Do sensors make sense?

We had decided when going onto insulin that we would put the boys onto sensors this weekend, a week and a half into getting them settled into the new regime. Tom has been feeling very wobbly about having them. He has had one before, but he hasn’t had one that looks like this with the little white transmitter, so it feels different to him. He still gets wobbly when he has had his set changed; something which is psychological I am sure, as even he said it didn’t hurt at all last time.

So the idea was that Joe would get his sensor on the Friday and Tom would follow suit on the Sunday. I have to say, so far it has been a roaring success. Well, from our perspective anyway. Joe has found it a bit frustrating but I think this is due to his expectations of what the sensor would do for him. In his eyes, I think he thought the sensor would take away some of the burden. He thought it would let him know when he was low and when he was high so he could forget about it all for a while. I think he wants it to let him be normal. That’s one of the difficult things about insulin dependent diabetes. Often you are told that it shouldn’t hold you back, and you should do whatever you want to do. Yet it does hold you back in as much as it changes the way you can tackle anything you want to do.

We had chips on the beach for lunch yesterday. We reckoned we would do the difficult eating all on Saturday so we can aim for really good levels for the rest of the week so we can catch up on some sleep. Chips for lunch would always mean highs for Joe and Tom. So test number 1! They had at a rough guess 125grams of chips, which we have now begun to count at 30% carb to tackle the fat later. We did the bolus on a dual wave, 50/50 and hey presto brilliant levels for them both! Strike 1!

Saturday is also our sweetie day. That means Joe and Tom get to choose some sweets between lunch and dinner. Annoyingly they have had loads of chocolate recently (bloomin’ Easter) so I did feel quite so charitable on Sweetie day as I usually do. However, they chose chocolate (Tom a Thornton’s Fudge bar thing, and Joe a Lion Bar, and both a Kinder Egg which has become tradition for some unknown reason) and took it home to eat whilst watching an episode of Dr Who together. We used a normal bolus, which was just fine for Joe - stayed on about 7mmol - but not for Tom - who rocketed up to 16mmol 2 hours later. I have to presume the Thorntons was more fatty, its not a big bar but it has whipped gooey fudge stuff in the middle,  and that next time we should also use a dual wave for this. Lion bars are probably more sugar with the nuts and fruit and bits of crunchy rice stuff. I paint a picture with words, do I not?

And then to the greasy Indian take-away. We ate late so I had already corrected Tom’s 16.1 back down to 8.8mmol before we ate. Joe was on 5.6mmol before dinner. I weighed the rice, guessed the naan (a quater portion) at 15g cho, and gave each sauce 5g cho for Tom but with a 10g cho for the dahl for Joe as he eats more of it. Dual wave over 2 hours and 50/50 as before. By 11pm Joe was on 9.1mmol (not bad) and Tom was on 7mmol (even better), and by 2.30 am Tom was on 11.7mmol (wow, nothing like the usual highs this would bring) and Joe 10.8mmol. So, give or take a little dodgy carb counting maybe, that was a pretty brilliant result.

I have not been correcting over night recently as wanting to see what the basals did without it. However, I am going to suggest to Olly that we now begin to use the bolus wizard to correct overnight if they are over 7mmol. The basals certainly don’t drop them until they hit the morning hike at 7am - which is there to help with the breakfast spike - though we may have to rethink them a little as they do mean lie-ins are a bit dodgy. I have to say though, I am getting more and more happy with the boys levels. Joe’s averages on his BM kit are the same as they used to be on MDI but without the really big highs and the really low hypos. Even if their HbA1cs stay the same after this switch, they are safer and have more freedom.

But now to the sensor. When Joe is in the right range, and not going up or down the sensor seems to be inside 1mmol correct. That is pretty brilliant. However, when he is dropping quickly or rising quickly the sensor moves outside of the actual reading by about 3mmol. I know this is because of the time lag. In these cases it is the trend arrow which becomes very useful, next to the number on the screen. This shows me that Joe is on 9mmol but that he is still going up sharply. What I haven’t yet managed to work out is what I do about this. If Joe is dropping sharply but not yet hypo that’s pretty straight forward, I know he needs a small, say 5g cho, snack. But if going up I am not yet sure if I should correct or change the basal or what.

I corrected Joe yesterday morning when his pump showed 12.5 with double arrows going up. He tested and was on 15mmol. We corrected the 15mmol, but then he was hypo a few hours later -midway through the chips actually so hurrah for the dual wave - down to 2.9mmol. So this was a spike and I shouldn’t have corrected it. That means I have learnt that we may need to do something different with Joe’s morning insulin still, maybe putting more into the bolus and pulling back the basal (as Angie described in her fascinating comment).

So , in this way I am coming to think of the sensor as an adviser for tomorrows highs, and a guard for today’s lows. It isn’t a little angel on the shoulder saying what you need to do here and now. That’s what we would all want them to be though, isn’t it? Its almost like its actually a statistician, a sort of bank manager, watching the numbers and tutting when they seem to be in the red or when you haven’t transferred funds to your savings account. It’ll have to be a bit more useful than that before I’d want to spend all my time with it. But I don’t mind having a visit for a review every now and then. Does that make sense?

But, I haven’t seen the down loaded information yet. That’s homework for today. So I may change my tune entirely when I see what that shows.