My name is Clemma and I am writing about my experience with the Dexcom Seven continuous glucose monitoring system. I live in Minneapolis with my young son and my not so young husband. I was diagnosed with Type 1 diabetes 11 years ago, when I was almost 21 years old. I started pumping 7 years ago, first with a Minimed 508, then an Animas IR1200, and now with the OmniPod. Friday, June 29 I hooked up to my newest constant companion, the one and only Comrade Dex...

Thursday, July 26, 2007

Stupid User Experience: Rebound high

About a week ago I had a Stupid User Experience (SUE). See the screenshot of the Glucose Trend graph. Note that this is an example of enlarging a selected time frame for closer scrutiny.

I was especially exhausted this night, and I had gone to bed without bringing some source of sugar for a nighttime low, like I usually do.

A little before 11:00 pm, I got the buzz alerting me to a breach of the low threshold. I was tired and really didn't want to get out of bed to find some juice. I'm embarassed to admit it, but all I did was turn off my basal delivery for an hour and a half, hoping that would counter the insulin on board, and I would magically sleep through the night without going low. Well, you can see the result. Around 1:30 am, I got the buzz telling me I was headed up. I think the high peaked at about 240.

Why am I sharing this? Two points. One, this is a great example of the Dexcom doing its job. One of my motivations for buying this thing was the increasing number of mornings I woke up over 200. Without this monitor, I probably would have slept through the whole rollercoaster ride. I would have gone low without realizing it, and I would have rebounded without realizing it, waking up hours later with a high blood sugar and no idea what had happened. Without the high threshold I would not have taken a correction insulin dose at 1:30, and might have peaked even higher, certainly for much longer, before I woke up.

Dexcom also did its job alerting me in plenty of time to avoid the low in the first place, which brings me to the second point. One big problem about diabetes that is probably common to many chronic conditions: it's easy to get complacent, and having the CGMS doesn't magically protect me from extreme blood sugar swings. I feel silly needing these occasional reminders, these SUEs, that simply being alerted to a low isn't enough - I still have to be in charge, even when I'm too tired. I don't know if non-diabetics can understand, and I hope I'm not the only one out there who does things like this.

I also hope after posting this that no one shows up at my door and revokes my license to practice intensive insulin management. Turning off my basal delivery - what was I thinking? Next thing you know it will be Regular and NPH for me, just like in the dark ages. Nooooooo!

The main point is: thanks Comrade Dex for doing what you're supposed to. I dropped the ball. Nice textbook example of a rebound hyperglycemia though.


Scott K. Johnson said...

I love the expression "SUE" or "SUE's".

I have lots of them too. And feel even "stupider" when I repeat the same SUE over and over again!

mollie said...

i turn off my basal or reduce it by 1/2-- very often when i am low or going low - especially if i do not have any glucose tabs with me(shame on me, i know)...I am far from a perfect diabetic... it can work, but i found for me, never turn it off for more than one hour

Kevin said...

I too turn off my basal when I'm low, mostly out of fear. I don't know if I'd necessarily call that a SUE, though...

But it also seems like hanging in the 40s for 2+ hours could cause your liver to come alive with a glucose dump to exacerbate the absence of insulin.

It is nice to see these new tools working well. But we have to remember: these are just better tools in our toolboxes. We still need to learn to use them and take charge of ourselves and our disease. It's a skill. It's science. It's art. It's a pain in the ass.

Brett said...

Thanks for posting your "SUE". It really shows the advantages of CGMSs --- because we are all human and are tired sometimes and take shortcuts or make mistakes --- and in this case, the STS definitely helped out. Also, I think everyone should always cut themselves some slack on "SUE"s because the fact is that the huge majority of times we're all handling the treatment correctly.

DiabetesDoctor said...

I am Editor of a medical journal that closely covers continuous glucose monitoring: "Journal of Diabetes Science and Technology".
( I would like to email you directly or speak with you about your experiences with the continuous glucose monitor. Please go to the journal website to find the contact information for the two Editorial Directors and then phone or email one of them with your contact information so I can get back to you. Thank you.

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