Testing 1, 2, 3

Not to leave you all hanging: after my latest bout of unexplained high blood sugars (S.U.S.), I was determined to make my actions count. In fact I was lying in bed awake night after night with a fierce determination to do something — other than “correct” all day long and write pissy posts about it :)

DunceWas it my insulin-to-carb ratio that had gone off, or was it just that my basal settings were no longer doing the trick? Start from the ground up, I thought. Only one way to accomplish that: basal testing. Oy vey! That dreaded don’t-eat-for-hours / get-up-all-night-to-check-glucose test. I did my homework, and the methodology looked ugly:

  • Fast for 4-5 hours prior to beginning the test and do not take any insulin other than that provided by your basal rate.

  • With blood sugars between 90 and 140, start the test and measure
    your blood sugar levels every 2 hours. If BG above or 65 – 165, stop test.

Night 1, test at:

10:00pm
12:00 midnight,
4:00 am,
8:00am.


Night 2, test at:

10:00pm
2:00am,
6:00am.

Not to mention all the daytime tests, every hour on the hour, according to some sources.

YIKES!

But then it dawned on me – D’OH! This is what CGM is for, Silly. Why set my alarm for 4 tests a night when the continuous glucose monitor can do it for me? I still had my DexCom Seven in the drawer where I left it, and suddenly, it looked pretty sexy again.

What a fantastic invention. Think of the parents who have to basal test their children. Those poor, sleepless, exhausted people. I can honestly say I have walked in their shoes…

Anyway, to make a long story short, I wore the DexCom for seven-plus days about week ago now with mixed results. I found it more comfortable and easier to use than my last round. But the accuracy — or lack thereof — was a bit shocking. It had me at 60 when a fingerstick confirmed 120. Or it read in the 200′s when the fingerstick said 130. Huh? Two possible explanations: There’s a major lag time that I’d forgotten about, or I had a bad sensor. Either way, I ended up tossing the data. No need for my endo to see anything that off. Still, it made me pay close attention to my readings throughout the day and night.

I ended up adjusting not my basals, but my insulin-to-carb ratio for bolus dosing, which has helped a lot. I’m running MUCH closer to target these days.

Latest Glycomark results: 4.1 (normal at my lab apparently starts at 6.0) Oh, when will those post-prandials EVER behave?

Latest A1c: 6.1 !!! So a big, wet raspberry to the Glycomark test.

Without frequent lows to offset the high post-prandials, I have no idea what this combo of test results is telling me. But since the A1c remains the Gold Standard, I’ll take that 6.1 and run. Yay me!

And as for old-fashioned basal testing… that gets a raspberry, too!

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10 Responses

  1. CALpumper
    CALpumper February 1, 2008 at 10:55 am | | Reply

    OH Amy, I love this post! Love it love it! I have been there, test this, test that, try this, try that. My last overnight testing was related to morning lows, ugh! I would rather be high, any day.

    Either way, while I do not have the wonderful resources you do to try all of this and really, truly stick with it (kudos to you for that!!!) I am now wondering when a darn CGM will be on the market that WORKS!

    More importantly, what does all of this testing tell us? Like you, I end up adjusting my basal-carb ratios more than anything. After 23 years, factoring what I was doing at the time (physically AND mentally where I was), what I was ABOUT to be doing, what may still be with me from the hour or morning or night or day or week or or or before, how do we EVER know what is really going on? And if we do not know, how can we adjust it?

    So many factors to consider. I leave it at this for my “male” Endo, I love him btw: stress and female.

    Insulin is a hormone and I am 29, I am “in my prime” and a lot is going on physically. I have been through hell and back in the last 2 years so mental stress is a huge factor. Of course finding someone in the medical field to truly discuss this with?!?! Right….they have time? I don’t! But I am aware of it. And through the years, trial and error life, I just go with the flow. What else can I do?

    Too many have no idea what it is really like to live with Type 1. Unless you have it, unless you experience some of this, you just do not know.

    That is ok because I hate it so I would not wish it on anyone. But in the meantime, what do us Type 1s do to stay sane?!?! I personally tell myself, in order to find a balance of sanity, that I am meant to go through these really hard times alone for some reason, main one being: to help others. (but man, if I didn’t have to…whew, I don’t know what I would do with myself!!)

    Hang in there and congrats on the AIc. And try not to be too hard on yourself…. ;-)

  2. Mark
    Mark February 1, 2008 at 11:01 am | | Reply

    You’re right.

  3. Kristin
    Kristin February 1, 2008 at 11:09 am | | Reply

    Thanks for the post, Amy! Congrats on the awesome A1c! I am trying to get myself “in the mood” for basal testing again. Maybe tomorrow. I’m having unexplained highs between breakfast and lunch- I’ve got the carb counting down cause my breakfast is pretty simple. Is there anyone that uses different insulin-to-carb ratios for breakfast? I heard once that it could be useful… but I guess I have to do basal tests first :(

  4. Amylia
    Amylia February 1, 2008 at 3:48 pm | | Reply

    Congrats on the A1C. It’s nice when the hard work pays off with a juicy number like that.

  5. Marie D.
    Marie D. February 1, 2008 at 4:15 pm | | Reply

    Sadly, I cannot even imagine being that careful with my diabetes… :-(

  6. Windy
    Windy February 1, 2008 at 7:13 pm | | Reply

    Dang Amy… I need a nap after that post. My brain hurts. Diabetes is an endless statistics problem, isn’t it? Your A1c rocks though. So Good job!!!

  7. Bennet
    Bennet February 1, 2008 at 8:06 pm | | Reply

    “Think of the parents who have to basal test their children. Those poor, sleepless, exhausted people. I can honestly say I have walked in their shoes…”

    Thanks! I like to think we have walked along side you too.

  8. Bernard Farrell
    Bernard Farrell February 1, 2008 at 9:44 pm | | Reply

    Amy, congratulations on your A1C. And thanks for the pointer to Glycomark, I’d never heard about it.

    I’m sorry the Dexcom didn’t work well for you. I’ve used it a number of times to do basal testing and tweak my settings. And generally I get fairly good consistency between the Dexcom and the meter. But when it’s bad, it’s REALLY bad.

    I really can’t wait for the next generation of continuous glucose monitors with higher accuracy and better design/usability.

  9. tina
    tina February 2, 2008 at 5:33 pm | | Reply

    My uncle has a DEXCOM series 7 cgms and as a result of using it, his DR has regulated his sugars and he no longer has a need for it. He purchased a lot of sensor to start and now has no use for them. If you are interested in buying the sensors let me know because they were expensive and I don’t want to waste them. They exp in may so I want to get rid of them. COUPE7330@YAHOO.COM

  10. Scott K. Johnson
    Scott K. Johnson February 7, 2008 at 4:23 pm | | Reply

    Great post Amy, and great job with the fantastic A1C!

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