Logging in the Era of CGM
Struggling to capture the context of my diabetes managment decisions
November 2012 — Logging my diabetes information is something I know I should do, but rarely actually do. But it all changes when I have an endocrinologist appointment coming up. That approaching appointment makes me try my best to capture data that will help him understand my diabetes management decisions and actions. How can I expect him to make any therapy suggestions if he doesn't have any information to go on?
So the exercise begins, and I work hard to log everything. I record blood sugar records, carbohydrate counts, insulin doses, and exercise sessions. But it quickly frustrates me because the tools I have to record all of that don't match living life with diabetes. There is so much context involved. And that context is hard to capture.
I fight the frustration by remembering to pull back to the basics. Maybe I don't need all of the context? How can I present all of that context to my doctor in a way that he understands anyway?
So I stick to the basics, largely in part because that is what fits the tools.
But shaping my diabetes logging to fit the tools doesn't feel right. There's so much happening behind the scenes that change the decisions I'm making about my diabetes management.
Then it hits me.
I decided to eat that half-sandwich before basketball because I saw a drop on my CGM. I added a little bit of insulin to that correction bolus because my CGM said my blood sugar was still going up. I started that temporary rate a little earlier than usual because my CGM graph showed a slow downward trend over the past couple of hours. I decided to eat lunch a half hour early because I was heading for a low, or maybe dinner was an hour late because I was running high.
So many of my decisions these days are influenced by (if not based on) what I'm seeing on my continuous glucose monitor. I have hundreds and hundreds of mostly reliable information points at my fingertips. While I'm as guilty as the next person for over-reacting to what I'm seeing, and for being reactive instead of proactive, all of this information is changing how I manage myself.
How in the world do I log that little glance at my CGM device that made me change what I was about to do?
Does it even matter?
Maybe not. But I think that times are changing in diabetes record keeping. The already-lacking tools we have for record keeping have been outpaced again by continuous glucose monitors and the stream of information they provide.
If we expect our doctors to help us with therapy suggestions, they need to have some way of seeing what's going on inside our heads. The logbooks of today can't even do that, and here comes another evolving technology that multiplies the amount of data we have by hundreds and thousands.
I don't have an answer to this problem. I don't even have the seeds of an idea that might help. But sometimes recognizing the problem (or part of the problem?) is a good first step.
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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Years before I was diagnosed with type 2 diabetes, The Other Half came out of a doctor's appointment with a diagnosis of "borderline diabetes" and an ADA exchange diet sheet. His health insurance agency followed up on the diagnosis with a glucometer and test strips. After a year or so of trying to follow the diet plan and test his glucose levels, things appeared to be back in "normal" range, and stood there until a couple of years after my own diagnosis. Shortly...