CGM: Polaroid to Streaming Video
Making sense of the real time revolution.
By Kerri Sparling
December 2007 — No kid likes the finger prick. That promise of "this won't hurt a bit," followed by the sharp sting and then the billowing cotton ball, capped off with a Spiderman band aid and a sticker. I remember these finger pricks from before I was diagnosed with diabetes, sitting on the edge of the pediatrician's examination table and swinging my legs.
While I don't remember being diagnosed with diabetes as a little girl, I do remember the subsequent finger pricks. My first lancing device was something not unlike a guillotine, with a spring-loaded lancet that arched across the perimeter of a blue device and slammed into my blemish-free fingertip with considerable force. My first few months of blood sugar tests were filled with flinches and tears.
My mother and I tested my blood sugar several times a day, as this was the best way for us to react to any curve balls diabetes could throw. Monitoring my numbers helped us detect which foods sent my sugars into the stratosphere and which ones barely made my A1C blink. Testing first thing every morning set the stage for the diabetes day to come, and sometimes my mother woke in the middle of the night to make sure I wasn't dropping into a low in my sleep.
As time passed, lancing devices progressed and became a bit gentler. New meters upgraded me from wiping a blood-smeared test pad with a cotton ball and waiting 120 seconds for a result to the quick 5 second, wipe-free results of newer machines. The calluses on my fingertips grew and testing my blood sugar became increasingly less painful. I didn't mind testing so much when I barely felt the sting and it literally only took seconds to complete. I need to know these numbers in order to best manage them.
Every number is a snapshot of my diabetes health. Seeing that 139 mg/dl this morning let me know that I slightly overtreated my low before bed last night. A 99 mg/dl at 3 am confirms that my overnight basal rates are set at an appropriate level. But as helpful as these numbers are, they remain snapshots, mere single moments captured in the memory of my meter. What's that? 102 mg/dl? Well that's a great result … unless I'm on the way down to a nasty low, or cruising up to a numbing high result.
After experiencing a few frighteningly low blood sugars in the wee hours of the morning and feeling a general frustration as to reigning in my numbers, I decided to give a CGM a whirl. Constant glucose monitoring systems are bits of technological hardware that are worn on the body and automatically test blood sugar results every 5 – 7 minutes and send those results to a transmitter. Thanks to the generosity of a friend, I had the opportunity to try out a Dexcom earlier this year. While the device was sizeable and the sensor was a small bit uncomfortable, the information I gathered was fascinating. I could look at my Dexcom receiver and see that my blood sugar was 145 mg/dl and had held steady at that number for over an hour. Using the trends I noticed from the CGM, I could confidently correct blood sugars that I would have otherwise let stand. An alarm went off in the middle of the night if my blood sugar began to trend out of range, protecting me from the possibilities.
Finally, I saw past the Polaroids and had a chance to see my numbers in real-time. Despite the bulky hardware, the data outweighed the device.
In the coming days, I will be fitted with the Minimed Real-Time system to accompany my new insulin pump. With my wedding just a few months away and motherhood in my future, keeping tabs on my numbers is more crucial than ever to me. Using the CGM systems, I can stop reacting to curve balls and instead be more proactive. Understanding and analyzing my overall blood sugar trends could prove to be just what I needed to achieve a greater level of control.
While I'm careful not to apply too much confidence to a CGM, it's a far cry from the rudimentary glucose-testing devices I used over twenty-one years ago. Those calluses pale in comparison to control.
But I still have a stash of Spiderman band aids, just in case.
Visit Kerri's website.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...