Taking a Day Off

I have had the Continuous Glucose Monitor (CGM) for a little over a month. It has been very helpful with trends and helping me keep better control of my blood glucose. The alarms can get annoying but they do help. The other day the sensor I put in was hurting and just generally bugging me so I decided to take a day off.

I don't know if the site was getting sore from being bumped by my daughter, just in a bad spot, or inserted poorly. After feeling like something was poking me on the inside I decided I needed a break.  It was a little weird to not have the sensor there but it was also  somewhat nice. I did miss the predictive alerts but I didn't have to hear alarms going off in the middle of the night as I had for the past few nights. I was extra careful in my food selection and tried to make sure the carbs I counted were correct. I still wanted to do well so I would worry about the highs and lows.

I actually had a pretty good day without it. My blood sugars were good and the worst one was 174 the next morning. Plus, it was nice not to get a high alarm in the middle of the night. I have since put a new sensor back on because I am driving a lot with the kids and have other activities. During my golf league it is especially helpful since walking 1-2 miles on nine holes carrying a golf bag is pretty good exercise and can bottom out my sugar pretty quick. This way, with my Gatorade in hand, I am able to keep a fairly consistent level without having to pull the meter out all the time.

The day off was nice and will probably do it again but I don't know if I could go much longer than one day. 

Yelling at the CGM

Some days/nights I seem to get a little angry at the Continuous Glucose Monitor (CGM). I knew there would be difficult times because controlling diabetes is not a perfect science. The CGM is a great tool in staying in control but there are some frustrating moments. This leads to me yelling at my pump/CGM.

There are times that I am going about my everyday activities and I will get the predictive low alert. This is great because I can head off that low before it happens, but it sometimes will not go away. We are getting ready to have a garage sale, so I have been moving stuff into the garage and trying to get organized when the CGM gives a predicted low alert. No problem. I go get a snack and a drink and get back to work. A few minutes later, it is beeping at me again for a predicted low and I acknowledge it but keep going about my work since I just had a snack. A little bit later it is beeping at me for a low blood sugar so I go and get another snack. Thus far I have eaten one pop tart (one pop tart is about 37 grams of carbs). I figure I should be good to go but the CGM thinks otherwise. After 5 more minutes I get another predicted low alert. At this point I am getting frustrated so I start asking the CGM what it wants (unfortunately it thinks this is a bit of a game and doesn’t tell me what it wants). I check my blood sugar with my meter and indeed I am low - 68. I debate on the next action to take since I just had a pop tart. I decide to have some milk and some goldfish crackers. About 10 minutes later I get another low blood sugar alert. At this point I probably look like the guy standing on the corner yelling at traffic.  I decide to have something else to eat to get to some kind of normal level. Finally my CGM is in the 100s and in a normal range.

You may be able to guess what happens next.  In a short while I start to feel a little lethargic. I look at my pump to see the CGM reading and it is 145 with the double up arrows (meaning my glucose is rising at more than 40 points per 20 minutes or over 2 points per minute). Shortly I start to get the predicted High warnings and soon to follow high glucose warnings. Now I have to go back and think of how much I ate in grams of carbs to correct the low I was having earlier. I test and the blood glucose is already at 175 (30 points beyond the CGM). My pump tells me that I need to bolus for the elevated blood glucose. I also figure the carbs I had and add about half of them to cover that as well. I continue to get high alerts for the next half an hour or so and the crazy man yelling at the pump continues. The best part is as my glucose levels top out and start to come down I still get the alerts as it hits certain numbers on the way down.

After a frustrating couple of hours and plenty of yelling at the CGM everything finally got back to normal glucose ranges.  Through all of this I have learned one thing; the CGM listens to me as well as my kids do.

CGM Time Frame

I recently had a discussion with a friend of mine over the length of time you should wear the CGM sensor.  It is quite interesting to me and I will layout what she said and my thoughts and ask for your opinions:

My friend's doctor says to wear the CGM three days and then not for a couple of weeks.  Some of the reasoning is that you can become obsessed with it which is not a good place to be either.  The three days helps you get regulated and then to practice the same through the next two weeks, plus it can confirm how you are doing from your previous two weeks.

My thoughts are to wear the CGM all the time.  I believe it is an effective tool in helping recognize the trends of my blood sugar and help me prevent those lows and highs.  I have found that since starting the pump and using only fast acting insulin (Humalog) and discontinuing the Lantus that the high blood sugars feel much worse much sooner.  Plus when I am out and about with the kids it is nice to have that comfort of being able to see where I am at and see if I my blood sugar is trending one way or the other.

Everyone must take care of their diabetes the way that is best for them. I don't think either of us is more right than the other as there are more than two ways to make a cake.  Give your thoughts on the way you manage your diabetes with or without the CGM.