Tag Archives: CGM

This is my diabetes.


This is my insulin pump. It is my lifeline of sorts, in that it allows a steady rate of insulin to be infused into my body throughout the day. Also, it lets me add extra insulin to cover the carbohydrates I eat, and to correct any high blood sugar numbers that might happen from time to time.

If you’ve never lived with diabetes… imagine this external device as part of your life 24 hours a day, seven days a week, forever. The only time it comes off is when you swim or take a shower. It can also add a level of concern about what might happen in the future, should something break, or should insurance stop covering some or all aspects of this therapy.

It will also be the subject of additional scrutiny from TSA agents when you go through security screening at the airport. As I’ve found out firsthand, that’s including when you go through the TSA Pre-Check line.

This is my diabetes.

Here’s a Dexcom Clarity report. It gives me valuable information on glucose trending for the past seven days. Among other things, it helps me to know if I need to consider changes to the basal rates on my insulin pump.

If you’ve never lived with diabetes… imagine an extra level of concern about what might happen in the future, should the report not be as well as expected. Imagine living with concern over just the anticipation of a report or a simple lab test. Concern about the future is something I try to put in a box, safely stored away until the time when I might have to address it.

Frankly, I don’t know if I could handle it if I started to worry about potential complications all the time.

This is my diabetes.

I have a quarterly appointment with my endocrinologist next month. I have a meeting with my primary physician a month after that. I’ve already been to the ophthalmologist this year. And I have to schedule time with a podiatrist and my dermatologist too.

Meanwhile, there are prescriptions to fill. I have a couple of everyday medications that are refilled every 90 days. Add in the insulin I need, which I need to have refilled every 90 days too. Then there are strips for my glucose meter, sensors for my CGM, infusion sets and reservoirs for my insulin pump.

My out of pocket expense for all of this, the amount that insurance does not cover, has passed $3,500 per year.

If you’ve never lived with diabetes… imagine spending the price of a European or a Caribbean vacation every year just to stay healthy. Think about not finishing college, just so you can afford your medication and supplies.

And that’s not counting the cost of the time it takes for all of those things mentioned above.

This is my diabetes.

If we handle all of this well (and who can do that all the time?), we’re considered obsessive about our disease, making it a bigger part of life than it should be. If we don’t handle it well, we’re considered “non-compliant”, or worse. And that’s without any outside influences like stress at home or in our careers.

In addition to a constantly vacationing pancreas, we go through these internal struggles too, all the time, every day.

This is my diabetes.

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This is my diabetes.



This is the most recent infusion set I used to pump insulin into my body. You know, the thing I need to do 24 hours a day, every day, or else I die.

When you inject insulin, either by syringe or by insulin pump, you run the risk of drawing some blood out at the same time. It’s just part of the landscape. You learn to live with the possibility of blood coming out while you’re trying to get insulin into your body.

If you’ve never lived with diabetes… imagine pulling an infusion set from your body and small (and sometimes, large) amounts of blood comes from the site. Imagine having to pull a set early because you can see that blood is on the outer portion of the adhesive used to hold the cannula (the small plastic tube that winds up inside your body, through which insulin is pumped) in place.

Then imagine the idea that this will happen many times if you’re lucky enough to live many years with this condition.

This is my diabetes.


This is the site on my leg where that infusion set was placed. I took this photo within five minutes after pulling the set. My leg will look like this for a couple of days, at least. I need to be careful not to use that site again for as long as I can, because the scarring that has gone on under the skin could keep me from being able to pump insulin through that spot for some time. If I overuse that site, repeated scarring could make it impossible to pump insulin through there permanently.

If you’ve never lived with diabetes… imagine looking at a site like that after three days (or less). Imagine knowing you’ll have another site just like it to look at in three more days (or less). Do the math and imagine how many of these wounds you’d willingly give yourself over the years just to keep from dying.


This is my Dexcom sensor site after two weeks. The sensor sits under the skin and measures glucose in the interstitial fluid between your skin and your blood vessels.

After about a week or so, the adhesive around the sensor starts to pull away from the skin. To continue to hold the sensor in place, I add something called KT tape. It’s the tape you see beach volleyball players wear. It’s flexible and stays in place and is fairly water resistant.

Using the tape allows me to get an extra week or two worth of wear from a sensor. Sensors are expensive, and they’re just one of the many things we’re required to purchase if we want to manage our diabetes as well as possible.

If you’ve never lived with diabetes… imagine getting out the tape every couple of weeks and carefully cutting a hole (hopefully better than the one above) and even more carefully placing the tape over the sensor, placing it so it will hold the sensor and surrounding adhesive in place for a little while longer, so you can afford to purchase something else you really need.

This is my diabetes.

The crazy thing about all of this is that I’m one of the lucky ones living with this disease. I actually have access to an insulin pump and supplies, a continuous glucose monitor, and other tools of diabetes management.

But I’ll never outlive the scars. I’ll never get a chance to rest. There will always be one more thing that needs attention. Every day of my life. It is never ending.

This is my diabetes.

Prickless.

No, this is not a story about removing the president of the United States from office.

Instead, this is about something I did recently.

I went a full day without doing any fingersticks. Twice.

I got the idea when a Dexcom sensor ended, and I still had about four days left in my trial of the Freestyle Libre (Disclosure: Abbott paid for the reader and two sensors. Opinions are my own).

At first, I wasn’t sure about only wearing a CGM that I didn’t have a lot of experience with. But during the trial, it had been pretty reliable. Then I thought, “the Libre doesn’t require fingersticks, even for calibration… what if someone didn’t want to do one?”. So I spent an entire day, a Sunday, not using my meter even once.

Then, once I got through a day using only the Libre, I knew I had to do the same thing with my Dexcom G5. The Dexcom only requires fingersticks for calibration, so in theory at least, after calibration, I could go quite a long time managing my diabetes with only the Dex. Dexcom’s turn came earlier this week.

I don’t know a single person using either of these systems who ever actually does this. I’m sure there are, but I haven’t seen anything about it anywhere. How was my experience?

In a word, I was terrified. When you rely on pricking your finger with a sharp (okay, blunt) object multiple times per day for years on end, drawing blood and using that blood to give you a handle on your diabetes, you get used to it enough to rely on it first. For me, my meter is my truth teller.

Occasionally, my CGM will give me a weird reading I just can’t believe. When it does, it’s important, even comforting, to know that I can grab my meter and trust what it tells me. But the thing is… more often than ever before, even in these moments, the meter and the CGM are very close.

I didn’t have any notable moments during the two days. No big highs, no major lows. I just lived my life, checking my BGs only via my CGM display. Managing insulin dosing and carb intake accordingly. Out of sheer instinct, I took out the meter a couple of times each day, nearly checked, but then put it back in the drawer with a laugh.

Since things worked so well over these two days, you may be wondering if I might want to ditch the meter entirely. The answer is No. As I said, when it comes to blood sugar, I’ve come to rely on my meter as the one bastion of truth above all others.

But… I could see backing off on glucose checks in my future. Maybe I won’t check seven to ten times each day. Maybe four or five, or even three or four might do the job. Maybe it’s time to think of my CGM as more than just an emergency alert system.

What this experience has done is give me the feeling that I can step back and reassess whether I need to give my continuous glucose monitor more of a place at my diabetes table. I would have never guessed that I might do that. I’ll still keep my meter handy. But going forward, I’ll be just as likely to rely on my CGM.

The Freestyle Libre (part 2): Final Analysis.

Disclosure first: I was given the Freestyle Libre continuous glucose monitor to try at home. Abbott is covering the cost of the device and two sensors. I am not being compensated in any other way. All opinions on my brief experience with this device are my own, as always.

My trial run of the Freestyle Libre CGM was pretty smooth sailing.

There are a number of things I should cover, so let me give you the rundown of what I’ve observed:
 
 
– First of all, as I mentioned earlier, the sensor warmup period is a lengthy 12 hours. It’s great that there are no finger sticks involved, but there certainly are when you have to wait 12 hours for your first CGM reading. You still have to know what’s happening with your blood sugar over the course of 12 hours. So even though I’m not using them to calibrate (the Libre is self-calibrating), I’m doing a fair amount of fingersticks during that 12 hour warmup period.

It’s been mentioned elsewhere that the warm up time in other countries is significantly less than 12 hours, so here’s hoping that gets ironed out soon (also, more on the “careful” versus “full gusto” submission processes with FDA below).
 
 
– Unlike what I’ve been reading from others who have been doing the same trial, the numbers I saw from the Freestyle Libre were almost always higher than what I saw from my Dexcom or my Accu-Chek Guide meter. When my numbers were lower, they were pretty much in sync, single digits separating the numbers on the screens. When the number got over, say, 140 mg/dL, the numbers on the Libre were higher.

In these situations, the Dexcom always showed the lower number, and the Libre the higher number. The number from my glucose meter was somewhere in the middle. Like this:

Obviously, I don’t know this for sure, but to me, this would indicate not a failure, but a difference in how the glucose data is being interpreted by each individual CGM. As many will tell you, it’s not usually the number, but the trend that’s important. Plus, if glucose is being interpreted a specific way on a regular basis, it’s easy to account for that, or at least understand when to do a BG meter check to make sure.
 
 
– The size of the sensor is very small compared to any other CGM sensor on the market (for those of us in the USA, about the size of a half dollar). Insertion was easy (don’t forget, my user guide was in Spanish, so I did my insertion based on online tutorials). The comfort level wearing this on my upper arm is without compare. And it stayed on, without the need for extra adhesion.

This might be a factor to keep track of down the road… If they get enough competition, I can foresee Dexcom breaking the mold, so to speak, and speeding up work on a smaller sensor and transmitter option.
 
 
– There is certainly a convenience factor in being able to take the reader, scan it over the sensor on your arm, and see a new reading instantly. Even less than a minute apart. For the record, Dexcom gives you a new reading every five minutes.

This is not a big deal to me, but I have to admit that sometimes, I found it easier to have the reader next to me when I slept, and instead of reaching for my phone and getting the number in the middle of the night, I just scanned and saw the number on the Libre reader.
 
 
– That said, I have my phone with me throughout the entirety of my waking hours. To roll out a medical device in this day and age, and not have a Bluetooth/Mobile option of some kind attached to it is a real shortcoming. Especially considering the reader options are significantly limited. There is a mobile app for Freestyle Libre available in other countries (known as LibreLink), but not yet in the USA.

I get it… Abbott either wanted to make sure they got the Freestyle Libre approved as a standalone without having to get the mobile app approved at the same time, or they couldn’t get it approved right away and went instead for just the sensor and reader. They’re probably working feverishly to get the mobile app okayed as soon as possible. I’m only speaking for myself here, but that’s a dealbreaker. Double dealbreaker if the mobile app eventually comes out only on an Apple platform (LibreLink is available in other countries on Android, so yay).

You might wonder why, in this case, I seem to be holding Abbott to a higher standard than maybe I held Dexcom a few years back. Why? Because it’s 2018. In case you haven’t noticed, we’re in a digital, mobile-manipulated world, and yes, I’m expecting industry to keep up with the times. Is that asking too much?
 
 
– One additional item: There have been rumblings about the lack of alarms with the Freestyle Libre. That’s true in a sense, because alarms are not part of this package, unless you’re actually scanning the sensor. You, as an individual user, will have to figure out whether that’s important to you or not. I’ve also heard a lot about alarm fatigue from the Dexcom, so I will leave it up to you to decide what is best for you.
 
 
Overall, I think the Freestyle Libre is a good option for People With Diabetes. The cost is less than the Dexcom, the readings are accurate enough for this cowboy, and you can’t beat the size and comfort of the sensor. I also think this might be a super option for some (if they can get it approved by insurance), because of the longer sensor life (10 days versus 7 days for Dex), and the fact that finger sticks are not required (other than sensor calibration, finger sticks are not required for Dexcom either).

Bottom line: For now, I’m not moving away from my Dexcom. If there’s a mobile app that allows me to see the reading on my phone, and helps me share data? Then I’ll be happy to take a second look.

Again, and I don’t think I can say this enough, it is wonderful to have an additional CGM option, and one that isn’t forced to be linked with a specific insulin pump. There are plenty of reasons to like the Freestyle Libre, and only a couple of reasons for me to hold off on a full throated endorsement (for now).

The Freestyle Libre (part 1)

Disclosure first: I was given the Freestyle Libre continuous glucose monitor to try at home. Abbott is covering the cost of the device and two sensors. I am not being compensated in any other way. All opinions on my brief experience with this device are my own, as always.

You might have noticed a lot of talk about the Freestyle Libre gaining approval by the U.S. Food and Drug Administration a couple of months back. That means that we here in the United States now have access to a device that has been a hit in Europe for a couple of years now.
 
 
Since I was given the receiver and a couple of sensors to try, I am happy to share my experiences using the Freestyle Libre. The setup was easy and completed without even checking the enclosed user manual and other material (more on that in a minute).
 
 
The initial two things I have to say about it fall under the Bad Thing/Good Thing heading.
 
 
Bad Thing: all of the documentation I received is in Spanish. The user manual and quick start guide are all en espanol. I can read and comprehend some Spanish, but not enough to feel confident using a medical device.
But… Good Thing: The online tutorials were terrific, and all I needed to get started.
 
 
Bad Thing: The Freestyle Libre calibration process takes 12 hours.
Good Thing: It’s true… this CGM does not require a fingerstick to calibrate.
 
 
I think that’s enough to start with. If you want to see what others have to say about the Freestyle Libre, just look around a bit… you’ll find plenty of information and opinion. Then come back here, as I will likely have more to tell as the next 20 days or so pass.
 
 
One more thing: I am thrilled that there is another tool for People With Diabetes to choose from to help them manage their misbehaving pancreases. As a community, I hope we can continue to encourage and empower choice and access for everyone.

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