The Grand CGM Adventure

It's been a hot second, hasn't it? I essentially ran out of things to discuss. I'm not a doctor, so I'm not going to come rushing back here "With the latest news in diabetes treatments and technologies!" But it's once again time to check in because something old and new is happening.

Go ahead, Rob. Confuse what few readers you have.

I'll start with the old stuff, which involves my diabetic neuropathy. This is some BAD juju. My nervous system is in such rough shape that I can no longer accurately tell what my blood sugar is without a meter. It wasn't as though I could guess a number and have the glucometer confirm it, but I could at least say when I felt high, low, or normal. Now...? I'll feel hyperglycemic when I'm actually normal. I'll feel hypoglycemic when I'm running a bit high. And apparently I've gone as low as 54 without feeling it.

That, my friends, is a dangerous way to live.

For several years, I've griped about how Medicare doesn't cover CGM's. Continuous Glucose Monitors. It was so stupid. Here was a piece of technology that could help us diabetics know at a glance what our blood sugars are before, during, and after meals, which could lead to tighter control, and they refused to pay for it...

...until March of 2022. I found this out when I'd finally lost my patience with not knowing what my blood sugar was doing. This is when my glucometer came back with a reading of 54, and until I saw the number, I had no idea I was that low!

Part of my problem with monitoring my sugars was the fact that the prescription for my testing supplies read that I should check "four times daily." That meant, at the most, I could only check four times a day because insurance wouldn't allow for extra tests. I was determined to send a message to my PCP through the patient portal saying that I needed a new prescription that would allow for testing up to eight times a day.

While typing out my message, I got curious. Off to Google I went to ask, "Does Medicare cover CGM's?" I felt I already knew the answer. "No. Beg all you want, peasant! We only pay for technologies that are around five steps behind anything people would consider 'modern'." So imagine my shock when I discovered that CGM's have been covered since March of 2022!

If I had two feet, I'd have danced a jig!

My message to my PCP was changed to "I need a CGM yesterday!" He agreed. And while he and my pharmacy were jumping through bureaucratic hoops, I learned that I would still need the supplies to test manually eight times a day, just to make sure the CGM was working properly. I would swiftly learn it's just a wee bit more complicated than that.

So now that I have a CGM stuck to me, here's how testing goes:

1. Check the CGM. Let's imagine it says that my blood sugar is 133.
2. Manually check my glucose. The meter say I'm 92. 
3. That's a fairly sizeable gap between results, so I go into the receiver of the CGM and calibrate it to the meter's results.
4. Finally, I get another read from the CGM and it now reads 103, which is a much better differential, 92 to 103, than 92 to 133.

The thing to keep in mind is that BOTH devices aren't 100% accurate. There's always a miniscule +/- variable that we mere mortals can't calculate. We have to operate on the assumption that the meter is closer to the right number, and therefore we need to "teach" the CGM to close the gap when it reads a wide difference between results.

Now for some confusion... because what would my life be without confusion, right?

I kind of cheated when I sat down to learn how to use my sparkly new CGM. I went to YouTube, found the manufacturer's channel, and watched a few "how to" videos. The video on calibration said to calibrate the receiver every 12 hours. That seemed... wrong. If it was going to have such a wide discrepancy every time I manually checked my glucose, shouldn't I calibrate at that time?

It's my philosophy that "smart technologies" are very smart at all. Do the wrong thing at the wrong time and you could confuse whatever device it is that's supposedly "smart." Without insurance, my CGM costs over $550 for three sensors, one transmitter, and one receiver, so I was afraid I'd break something and wind up having to scrounge up the money to replace it... which is why I called up their customer service line to ask if I calibrated every time I checked my glucose manually, would it... ummm... blow up?!

The simple answer? No. In fact, the CGM seems to be more accurate every time I calibrate it. After four days of correcting the receiver, there's been less and less of a gap.

Going from most recent to most distant, my last four A1c's have been 6.8, 6.5, 6.5, and 6.4. My PCP is starting to think I'm a unicorn, in that he's simply not accustomed to seeing a diabetic consistently stay between 6.0 and 7.0. Why bring those up? Because if I followed how I felt without knowing what my blood sugar actually IS, my A1c's would turn to garbage. Allow me to give an example:

Sitting here, watching a movie or writing a thing, and suddenly I'll think I'm feeling low. That's when I'd reach for something to bring my blood sugar up. I wasn't allowed to check my glucose between meals due to insurance restrictions, so I'd blindly treat what I believe is hypoglycemia. Yesterday, I started feeling low, but now I had the benefit of pressing a button on my CGM receiver, and... Hmmm... It says my glucose is 144. Is that right? Check manually, since now I can check eight times a day. My meter says I'm at 130. I would have eaten something to raise my blood sugar when it it was completely unnecessary! If I did that too often, my A1c would come back indicating that I was losing control of my diabetes.

Also, do you remember my entries that included the Somogyi Effect? Well, now the CGM's alarm sounds when my blood sugar dips in the middle of the night. Unfortunately, the device isn't as fast as I'd like it, so its alarm will go off repeatedly while I'm treating my hypoglycemia. I wish there was a way to teach it patience. Like, "Dude, cool pits. I'm working on it. How about you learn how to alert me when my sugar's reaching a normal level?" Alas, I fear I'm asking too much.

So, my friends, we've reached the conclusion of this latest adventure. This is usually the part where I put a picture of a beautiful woman and claim that she's my wife. Alas, todays human female is FAR TOO YOUNG. Take a look...

This is Faye Nightly, age 10.

For reasons beyond my understanding, my Facebook feed will throw suggestions at me, trying to catch my interest. Their suggestions are usually WAY off. Then one fine day, FB suggested little Faye, here. What captured my attention immediately was her massive wealth of hair! There's just so much of it! It's crazy! As I understand it, her hair has never been cut. Trimmed, perhaps, but never outright cut. So she's been growing that mane since birth! She's youngest and smallest of some youth acting/dancing troupe. (Apparently she's 10 years old and about 4' 6".) She has an Instagram account if you want to learn more about her. Just don't be weird about it, okay?

Still, I can't end my post with stuff about a little girl with enough hair to play Medusa in the MCU. How about bringing back a classic?

It's the return of Jane Douglas!

Hey, I sent her the divorce papers! "Jane Douglas, Somewhere in the U.K., possibly near London." Since she hasn't sent them back, I'm assuming she wants to remain married to the walking, talking wreckage that is me. If she wants out, she can send me her exact address. 😁