Changing the Landscape of My Diabetes
by kerri morrone sparling
When I was diagnosed in 1986, blood sugar meters took 120 seconds to give a result, and the devices used to give those results were remedial and clunky, at best. At that time, my blood sugar was tested five times a day: fasting, before each meal, and then before bed. The information was plotted in my logbook and presented to my endocrinologist every three months so adjustments could be made to my insulin doses. This system worked well enough to earn my mom and me A1c levels in the steady low 8% range.
"Eight percent? That is so high!" said a friend of mine, when I told her about my blood sugar goals when I was younger. "Isn't that high for you now?"
"Yeah, but back then, the only warnings I had for a low or high blood sugar were the symptoms that set in once the numbers had already started to cruise out of range. Not much notice then."
"Which is why you wear that continuous monitor thing now, right?"
"Exactly. Gives me a heads up, whereas before I was clueless until there was already a problem."
Wearing a continuous glucose monitor (CGM) sounds excellent … in theory. But you need to be prepared for both the influx of information and the added physical device component in order to make a CGM effective in your diabetes management plan. And when it came to beginning my journey with the CGM, I wasn't sure how much I was going to like this new addition to my diabetes family. Was a second device really worth all the trouble?
When I first decided to try a CGM, it was just after my now-husband asked me to marry him. We were planning our wedding, and while we were enjoying being engaged and looking forward to being married, we also knew that our timeframe for having children was sooner rather than later. Knowing that my diabetes control needed to be in top shape before conception, I started on a CGM while we were planning our wedding.
At the outset, I experienced some serious technology joy. (No lie: It felt like Christmas when that FedEx box arrived.) I was intrigued by the new gadgetry, the software, and that ability to click a button and access blood sugar trends at any given moment. I could see my numbers climbing after coffee, and plummeting after workouts! In my mind, the CGM emitted both rainbows and glitter; it was like diabetes nirvana. It was like going from Polaroid snapshots of my blood sugar numbers to live, streaming video. The first three months of using the CGM were euphoric, my A1c dropped a full point, and I marveled at this new and constant access to information.
But then, once the novelty wore off, I began feeling a little indifferent. Some days, I was happy to put another CGM sensor on my body and I didn't mind toting around the external receiver. I still looked at the graphs and made calculated adjustments to my insulin levels, and when that sucker BEEEEEPED loudly in the middle of the night to warn me of a low blood sugar, I appreciated it. But there were other days when the sensor got caught on my waistband and the adhesive wasn't holding. Or the alarm would go off, clueing me in to a high blood sugar, but I'd ignore it because I was busy or frustrated or mad. It was frustrating, knowing that I wasn't using this technology to its fullest advantage.
For me, using a continuous glucose monitor is as much an emotional balance as it is a physical one. Sure, I can get the CGM to calibrate and give me results that are pretty darn consistent with my meter, but I need to do something with that information once I have it. I can't just click the button, look at the graph, and then disregard it. The CGM is one of the precious few proactive measures I have against my diabetes, and I need to be more reactive to the information it provides. At times, the CGM felt like too much information. I almost didn't know how to handle it, when I was in moments of diabetes burnout, because it was just another physical thing to maintain and another contributor to my emotional diabetes burden. I remember looking at the graph, seeing its uncanny and infuriating resemblance to a giant letter M, and throwing it in frustration.
It wasn't until when I was pregnant that the CGM, and all its potential, mattered most. From those first few weeks of pregnancy, when blood sugars in the 20s and 30s were common and without symptoms, to the rising insulin resistance of the third trimester, I have never been so grateful for access to constant blood sugar information. With my body's needs for all things shifting every few days, I would have been lost without those blood sugar trends. And once my daughter was born, I felt as though the CGM was there to protect both of us, helping keep myself safe in effort to take the best care of my daughter. I currently wear my CGM almost 24/7, but this is because I understand how it works in my management plan. I don't expect the results to match exactly with my meter, and I don't anticipate that the sensor adhesive will hold perfectly every time; I am comfortable with its shortcomings. But I do expect it to alarm when my blood sugars are out of range, and I want to use those 24-hour graphs to assess the effectiveness of my insulin doses. I know it's not going to change the landscape of my diabetes, but it can definitely help me uproot more than a few unsightly weeds.
Like anything else with diabetes, a CGM is a tool for management, but not a cure. It's not the only way to monitor your numbers, and it has just as many bumps in the road as any other budding technology. But I do know that when I'm wearing it, I feel safer. I drive more confidently, and I sleep more soundly. (And if my seven-year-old self had even an inkling that this kind of technology would be available in the future, she would have been in even more of a hurry to grow up.) If diabetes is a balancing act of blood sugars and exercise, food and stress, emotions and information, then the continuous glucose monitor is like a safety net beneath me while I do my best to stay balanced.