The 24-Hour Glucose Channel
Experiences with a constant glucose monitoring system.
with Amy Tenderich
Editor's Note: While this columnist is no longer writing for dLife.com and we have ceased to update the information contained herein, there is much to be read here that is still applicable to the lives of people with diabetes. If you wish to act on anything you learn here, be sure to consult your doctor first. Please enjoy the column!
August 2006 —Last month, I was outfitted with one of the brand new, first-generation continuous glucose monitoring gadgets recently approved by the FDA (at my own expense, I might add). So instead of looking at "snapshots" of my blood glucose a few times a day, or every few hours at most, I'm now watching the ongoing "glucose movie channel." As hoped and expected, this is changing my life, but not exactly in the way I thought it would.
Allow me to tell you about it:
The whole thing started off with a sense of euphoria: people with diabetes have been waiting for continuous glucose monitoring (CGM) for decades, and I was to be among the first to put it into action! No more guessing at where my numbers were headed after meals, or scratching my head at numbers over 200 mg/dl (11.11 mmol/l) in the morning, when I'd gone to bed at 130 mg/dl (7.22 mmol/l). What the heck happened? This new technology would show me a line graph, so that at last, I would know for sure!
On top of that, I had butterflies in my stomach about attaching the sensor to it (my stomach, that is). I've been very hesitant to have any kind of medical contraption "hanging off me." Part of the reason the DexCom STS system is so appealing is that it uses wireless technology, so you wear only a tiny sensor (a little over an inch long) stuck to your abdomen with an oval-shaped adhesive.
So my "invisible disease" would have an outward sign now: this badge on my belly. Even that had a certain excitement to it. How would I or others react?
A Dose of Reality
Attaching the sensor turned out to be easy and painless. I found I hardly noticed it (even during intimate moments) unless I suddenly glanced down to catch an unexpected glimpse of the little black square – or accidentally brushed it with my arm.
But the first lessons in CGM function were more sobering: this is certainly no magic wand for transforming your glucose control overnight. And right now at least, it is NOT an escape from multiple daily fingersticks. You do need fewer fingersticks, but the DexCom must be calibrated at least twice a day by taking a fingerstick reading with the OneTouch Ultra (the only meter that interacts with the DexCom at this point). Also, you need to double-check your glucose level with a fingerstick test any time anytime anything really happens, i.e. prior to dosing insulin or whenever the CGM alerts you to a High or Low glucose episode.
The most disconcerting thing was the sometimes-large gap between the CGM readings and those from the traditional meter. If the DexCom has me at 190, (10.56 mmol/l) but the OneTouch says 150 (8.33 mmol/l), what do I do? I've learned to triple-check with yet another standard meter that I have in the house.
So if accuracy is questionable, what good is the CGM? That was my big question. Here's what I learned: right now using CGM is not so much about the individual number(s) as it is about spotting the trends. Remember that no matter what number you get with a fingerstick, you never have any idea which direction you're going. Enter CGM, which gives you a line graph that quite accurately reflects whether you're having an upswing, downswing, or a nice steady lull. Alarms even go off to alert you when you're going out of range (mine are set to 70 (3.89 mmol/l) or below, and 220 (12.20 mmol/l) or above).
I was able to see – in real-time even – that my post-meal results after breakfast and lunch were consistently sky-high. I could also see that any time I went to bed at 140 (7.78 mmol/l) or above, I'd just keep rising overnight. Within just a week or so, I'd clearly pinpointed my "problem phases."
Getting Off the Couch
So watching the glucose channel has me very well-informed. Now what? It took a little while to dawn on me that the CGM device itself does nothing to improve glucose control. Rather, it provides valuable information about what you can do to improve your own diabetes management.
In other words: Time to get off the couch! Just watching the glucose channel is not enough. In order to gain any value at all from the CGM, I have to actually use the info it provides by making changes in my regimen.
I've switched from high-carb cereal to tofu and scrambled eggs for breakfast. I'm dosing my insulin earlier (no more waiting till I've cleared at least half my plate) and more aggressively (by tightening my insulin-to-carb ratio). And would you believe? The 24-hour Glucose Channel is showing me that my numbers are evening out!
* For ongoing reports on Amy Tenderich's experiences with continuous glucose monitoring (CGM), visit http://www.diabetesmine.com/dexcom_and_me/index.html.
Read more about Amy Tenderich.
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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