By: Clay Wirestone
Words. Images. Facts. Figures. Data. Times and dates. Over and over and over again. The defining characteristic of life in 2013 is this constant swirl of information. It surrounds us and envelops us. Many people seek a way out, a way to live without this constant barrage of email and Facebook updates, and tweets, and texts.
So why am I seeking more information? Why am I consciously setting out to make that swirl of information around me thicker and richer, denser, and more complicated to navigate?
I might be nuts, yes. But I’m also a diabetic, and I want more information about my disease.
That’s why I started using a continuous glucose monitor this fall. For those who aren’t familiar with the technology, a continuous glucose monitor is a device that provides a constant stream of blood sugar readings — mine refreshes the number every five minutes. It graphs those numbers so you can see the ups and downs, and it also provides a trend line to show if your blood sugar is skyrocketing or plummeting.
In other words, I voluntarily signed up for a device that will pump my head full of data 24 hours a day. I sought out this deluge of new information. You might expect that such a wealth of data would be overwhelming. And you would be right.
I meant to start a continuous glucose monitor back in 2011. That was a little over a year after I began using an insulin pump, and it seemed to make sense to do it all at once. I had tested out a unit at my diabetes educator’s office and become addicted to that steady flow of blood sugar numbers.
But life got in the way. My son was born, and my life changed in all sorts of ways to make room for his life. My mother died unexpectedly a few months later, throwing the rest of the normalcy in my life out the window. I managed to hang on during this time, but changes like a continuous glucose meter just seemed to difficult to imagine.
After that, I got lazy. I had managed to figure out how to make my family, work, and chronic condition all work together. They didn’t necessarily work in harmony, but neither did they have knock-down, drag-out brawls at a moments’ notice.
Again, the CGM just seemed like too much work.
But earlier this year, things changed. My control, which had generally been quite tight on the pump, became more erratic. My son, no longer an immobile infant, began to run around the house and yard. I was chasing after him constantly, and watching my blood sugar levels fluctuate as a result. I wasn’t happy.
Over the period of a month or two, I had one too many instances where I found myself working way too hard to raise my blood sugar after miscalculating insulin doses. None of the situations was serious in and of itself, but it tired me out.
I was ready to take a different approach.
Taking the Plunge
Once I made the decision, the actual process was quick. I filled out the paperwork and talked to both my doctor and diabetes educator. I chatted with someone from the company that made the sensor (I won’t identify them by name here, so you’ll have to use your imagination).
Within a couple of weeks, the sensors and meter were at my house and in my hands. “Wow,” I thought. “That was simple.”
As mentioned above, I’d used a CGM a couple of years ago, so I knew how to insert the sensor under my skin. I’m not a fan of the process — it does, after all, involve a long needle — but it went off without a hitch. I double checked the instruction manual and was getting readings that evening. “That was simple too,” I thought. “Piece of cake, Wirestone.”
I would eat something, and watch the numbers increase. I would pump some more insulin, and watch them go down. “Just like I always suspected,” I thought. “How much simpler could you get? End of one chapter, beginning of another.”
But then all of the not-so-simple stuff began. I had to integrate the meter into my life. That entailed learning several lessons, some of them the hard way.
Learning to Live With It
The most important point that anyone who lives with a CGM must remember is that it’s no substitute for blood sugar checks. Most of the time, the reading by the CGM will be reasonably close to your actual number — within 15 to 20 points either way. Given the natural variations of blood sugar meters themselves, this works well.
But there can be bigger differences. I noticed them in two situations: First, when my blood sugar was dropping after a correction, the CGM’s reading would lag behind the real number. Depending on the amount of insulin in my system, it could be as many as 40 to 50 points over where I actually was.
Secondly, my morning fasting readings might be some 30 points off. In this case, I attributed the difference to drift — I wasn’t able to calibrate the device while snoozing, so a change that took place over several hours might have gone undetected.
How did I learn to live with these variances? Simply by knowing about them. That informs my actions when using the CGM. If my numbers are falling quickly, I can check to make sure the actual number isn’t too far below. (If it’s nearly the same, I know that the speed of descent is slow and steady enough to be reflected on the meter). In the morning, I know not to immediately treat an 80 or 90 as an 80 or 90 — they’re much more likely to be a 110 or 120.
For some people, issues like these may scare them away from a CGM. It’s not a device meant to achieve pinpoint accuracy, and for certain types of diabetics, this would be an immediate disqualifier.
But my perspective was different. I spent some time recently researching the results given by home blood glucose meters. And the amount of variance there can be startling — results can vary by more than 10 percent for each check (sometimes much more, depending on environmental conditions). And even then, that’s for 95 percent of the time.
In other words, there is almost no way to know precisely, with 100 percent accuracy, what your blood glucose is unless you’re having it checked in a laboratory. Everything else — from a finger-stick meter to a high-tech CGM — is an approximation.
My other concern about the system is personal. Because I now have the ability to see a rough approximation of my blood sugar at all times, I constantly have the meter out and about. Because the meter is small and black, it’s quite easy to misplace. I’d like to say I’m not absent-minded, and not the kind of person who would leave gear like that sitting around, but then I would be telling you bald-faced lies.
So far, though, I’ve been able to recover the meter after misplacing it. So far.
So, Should You Do It?
After nearly two months on the continuous glucose monitor, it’s safe to say that I’m a fan. You have to remember the device’s limitations, but it does a great job as long as you keep them in mind. I have a much more nuanced and accurate understanding of how my blood sugars behave now, one that likely couldn’t have come any other way.
But I’m also comfortable with — in fact, I enjoy — dealing with lots of information. The sheer amount of stuff a CGM tells you is not for everyone.
Indeed, if you feel comfortable with your current diabetes regime, if you feel like you know how your blood sugar behave most of the time, I’d be hesitant to say the CGM is a requirement. You might not learn much that’s of use — and what you do learn could probably be gleaned from wearing one for a week or two.
Some folks, though, will find the device an amazing addition to their lives. These would be people who, like me, enjoy having constant flows of information around them. They would be people on less-regular schedules, or those with more erratic diets, who need to make sure that their insulin and carbs are matching up properly.
These people, in short, would be a lot like me. If you are, consider what a CGM would mean for you. It might be just the thing.