• Please Remember: Members are only permitted to share their own experiences. Members are not qualified to give medical advice. Additionally, everyone manages their health differently. Please be respectful of other people's opinions about their own diabetes management.
  • We seem to be having technical difficulties with new user accounts. If you are trying to register please check your Spam or Junk folder for your confirmation email. If you still haven't received a confirmation email, please reach out to our support inbox: support.forum@diabetes.org.uk

Alert before low

SB2015

SB2015

Well-Known Member
Relationship to Diabetes
Type 1
I am still very twitchy about the retinopathy letter so in search of easy ways to get my HbA1c down. It is regularly 50-53 and when I put myself under pressure to get it in the 40s before it led to burnout with all that I was focusing on. I have agreed with my consultant that I will try a few things and then we will review these in a couple of months bearing in mind the emotional impact as well as the physical impact.

First an easy win pre-bolus for breakfast
I find it difficult at times to wait the 25-30 minutes I need in the morning for my pre-bolus. I now bolus and set a timer in my phone for 25 min, then go off and do stuff such as feed the fish, gather up a bit of that pesky bindweed, music (guitar practice on pause as I now have a trigger finger or add into the mix) . Then on alarm prepare my breakfast. That is working well, and if in a hurry I go and have my shower straight after the bolus as there is a windows when it does no basal immediately after a bolus, so no missed insulin.

One that is not working so well
I have dropped it from 6.1 to 5.5, but now I am VERY regularly getting ‘alert before low’. (Some help from 780 users ? @everydayupsanddowns , @heathero , @jessd1 , @Oblomov). I vaguely remember that this alert is set at a fixed amount above 4.0 and does not base these on my manual settings, but the alerts are driving me potty. It is fine at night and if I can’t sort it I will need to switch back to 6.1 during the day. Any ideas very welcome.
I have tried ignoring any with a single arrow which has worked sometimes and the loop has sorted it out, but whilst I was away last week (and no doubt getting carbs a bit wrong, life being more unpredictable and pre bolusing difficult as we were eating out more) I ended up with loads of alerts and we regular,y needed to stop whilst out walking due to hypos. So I needed to react to all the alerts, …. (I guess you can sense my frustration)

Any help very welcome.
Do others get these alerts regularly and do I just have to accept it as part of a tighter target? Or go back to higher target and accept higher HbA1c and then deterioration of eyes, ……
 
What do you have your ‘low snooze’ set at @SB2015

As I understand it this is the gap where the low alert will fire again. If you are happy that once you know, you’ll keep an eye on it, you could make that much longer?

These are my settings:
  • Smartguard Target: 5.5mmol/L
  • I have my ‘suspend before low’ alarms off. I don’t need to know about the suspends thanks!
  • Alert Before Low is off. I only want it to tell me once I’ve hit my low limits, these are high enough to take action.
  • I have a lower ‘low’ value set at night than during the day (4.8 daytime, 4.4 night time)
Depending on where you have your low settings set, could you just turn off the ‘before low’ nags? And then increase the low alert snooze?

That should reduce alarm fatigue while retaining good notifications/early warnings?
 
everydayupsanddowns said:
What do you have your ‘low snooze’ set at @SB2015

As I understand it this is the gap where the low alert will fire again. If you are happy that once you know, you’ll keep an eye on it, you could make that much longer?

These are my settings:
  • Smartguard Target: 5.5mmol/L
  • I have my ‘suspend before low’ alarms off. I don’t need to know about the suspends thanks!
  • Alert Before Low is off. I only want it to tell me once I’ve hit my low limits, these are high enough to take action.
  • I have a lower ‘low’ value set at night than during the day (4.8 daytime, 4.4 night time)
Depending on where you have your low settings set, could you just turn off the ‘before low’ nags? And then increase the low alert snooze?

That should reduce alarm fatigue while retaining good notifications/early warnings?
Click to expand...
Thank you Mike

That make sense and I have changed my settings. I think that alert before low kicks in at 1.3 above low setting which I had on 4. That gave no leeway with a target on 5.5 so alerts were coming thick and fast and driving me potty.

Changes made and alert before low now off, and higher low targets. Looking forward to being allowed to sleep a gain, and hoping that the lower target can then impact my overall glucose levels.
 
Hope the new settings work well for you @SB2015, and give you a bit more ‘wiggle room’ with the lower Smartguard setting.

Here’s to uninterrupted nights’ sleep!
 
I love being able to watch the constant basal tweakery going on too… thick pink, regular pink, no pink… more basal, standard basal, no basal.

Look at how attentive Hermione is being to get you that outcome @SB2015 <3

It’s no wonder our levels were a bit more ragged with the old splosh-in-some-Lantus-and-hope-for-the-best approach!
 
SB2015 said:
She has certainly got the hang of things now, and it is good to be able to help her.
Click to expand...
Bless her! Long may your uncanny flat overnight traces continue!
 
Ok, so now I want to know everyone's secrets! My 780g has always given me a sine wave overnight. I have to set the target to 6.7 as otherwise I have the low alarm going off every few hours. If I used Mike's settings I'd be hypo all the time! DSN said the graph looked odd but never got back to me with any suggestions, just "try changing things and see".

I am generally happy with my pump but this thread has got me realising how much better things could be yet! How do you get it so stable???
 

Attachments

  • Screenshot_2025-05-30-21-22-20-640_com.medtronic.diabetes.minimedmobile.eu.jpg
    Screenshot_2025-05-30-21-22-20-640_com.medtronic.diabetes.minimedmobile.eu.jpg
    19.8 KB · Views: 4
Hi @Pigeon
Is it the alert before low that keeps going off or the alert on low?
‘Alert before low’ was driving me potty which is why like you I used a higher target in Smartguard. Even at 6.1 it was going off more than I liked. I have now turned that off.

I now have a list of the variables that we can change in Smartguard and have worked through them systematically. Probably time for me to do that again.

I am using Mikes hypo settings (lows) of 4.8 during the day which then gives plenty of time to head off the hypo. I had to remember today that I couldn’t ignore it. Overnight 4.4 is working so far. This feels a bit weird but all good so far, with just one alert as I had been out for lunch and guessed the carbs and then walked home.

I have sine curves overnight often if I have had a bigger meal or a fatty one. Just happy that the looping seems to settle things down and the amplitude of the curve decreases gradually.

I also see a pattern that I get curves if I have drunk alcohol. Whilst my body is processing that the liver stops giving out glucose (so a dip) the it sorts that out and gets back to work again (a rise) which the autocorrections deal with.

Looping certainly improves things in general but it still requires some work. Just a lot less than before.

I shall see what happens tonight. Hoping for another sleep with no alerts.
 
This is a summary of the variables that Mike posted elsewhere.
A very useful list.

You have a few levers you can use to make the MM780G act a little more firmly.

The most obvious is setting the Smartguard target as low as possible (5.5mmol/L).

You can also artificially shorten your duration of insulin action. Pharmacologically this is likely to be 4-5 hours, but you can set the Active Insulin Time as short as 2hrs, which means that the algorithm perceives less ‘insulin on board’ earlier, so is able to correct more freely.

You can also adjust your Insulin Sensitivity, and even Insulin:Carb ratios.

The MM780G algorithm has some ‘same bolus’ adjustments it will make in certain circumstances (eg a basal suspend after each meal bolus) so I have a slightly beefier i:c ratio than I might actually need on paper, to cover the missing basal

It is a hassle checking carb ratios throughout the day, but if things are seeming wobbly for part of the day it would be worth a check. It is good that we don’t need to do the Basal rate test as that is out of our hands since it is constantly changing automatically to suit the circumstances. That was one that took me days to check in manual.

The one that had the biggest impact for me was changing the action time for the insulin. I did a DAFNE for looping course and that was also very useful.

Let us know how you get on.
 
Thank you for your replies, @SB2015 . It's the Alert on Low alarm that keeps going off in the night if I set the target any lower, the Suspend before low alarm is off. I had it set to 4.2. I'd forgotten you could set the alarm limit differently at different times and so I've now changed this to 3.9 overnight as I find the sensors tend to read low anyway. I'd also forgotten about the low snooze time being customisable and so I increased that to 1 hour from 30 mins.

Thanks for the other tips. I'm a bit nervous about decreasing the active insulin time from 3 as whenever I've tried that I got more hypos.

That's a good point about evening meal size/content as this is always my main meal and we sometimes have pudding in the evening after the kids are in bed. So there probably is still some digestion going on overnight which may contribute to the waves. Will keep experimenting! Thank you.
 
Pigeon said:
Thanks for the other tips. I'm a bit nervous about decreasing the active insulin time from 3 as whenever I've tried that I got more hypos
Click to expand...
It sounds like you would need to increase the active insulin time for you. If you are having hypos you need to slow down the insulin, so letting the algorithm think that the insulin is working longer may help. I shortened mine because I was going too high and staying there so I wanted stronger correction.
It all takes time to get used to and to adjust for our own needs.
 
You must log in or register to reply here.
Back
Top