If I Knew Then: Continuous Glucose Monitoring – Dexcom.
I tried my first CGM system back in 2006 (this post outlines the very first awkward sensor application) and have spent the last seven years or so being thankful that this technology exists. If I knew then what I know now … actually, I started on a CGM as quickly as I could, and stayed on it. Why I wanted a CGM is an easy question to answer, but there are a few things I wish I had known before starting out:
I wish I had known that some of the sensors would hurt. So many diabetes devices are branded with “pain-free!” and “barely feel it!” advertising taglines, which I think is crap. We’re talking about a needle that pierces your skin and leaves a wire behind, underneath your skin, for a week at a time. To think that every sensor will glide under your skin with barely a whisper is bullshit. Some of the sensors hurt like hell when they go through my skin, and sometimes it takes an hour, or a day, for the site to settle down and not feel so tender. But most often, it is a reasonably quick pinch and then reasonably painless for the duration of the wear. Your mileage may vary with each and every sensor.
I wish I had known the data would be addictive at first. The first time I wore a Dexcom sensor, it was back in 2006 and was one of the first marketed versions of the system. But I was hooked on the data. I looked at the receiver every five minutes and went bonkers trying to make sense of the trends. The trouble was that the readings were far less accurate back on the Dexcom STS, but I took them as seriously as the numbers on my glucose meter. For the first few weeks of wearing the Dexcom, I drowned in data, obsessively checking it and chasing slight blood sugar climbs with aggressive correction boluses. I needed to learn to let the data flow into my management, not change the flow of my management.
I wish I had known I would go through a data burnout – and that’s okay. After I gave birth to my daughter, I went through some post-pregnancy burnout (adjusting to motherhood put my diabetes on the back burner for a few months) and for several weeks, the Dexcom was used to monitor my overnights (watching for lows), but not much else. I wasn’t in a mental state to micro-manage my numbers, and instead I needed the Dexcom graph to confirm that I was at a stable enough blood sugar to take care of my kid. The data was too much at times, and I frequently turned off the high alarm because it BEEP!ed relentlessly.
I wish I had known that thresholds were individual choices. Everyone manages their diabetes in a different way, and even one, single person can have varying styles and preferences. For a few years, I wanted to see my blood sugars between 60 – 220 mg/dL. When I needed/wanted tighter management (pre-pregnancy and pregnancy), my thresholds were between 60 – 140 mg/dL. And now, I keep my high alarm set at 140 mg/dL. I like knowing when my blood sugars go over 140 mg/dL because that gives me a chance to head them off at the pass and keep them from climbing into the 180’s and 200’s. Some people roll their eyes at wide thresholds, while others judge for not having the lines “tight enough.” Where you set your CGM alarms is a personal decision and one that needs to work for you and your medical team.
I wish I had known, and had been ready to accept, the fact that wearing a second device was going to be a pain in the ass. I wear my sensor on my outer thigh and the bulge is pretty obvious at times. When I go running, you can clearly see the outline of the sensor through my running pants (and you can almost read the word “Dexcom” through running tights). In a more fitted dress, the lump on my thigh is unmistakable. And sometimes if the sensor is a tough too high or too low, it’s right underneath where the pocket of my jeans sits, making it feel particularly lumpy and awkward. Of course, there are plenty of times when it’s barely noticeable, if at all. (And it’s always fun, and a bit cheeky, to talk about “the bulge in my pants.”)
I wish I had known that I would eventually learn to trust the algorithm. At first, I had to learn how to use my CGM, and I had to let the transmitter “learn” me. The numbers I saw, when compared to my meter back in 2006, weren’t close, but I needed to understand that the CGM provides trends, not exact blood sugar results. (The thing doesn’t even test blood sugar, but instead interstitial fluid. Knowing that, however, still doesn’t make me want to throw all technologies across the room when the meter and the CGM are 100 points apart.) And even now, using the most recent iteration of the Dexcom system (the G4 Platinum), the results are almost spot-on with my meter, but I need to remind myself to test my blood sugar to confirm how accurate the CGM is now.
I wish I had known that there could be an allergic reaction to the Dexcom sensors, but that it could be managed with someone as simple as a high-tech bandaid. After spending months dealing with a very volatile rash caused by my skin reacting to the Dexcom sensor adhesive, a reader suggested that I use a Johnson & Johnson Toughpad underneath my sensor. This simple solution worked to cure my Dexcom rash.
I wish I had known that the information I (hunt and) gather from my Dexcom data has made my diabetes easier to wrangle in. Sure, the thing alarms all the time and yes, wearing a device isn’t ideal. But when it wakes me up in the middle of the night because my blood sugar has dipped below 60 mg/dL, or when I can check it before driving and see, with confidence, that my blood sugars are stable before getting behind the wheel? For me, that makes any and all of the inconveniences worth it.
What did you wish you had known, before trying out a CGM?