!!!

That's the first really major overnight low I've had since living on my own (since August). I've had many other overnight lows, but not super scary-low lows! This one was totally my own fault, but I think at my appointment next week I'll ask about CGM. I could technically get a new pump (even though I've only had the Ping for two years) as I'm with a different employer so have different health benefits. I don't know if the stand-alone Guardian unit still exists in Canada (I haven't been able to find any information on it), and no clue if/when the Dexcom will ever get here, so I wonder if it would be worth putting up with the non-waterproof pump and super low-contrast screen for the benefit of the CGM (assuming it's covered).

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Comment by Howie767 on December 30, 2012 at 10:22am

I would strongly suggest not eating anything at all for at least 3 hours before sleeping and not taking any boluses either. For your purposes the Medtronic CGMS would be adequate especially since you live alone. Would a wafer thin credit card size magnifier help you see it better?

I wouldn't hold my breath for the Animas Vibe/Dexcom combo. The stand alone Dexcom will not come to Canada because Animas has an exclusive. The Guardian is no longer available.

Comment by Jen on December 30, 2012 at 10:40am

I don't eat before bed, I've found that's too iffy, so usually dinner is my last meal (around 6:00) unless I am running low before bed in which case I have a small snack (no bolus). I do correct before bed because if I don't I end up spending all night high (usually I will try to test twice to see if I'm heading up or down). Usually if I correct, I will wake up a few hours later to make sure I'm not low. I think last night I was just not thinking!

Too bad to hear the Guardian is no longer available. I thought that might be the case since I couldn't find any information about it. The Dexcom I have been holding out for for *years* now and I'm getting tired of waiting, especially because there is no indication that they are even working on coming here!

Unfortunately with magnifiers I need extremely strong ones (prescription), and when I looked at a Minimed pump a few years ago when I was deciding between Animas and Minimed I couldn't read the screen easily even with a 12x magnifier. I wonder if there would be a way of trying it out before deciding, but before I even go there I'll talk to my endo about it.

Comment by Howie767 on December 30, 2012 at 11:04am

Part of the deal between Animas and Dexcom was that Dexcom would not market the stand alone CGMS in Canada. Animas has exclusive rights to Dexcom in Canada and they intend to grab a whole bunch of customers from Medtronic by offering a far superior CGMS as part of their combo. This may include me although I do prefer the Medtronic Pump.

I keep hearing that the Animas Vive/Dexcom will be available in Canada any day soon. Phone their 1-800 help line and see if they have any idea when that will be. If you get the Medtronic, you'll be stuck with it for 4 years. I got a free trial of the Animas, I'm sure you can do the same with the Medtronic.

Comment by Jen on December 30, 2012 at 12:35pm

I already have an Animas Ping, though, so presumably if they did come out with the Vibe, I could just upgrade to that even if I was using a Minimed (the sales guy I talked to a year or so ago said the upgrade would be reasonable, maybe $750 or so). Last I heard there were issues with the Dexcom signal and weather balloons? I guess that's been resolved, hopefully! I do much prefer the Animas in terms of screen clarity (and also what I've heard of Dexcom CGM versus Minimed CGM), so if that's coming soon I'd prefer to wait. I'll give them a call next week and see. Of course, this is assuming Great West Life even covers CGM sensors, although my endo said they are good, so they might.

Comment by acidrock23 on December 30, 2012 at 1:08pm

drsoosie mentioned that she drinks almond milk in the evening and that it helps her smooth out AM BG too. I keep meaning to try it but am lazy and, well, drink beer at night but I'm going to try laying off the beer and will see how almond milk works. Even though the 1.8 may seem like something to fix, it's not that far off and suggests to me that you're continuing to make great progress with what you're doing!

Comment by Jen on December 30, 2012 at 3:23pm

I just realized that I'm using a new lab since I moved (this was my first time) and it uses a slightly different range for A1c. My old lab used 4.5 - 6.0 as normal, and this lab uses 4.8 - 6.2 as normal. So even though my A1c was 7.3 last time and 7.3 this time, I think it may have gone up or down slightly. Does anyone know how to convert my A1c to what it may have been at my old lab (after this I'll just use this new lab, but I'm a bit confused about how to compare them).

Comment by Jen on December 30, 2012 at 3:36pm

I just thought about it and drew a little number line diagram, and I think my A1c may have been about 7.1 if it had been measured at my old lab? If so, that is super awesome!

Comment by acidrock23 on December 30, 2012 at 4:00pm

I wouldn't worry about comparing the labs. Your next result will depend more on your tactical approach to each BG than what your last A1C was. If the first 7.3 was an ok result, maybe it was disappointing to get another "just" a 7.3 but you've done tons of work, been through new adventures in the pool (and getting to and from the pool, yikes!) and all of that and maintained a decent result. The 1.6 for a single result is perhaps a bit hairy but represents one, tactical mistake but I'd say the A1C suggests your overall strategy is working and small adjustments in numbers will keep making good progress for you.

Comment by Laddie on December 30, 2012 at 4:33pm
The Ping does show the Insulin on board, but doesn't subtract it unless you are just doing a BG bolus. But that doesn't mean that you can't subtract it yourself. I often will reduce my suggested bolus by subtracting out the IOB.
Comment by Jen on December 30, 2012 at 5:29pm

I usually look at the IOB and subtract it from the bolus myself if I think I'll go low. I think last night I was just really annoyed at running high most of the day and wasn't thinking that rationally! The Cozmo used to subtract insulin on board no matter what kind of bolus you were doing, and I wish the Ping did that. Definitely won't make that mistake again!


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