My Honeymoon with a Continuous Glucose Monitor
Why it is worth wearing another device if you can afford it
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!
September 2009 — I am only reaching the end of my second month using a continuous glucose monitor. I postponed the decision to wear yet another device for more than two years for many reasons:
- Not wanting to carry another thing on me, on top of the pump, the glucose meter with test strips and all the backup gear (extra meter, insulin pens, extra lancets if I feel the urge to change them, etc).
- The fact that I changed jobs twice in the past two years. Changing jobs led to changes in my insurance coverage and, as we know, this can sadly be the reason why you opt for or against a diabetes treatment option.
- The precision offered by devices in the market hadn't gotten to a point where I felt it was worth the extra gear and the extra financial sacrifice (in spite of the insurance coverage).
In early 2009, I started reading repeated testimonials from other patients using continuous glucose monitors that were talking about how much more closely the readings on their CGM devices were to the readings on the blood glucose meters at the time of calibration.
Also, a new feature I found particularly useful were the trending arrows showing the overall direction that your blood sugars were going into: given the fact that CGM readings lag 10-15 minutes behind blood glucose meter readings, these trending arrows are an incredibly useful indicator of where your glucose levels are heading.
So, I took the plunge: I called the company and they helped with the insurance paperwork, which luckily got approved (if you have not been so fortunate in getting approved, I recommend you check out the CGM Anti-Denial Campaign site). A couple of weeks later, I got my receiver and the first set of sensors in the mail.
The things I have gained and learned thanks to CGM
During the first 2-hour sensor "warm up" period, the expectation builds up. You wonder if you will feel overwhelmed with getting readings every 5 minutes, if it will be just too much. It turned out to feel similar to wearing a pump and the abundance of data, for me at least, has been a good thing. These are the main things I have gained and learned thanks to wearing a CGM:
- The most important thing we've been able to spot is hypoglycemic episodes at night (I say "we" because my wife is the biggest fan of the CGM we have at home). The CGM alarm is a guarantee to wake you up in the middle of the night if you are too low. I have experienced the odd joy of being awakened a few times in the space of the past two months - nothing like munching on a handful of glucose tablets at 3 in the morning!
- Since you can see the trend of your glucose levels over time, I have been able to spot moments in the day where I could benefit from adjusting my pump's basal rate. The best example of this has been in the early morning, to deal with the dawn phenomenon. With the graphs on the CGM, I realized I was getting a small spike that I have been able to "shave" by increasing my early morning basal rate.
- Seeing for myself what stress does to glucose levels. You read about the impact of stress on your diabetes management everywhere, but it's very different when you can see on the screen how your glucose levels respond to elevated stress levels. Sometimes a picture is worth a thousand words.
- I have not received my new A1C test results since I started on the CGM, but I have downloaded my numbers from the CGM twice so far. I have seen an improvement of my average glucose levels, with an increase of in-range readings and a reduction of hypoglycemic episodes.
Disadvantages of using a CGM
Having said all the great things about wearing a CGM device, it's not 100% "roses." There are a few issues and disadvantages:
- The big elephant in the room is cost. Even having insurance coverage, I had to finance the $900 receiver with a credit card. On top of that, the sensors cost me more than $200 every month. I am glad that I have learned a trick to extend the life of the sensors.
- I have seen errors with the sensors (twice) in the space of two months. With that said, the first time the device recovered itself. The second time, the manufacturer sent me a replacement sensor at no cost. So the only downside was really the annoyance and the extra poke to get a new sensor in before it was time for it.
- For now, it still IS another device to wear on you and another gadget to make room for in your pockets or purse. There is promise in the horizon about integration with pumps, etc. but for now, there's no getting around the extra item. I considered the option offered by Medtronic, which integrates the receiver with the pump, but discarded it based on multiple comments I read complaining about device inaccuracy.
So, do I recommend continuous glucose monitoring? Absolutely! I just hope the technology continues to improve on one end and, even more, that coverage improves and costs start coming down so that more people can afford taking advantage of this great tool.
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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