Accountability
I met with my new endo late last week. She seems pleasant enough. She listened to me blather on and, when I bemoaned the fact that I wake up high more often than not, she suggested a 3-day CGMS study.
This was remarkable to me, because my former endo's office once said something to the effect of, "well, we use that really only when everything else has been straightened out." I took that to mean that unless I was doing all I could and was still experiencing unexplained highs, a CGMS run wasn't an option for me.
The problem with that approach, in my humble opinion, is that it fails to acknowledge just how disheartening and de-motivating (what's the opposite of motivational?) out-of-range blood sugars can be. In and of themselves, those morning highs are a reason to just crawl back under my diabetes shell and ignore the problem for another three months. And, since when is access to information about overnight blood sugars something to be earned?
After one full day of wearing the Minimed CGMS study unit (study = I don't see the blood sugars, they'll be downloaded later), I'm finding that just wearing it gives me focus. I walked by several holiday treat platters today, simply because the items offered weren't worthy of digging out the food diary record sheet that I'm keeping for three days (not to mention the uncountable carb values in your average homemade cookie). Tonight, for dinner out, I actually took the time to check the Pizzeria Uno menu on line so I'd know the carb value of my dinner.
For the most part, though, I'm motivated by the thought of my endo scrutinizing the details of this 3-day period. For whatever reason, I'm bringing my best game to this trial. Too bad my life isn't a series of 3-day stints, after which my endo and I analyze my blood sugars, insulin doses, and food choices! On second thought, thank God my life isn't a series of 3-day studies!
I'm more interested than ever in owning a CGMS. I'm working with the good folks at DexCom to get started on a system, hopefully in early January. I think the accountability offered by that little graph will be a good thing.
posted by Kassie @ 7:28 PM
11 comments
11 Comments:
I'd really really love a CGMS system, but right now with insurance not covering it and me not being willing to harrass insurance about it, I will have to wait. I hope it works well for you!
Can't wait to hear about what you learn from it.
And it sounds like your new endo is a much better fit for you.
I really think that we'll see more and more of the CGMS technology coming out, getting better, and being better covered by insurance.
I think it's a lot like when glucose meters first hit the streets. And now look where we are!
Um, is it useful to do the CGMS study if you are not eating as you normally would?
Cheers,
Felix.
I think so, Felix. I'll be better able to determine if my carb/insulin ratios are on target if I'm very precise about what I eat. That means only eating foods for which I have carb info.
If my pesky overnight blood sugars behave perfectly during this trial (so far, they haven't) then I'll know that my morning highs have more to do with what I eat before bed than any screwed up overnight basals.
So, yes, I think so. We'll see!
I think CGMS is a good tool for helping you identify what happens, otherwise it involves staying up all night and testing hourly ... no sleep for you. It sounds like your new endo is someone who is willing to use technology to make YOUR life easier, so thats a plus!
The 3 day study definitely helped to pinpoint the exact time of my dawn-phenomena. Before it we were just crap-shooting at times (its from 2am-4am btw).
I REALLY want a CGMS, but figure I'll wait until the next generation comes out. Too many bugs still. My endo offers 1 week trials of the Dexcom, but they found that the last batch of sensors they ordered were all bad. Didn't really help that group of people wearing it for a week.
"And, since when is access to information about overnight blood sugars something to be earned?"
Yeah!
I hated wearing the 3-day CGMS, but did get a little out of the experience. And I think you're dead-on about the changes in behavior it causes, which kind of defeats the purpose of actually wearing it. In sociology, it's called the Hawthorne Effect.
It seems like CGMS only becomes useful after you're less aware that you have this new tool, and then you can actually use it (like, you can actually see the data!) to trouble shoot and figure stuff out.
I hope your dexcom dreams come true!
And I hear you loud and clear on the accountability.
How is it wearing a second 'thing' stuck to you? It seems like it might be irksome to have two infusion set-like things taking up space on your body...
I know, I know, I'm thinking really deeply here - ha!
Kevin - I think the behavior changes defeat one potential purpose of CGMS (sharpening carb counting/food choosing skills) but that's not something I'm focusing on or could even imagine really tackling during a 3 day trial. So far, it's been motivating to sort out the blood sugar excursions I can 'own' (ie those that are the result of poor carb counting) from those that can be addressed with basal or ratio changes.
Erica - it's annoying! The CGMS Study unit is bulky and hard wired. But it's only 3 days, so I don't mind. I've seen the DexCom in action and the part on your body is pretty small.
Glad you liked the 3 day study! Have you explored any other CGMs and compared them to Dexcom? We have been using a Dexcom since May, and are giving up. It is great when it works, but rarely does. We often have to send the sensors back, always lose readings, etc. We have seen much more success in friends children that are now using the Navigator and MM Paradigm "Real Time" System. I do have to say, Dexcom has been extremely successful in replacing sensors, etc. but the results were not at all what we had hoped. Whatever you choose I wish you best of luck!
Sara
I can't bring myself to work with Medtronic, after a few years of terrible customer service (still unresolved). The Navigator isn't approved yet and to be honest, given it's bells and whistles, I'm worried about the cost. Plus, they'll have to work out their kinks once they do go live - I feel like dexcom is ahead of the curve on that.
I've heard some great success stories with the dexcom, so I figure it's worth trying.
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