The great CGM experiment

Thursday, June 23, 2011

"This thing costs $1,000. Please don't drop it in the toilet. With those words of wisdom, I was ready to go. I had the opportunity in May to use a continuous glucose monitor (CGM) for a week. The CGM tracks blood glucose levels 24/7 to pinpoint potentially problematic patterns.

Day 1

Being mindful of what I am doing, eating, drinking, dosing at all times. The numbers that the CGM tracks mean nothing if the diabetes educator has no idea what I was doing at the time.

Right now, those numbers are trending unpleasantly upward. Hmmm.

Day 2

This morning I dutifully calculated my insulin doses, planned my food for the day--all of it healthy--and measured it all out. The end result of all this due diligence?

My numbers are too high, trending in the low 200s. I went from 69 at 3 a.m. to 237 at 8 a.m. There are lots of potential reasons for that 237, which is why I am doing this experiment in the first place.

Day 3

Overnight blood sugars were rock steady. Unfortunately, the CGM was experiencing bouts of lows. Starting at 3 a.m. it woke me three or four times. The first time I checked my sugar and learned I was a perfect 107. Needless to say, by the 3rd time around, at about 5:30, I was feeling that the CGM was a little too needy.

It's like that school experiment where you take care of an egg or a doll to see what parenting is like. The CGM must stay within 5 feet of me at all times. It goes to the bathroom with me, sleeps with me, and needs to be fed data every few hours. I am constantly checking in with it to see what it is doing and if it needs anything.

It's kind of like...having diabetes.

Day 4

I am discerning patterns that will need to be addressed, like the fact that I seem to need more insulin at breakfast and lunch, and less at dinner.

Day 7

By the time the diabetes educator pried the device out of my hands, the CGM had become second nature to me. I found myself going to check it several times, forgetting we were no longer attached at the hip.

At the doctor's office, we printed out the data. Turns out, I go low almost every night, usually around 3 a.m. (this is something that I have long suspected). That's probably causing a morning rebound. That means, rather than take more insulin at breakfast--my first reaction--I will take less insulin at bedtime. We are making other tweaks as well.

Technology is an amazing way to problem solve, in a way that old-fashioned log keeping--and guesswork--cannot. 

This experiment also really underscored what it means to be proactive in health care, rather than reactive. That's something that HME providers have long understood, and it's something that I hope insurers and lawmakers are beginning to realize.