Blood glucose targets (AKA am I trying to over-complicate this?)

[Gary_W]

Sorry for yet another question on my Animas 2020...

I've got my targets set at 4.8 +/-3 at my 'typical' mealtimes and then I've got them set to around 7 at what is typically 2 hours post-meal.

I always check at 2 hours post meal. If I put this BG value into the pump, it is looking at my target at that point and figuring that a 7 is where I want to be. Which obviously it isn't. It looks at that and will never, ever suggest a correction.

If I just leave it set to 4.8 all the time, I'll still test at hour 2. It will be aiming for the 4.8 but it will take into acount the IoB and ONLY suggest a correction if needed / subtract this from the

Why would I want 'extra' targets? My IoB setting is at 4 hours, so my pump always thinks that 38% of my meal bolus is left at that point anyway (I will post that table for everyone once I've got it from note form into PC format, as I did it for every setting from 3 hours up to 5 hours).

This feature seems pointless to me now in light of my current thinking. Can someone point out what I must be missing as I'm probably being obtuse...

Gary

[Gordonm]

I have my target set to 100 all the time. Yes it will take into consideration the insulin on board.

[Funnygrl]

Yeah, you're over complicating it. Like Godonm said- the pump takes into account active insulin. That means, after meals, it will still consider your target, but it will count the insulin you already took as working toward that target. You should have it set as you want it all the time.

Have you had training?

[Subby]

I would guess multiple targets is not such a commonly used feature. But to answer your question why?, a possible scenario I can think of is that someone works in a "high performance" industry, like diving or piloting where having a little more buffer zone and minimising risk of hypo is really useful. Then they go home and can aim for tighter control where the situation is more flexible.

If that kind of thing doesn't apply to you, forget it completely.

As for choosing an appropriate target, I echo Funnygrl that training will be best the place to understand what and why. It did help me to have it set a little higher (making corrections a little less aggressive and hypos less severe) for a week or two, as I sorted out a useable ISF.

[Funnygrl]

I use multiple targets- I target a higher bg at bedtime.

[Subby]

Cool. I'm interested how you use the feature for that... when do you have the actual change programmed for? Does it need to be working for your dinner bolus? Or do you correct often between meals so it can start being effective a bit later, catching a later correction or two?

[Funnygrl]

I'm probably the worst example for this because I have incredibly bad sleep hygiene and irregular schedule. I have my target set for 85-120 during the day, at midnight it switches to 100-140. It doesn't effect my dinner bolus at all, as I usually eat dinner around 7pm. I often snack before bed, and it effects those boluses. I test close to 12 times most days, and am often over 140, so it affects any of those corrections.

[Gary_W]

Thanks for the replies.

During the training, both the nurse and pump rep thought it a good idea that I had targets 2 hours after meals that differed from the pre-meal. This may have been a compramise agreement, as I wanted to run significantly lower than they wanted me to, so I guess it was a way of keeping everyone happy!

I've re-set it to 4.7 +/- 0.2 for all day and I've put in a higher number in the night. It will be rare that I would correct at 3am, but correcting to a much higher number when you're going back to sleep is indeed safer and this makes sense.

Gary

[Subby]

I don't mean to diss your nurse/rep, but in my book that's rather dodgy advice they gave. You should simply put in the range of blood glucose levels you want to be at, if it was an "ideal world". Oscillating between 4.5 and 7 around meals makes no sense at all and simply means complications in tracking when the pump gives a correction according to one or the other targets, making it harder and more complicated to diagnose the efficacy of pump's decisions. What they should perhaps have done is argued the case to start off with a more generally relaxed target, say 5.5 or 6.

Out of interest, what would you consider a hypo for your body, or hedging towards the "danger zone"?

[Funnygrl]

Yeah, I agree, horrible advice on their part. Keep in mind a target it where you want to be a few hours later. If you're 180 and just took a 5 unit bolus for a meal it won't recommend a correction.

[Subby]

I have pretty bad sleep habits/have a hard time keeping sleep regular myself. I have found from experiments in the past that I have different basal reqs/I:C ratios/ISFs during my sleeping time - but hard to allow for this with the current regimented way of programming pumps.

Rather than taking this method of setting a higher target, the best results I got was setting a temp basal of 70 to 80% when I went to bed, for the time I imagined I was asleep. This avoided the night time hypos a similar way, but allowed me to keep my basals set agressively as if I was awake at the time. I don't think my corrections are consistent enough to be useful to rely on a different target, but may be worth a go.

I've slipped doing that temp basal when sleeping thing, I should go back to it. One problem is the hourly alarms for temp basals and patterns are very annoying when trying to sleep, although I guess I see the need. Using the MM, I wish patterns were easier to use... it needs to be very easy for me to keep at it, especially at bedtime. More flexible and voice activated pumps will be a blessing when they arrive. "Pump, go to night time mode for 6 hours"... All the various settings get changed over... niiice. :)

[Gary_W]

When I said that they thought it was a good idea, it was probably my fault; I went in with a lot of pre-conceived ideas due to having played with the pump extensively on the desktop. I had set up my demo pump to settings that I thought would make a good starting point based on my MDI knowledge.

They gave me a different pump to actually use in anger until my 'official' one turns up. They just recommended taking 30% off my TDD and adjusting the numbers to fit that. I then did the programming whilst they watched. They both wanted me to have a much higher target number, and the compromise was that I'd aim for a 4.5 to 5 before meals but put my target for 2 hours post meal to a higher figure. I'm guessing they knew that the corrections would correct to this higher number on a lot of occasions, but as that was where they both wanted me to run I can see why they thought the varying levels was a good idea; if I listened to the pump, it would always stop me correcting to my prefered lower number. They obviously don't want me to sail too close to the wind so early on and hence understand their advice. They both said that some patients do tend to over-correct, and that (until you know yourself on the pump) it's no bad thing to leave a mild high alone at the 2 hour point as it will probably come down by itself anyway. I've found that the absorbtion curve varies a little compared to MDI so again the 'not correcting mild highs' at hour 2 advice has been good advice so far :)

Gary