You are probably familiar with the poem “There was a Little Girl” by Henry Wadsworth Longfellow (1807-1882). The first verse goes as follows:
THERE was a little girl,
And she had a little curl
Right in the middle of her forehead.
When she was good
She was very, very good,
And when she was bad she was horrid.
When I started this post, my aim was to compare my Dexcom G4 CGM to the little girl. I am a huge fan of my CGM and most of the time it is a trustworthy and reliable device. But occasionally it shrieks, spews out bad results, and stomps its little sensor feet just to remind me that it is imperfect and I shouldn’t expect constant excellence.
The more I looked at this photo, the more I began to realize that I was seeing my own reflection rather than my Dexcom. I can be very good at making optimal decisions when it comes to things like diet, exercise, and insulin. The “Good Me” takes the normal ups and downs of Type 1 in stride and spends a lot of time in range. Unfortunately the “Horrid Me” takes over at other times and makes bad decisions amidst frustration, self-criticism, and just not giving a damn. I feel helpless with my BG numbers and want to scream, throw things, and live a self-destructive life eating chocolate-covered donuts.
Dexcom: The Very Good: In mid-August I had severe bronchitis and was prescribed oral steroids. As is typical with steroids, I experienced a huge rise in blood sugars and at one point was taking 5 (!) times my pre-steroid dose of insulin. Although I wasn’t seeing low blood sugars, I was worried about sleeping with such massive amounts of insulin on board. Adding to my vulnerability was the fact that my husband was out of the country on a business trip.
During the five days of steroids, my Dex G4 was as accurate as I have ever experienced as it tracked my blood sugars in a range from below 100 to the high 400’s. Most importantly it provided a safety net that if my BG tanked at night, it would repeatedly alarm until I responded. Without the CGM, I would have been terrified to be alone and probably would have needed to set hourly alarms to check my BG day and night.
Dexcom: The Very Bad: Ten days ago I started a new sensor. I know that the first 24 hours of any sensor can be wonky, but this sensor site was the worst. Double up arrows in the high 200’s followed by double down arrows in the 40’s when my calibrated BG was between 100 and 125. Vibrations and alarms were driving me crazy. I finally turned off the receiver to give it a few hours to think about how it could improve. When I turned it back on, I continued to receive multiple alerts—some accurate and others absolutely unwarranted. Rather than throw the receiver out the window, I finally just turned off all of the alerts except for the low threshold. Eventually the sensor settled into reasonably good results.
Besides the occasional bad results of a new sensor, another thing that drives me crazy about the G4 is that after alerting me to a low, it continues to alarm long after my BG has returned to normal. Unfortunately that is a characteristic of the interstitial fluid that the CGM measures and I am not sure that there is a solution for this. But it would be nice if the G4 didn’t alert for a low when your BG is moving up:-)
Living with a Dexcom: The Good Me and the Bad Me: Most of the time I live in harmony with my Dexcom. I do a good job of knowing when to trust it and how to optimally use the information it provides. One thing that I sometimes ignore is that the CGM is only as good as how I react to it. If things are rough in my diabetes life, I have the power to evaluate how I am using my CGM and make changes if necessary.
A lot of my recent frustrations with the Dex are related to alarm fatigue and data overload. There is not much that I can do to prevent a lousy sensor start or change the fact that interstitial fluid behaves differently than blood sugar. The Bad Me overreacts to sensor data and gets stressed by out-of-range BG numbers. I start making too many corrections that often lead to more erratic numbers. I start dismissing alerts without even looking at the receiver. I rage bolus to prevent highs. I eat junk food despite the inevitable cr*p results. I basically get burned out by diabetes.
The Good Me remembers that I am in charge of most of the settings on my CGM. After turning off most of the alerts last week, I lived with only the low alert of 70 for several days. I was amazed at how much less stress I experienced in relation to diabetes. I slept better and in general had improved BG numbers per my meter. I eventually turned back on the high alert, but at a threshold of 200 rather than 150. I didn’t change my personal goals for my BG range; I just reduced the Dexcom intrusions into my life. I look at my CGM often enough that except for the protection from undetected lows, maybe I am better off catching the changes myself rather than getting constant alarms for ups and downs. I have kept the rise and fall rate alerts turned off and have not missed them.
Summary: If you have followed my blog for a while, you know that I was diagnosed long before home BG monitoring, insulin pumps, and even multiple daily injections. On one hand I work hard to have access to the latest and greatest technology. There is no doubt that my life with diabetes has been enhanced with the use of a pump and a CGM. At the same time I need to remember that beeps, bells, and whistles don’t guarantee good blood glucose numbers or mental health.
Currently I have turned off many of the Dexcom alarms and that is working for me. There is no guarantee that this will work for next week or next month. There is certainly no guarantee that it will work for you. But the only way to make things better when diabetes seems to be winning the battle is to try something new. Good or bad, it’s worth a try.
Please note that as I got this post ready to publish, my new Dexcom sensor alerted to a BG of 53. Two meter tests of 100 and 106 confirmed my BG to be in range. Argh!!!