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. 😁

Cheaters Never Prosper

Yeah, yeah. It's a cliché. I'm sure we can all think of someone who cheated and prospered plenty, primarily because they were never caught. However, when it comes to diabetes, cheating on your diet without taking the proper precautions will eventually catch up to you.

I mentioned last post that I learned how to cheat on my diet right under the noses of the people responsible for making sure that I didn't cheat. The analytics of my blog have taken a dive and no one has commented, so I figured I'd just make my way through the list. But not necessarily in order. No, that wouldn't be any fun. I'm still just going to go with whatever I'm in the mood to write until someone makes a suggestion otherwise. So nyah! 😛

Back in the before times, when cell phones were an impossible dream and video games could only be found in arcades, my father became a member of The Suburban Players. This was a community theater group that would put on productions just a few short steps upward from high school quality. They may not have been the best shows ever performed, but they had fun.

In 1977, the musical they chose was Mame. The show has a character named Patrick Dennis. Patrick is 10 years old in the first act and an adult in the second act. And you'll never guess who was 10 years old that year!

That's right! It was me! (I made it really difficult to guess, didn't I?)

Me and a dozen other kids auditioned for the role. In the race for the role, I placed second, (making me the first loser). I was disappointed, but I was also 10, so it wasn't the end of the world.

And then the director and producer of the group realized that the kid they'd cast was actually a giant. They'd given the supporting role of Agnes to a sweet woman who was about 5' 2". In the very first scene, the characters of Agnes and Patrick are supposed to be lost in New York, and they pause for a musical number... as one does when lost in Manhattan. But the boy who got the role of Patrick was growing like a weed. He was already about four inches taller than Agnes and still growing.

So guess who replaced him! (Yeah, I'm terrible at setting up a mystery.)

For three months, every Monday, Tuesday, and Wednesday evening was rehearsal. Blocking, singing, and choreography. Ummm... When I use the word "choreography," I'm using the word VERY loosely. As a group, the Suburban Players could sing and act. But dance...? Not to save their lives! Me included! After those three months, it was showtime.

Totally unrelated to diabetes care, but entertaining... The most flattering compliment about my performance came during these rehearsals, and this compliment wasn't given with words, but with actions. The role of Mame was played by a woman named Marian. The character was supposed to perform in a show within the show and do so badly that she gets fired after her first performance. That's when adorable little me, carrying a bouquet of roses, stepped into the scene to lift her spirits with the song, My Best Girl. Every time - EVERY SINGLE TIME! - Marian would start to cry because she thought it was so sweet. And there was out director, Marty, shouting at her, "MARIAN, STOP CRYING! WE CAN'T AFFORD WATERPROOF MAKEUP!" 🤣

[/boasting]

As mentioned previously, I was taking only two injections a day. It was a mix of NPH (Neutral Protamine Hagedorn) and Regular insulin. What made it "regular?" No idea. I just know it was called "Regular." I took a larger dose during the day to cover the majority of my meals - breakfast, lunch, and afternoon snack - and a smaller dose to cover dinner and evening snack. For the record, the evening dose was about half the size of the morning dose.

Opening night, I was an uncontrolled ball of nerves. I'd been singing in front of the cast for months, but now I'd be performing in front of 300 strangers. ~ Gulp! ~ In my nervousness, I accidentally took my larger morning dose at night. And in case you've forgotten, being extra active makes insulin work harder. Even if I wasn't going to sing and dance, the adrenaline pumping through me would be enough to keep my blood racing through the night.

As luck would have it, one of our cast members was a pediatrician by day. My parents consulted him about what should be done to counter my accidental insulin overdose, to which he suggested - brace yourself - Twinkies. There wasn't time to feed me an entire meal to counter the higher insulin dose, so he recommended I just down a couple of Twinkies as a shortcut.

Can you see what just happened? Yes? No? Maybe?

I - a diabetic for three years up to that point - had been taught to absolutely hate my disease with every fiber of my being by the incubator and two years at a summer camp full of tyrants... had just learned that the "threat" of hypoglycemia warranted an opportunity to "legally cheat" on my diet. And because there was no way to instantly verify this back in the day, my minders had to take my word for it. Remember, this was still the time of urine tests, which were notoriously unreliable in terms of blood glucose management. Home blood testing was still years away. As far as 10-year-old me was concerned, I'd been granted carte blanche to eat whatever I wanted, whenever I wanted. It's really not the kind of thing you want to teach a less than emotionally stable diabetic.

Technically, that was the beginning of me pushing the boundaries of my diet off a proverbial cliff. This was the foundation to many of my hospitalizations, as mentioned in my post from 25 July 2022. By then, of course, I didn't have to lie to people around me. I could take my allowance money and buy the garbage I shouldn't have been eating without anyone being the wiser.

There's a different philosophy toward diabetic diets now. "Take enough insulin to cover your terrible eating habits." You don't have to lie and sneak around. Just be honest with yourself AND your doctor. They might not be happy with what you eat, but knowing you're actually paying attention to your blood sugars and adjusting your insulin doses accordingly will keep them from berating you. I'm still not a doctor, but I AM a diabetic whose Hgb A1c has been between 6.0 and 7.0 for the last eight years, with the last one being 6.5. So just as I said near the start... nyah! 😛

Okay. Here we go. Beautiful young woman... scantily clad... aaaaand GO!

Oh, great. I try to share a picture

of a beautiful, scantily clad woman

and wind up sharing a Link instead.

To My Type 2 Diabetics

Welcome. You're late to the diabetes party, but you're welcome here. (Your club card and membership jacket are in the mail. 😉) Especially because a lot of the nightmarish scenarios I've discussed are sometimes the inciting incidents that get you diagnosed with diabetes in the first place! You could be a diabetic for years, your beleaguered pancreas coughing up just enough insulin to keep you alive. You've chalked up all of the fatigue and general malaise you've been feeling as you simply getting older. 

And then one day you find yourself hospitalized with a seriously infected wound on your lower leg or foot. You tell the doctors that your feet and legs have had some weird pains for years, but, again, you thought it was aging. This wound...? You didn't even feel it when you got it. But that kind of thing happens all the time to people, right?

Yes... to diabetic people.

You've been alive for decades, doing whatever it is you do, following a diet that's somewhere between that of an adult and a seven-year-old. Yes, you had a perfectly balanced meal for dinner last night. But now that you're an adult and can do whatever you want without your parents yelling at you, an entire seven layer German chocolate cake for breakfast this morning was perfectly reasonable in your mind.

Suddenly you're being told that the dietary habits you've developed for oh so many years have to be radically changed, and this... THIS is uncalled for! "Radically change my diet?!? I REFUSE!" 

I get it. I really do. Because if you go back to my 13 July 2022 post, Diabetes: The Revenge!, you'll see that I reacted badly when the remainder of my life was explained to me at age seven. I was a child with the dietary habits of a child. I even had messy, childlike rituals for some of junk food. The two I recall most clearly were Hershey's with Almonds and Yodels, which was one of the many confections from Drake's Cakes. 

The Yodels were cakes rolled with a layer of cream and coated in chocolate. My ritual involved peeling off the exterior layer of chocolate with my teeth, carefully unrolling the cake so I could lick out all of the cream, and finally dunk the remaining cake in milk.

The Hershey's with Almonds was artistry in terms of the mess I could make. I'd break off a piece and hold onto it long enough for it to melt in my hand. I would then lick the chocolatey disaster from my palm and spit out the almonds into my "clean" hand. This would continue until the chocolate was gone and I had a tiny handful of almonds, which I'd then devour while humming tunelessly, but happily.

I know. Gross. But this was what I did between ages five and six! If I was still doing that at 55, your concern would be warranted. Now I just eat the almonds along with the chocolate I lick off my hand.

I'M KIDDING! Yeesh.

My point is that I was so blindly enraged when I was told that all of my junk food had to be cut from my life at age seven, that I can fully empathize with how much more difficult that dietary change must be with decades of life piled up behind you.

There's a reason why I'm bringing this up today. Y'see, yesterday I was visited by one of the building maintenance men, Max. (Not his real name.) He's a Type 2 diabetic. He'd recently told me his Hgb A1c was 13.0. 13.0!!! And when he arrived yesterday - 

"Rob? Quick question. What the heck is an Hgb A1c?" 

Oops. How on Earth did I let that one slip by? No idea, but I'll start by pointing out that I may well be labeling it the wrong thing. When I look it up, it's "HbA1c." But somewhere early in my self-education, I learned it as "Hgb A1c," so that's how I'll be writing it in my posts. Note: I'll use both for my posting labels.

A hemoglobin A1c is a blood test that measures your glucose average for the prior three months. As a diabetic, your target is between 6.0 and 7.0. Thanks to my vigilance in controlling my diabetes, I haven't had a result above 7.0 for nearly eight consecutive years. My most recent result was 6.5. So when I tell you Max had a 13.0, it means his average daily blood sugars have been 350.

An A1c chart clipped from some of the

finest Interwebs.

Through our conversation yesterday, I learned that he'd had a Snicker's bar just before coming to my apartment. Although I made it humorous, I was pretty angry that he was thumbing his nose at the very idea of managing his diabetes. He takes two daily doses of a 24-hour insulin, but he doesn't cover his meals with short-acting insulin - it hasn't been prescribed to him - and he doesn't check his sugars before meals. Let's look at another A1c chart to get some perspective on Max's 13.0.

Suicidal! This chart says Max's 13.0

qualifies him as being suicidal!!!

What I told Max yesterday is the same thing I tell every diabetic under such poor control. I AM NOT A DOCTOR! TALK TO THE DOCTOR HELPING YOU CONTROL YOUR DIABETES! Because all I can do is express an opinion. Mind you, it's an opinion backed by 48 years of personal experience, but it's only an opinion nonetheless. What's more, I only know how to take care of MY diabetes. I wouldn't even dare to guess at the precise needs of another diabetic.

I can say this much: Max needs to be checking his glucose and taking a short-acting insulin per meal. How much is between him and his doctor, but I suggested that if he's not going to adjust his diet, he should at least learn to take enough insulin to cover the garbage he wants to eat.

Look, this blog serves two purposes. It let's me vent about my diabetes while simultaneously teaching other diabetics about about their illness the best way a layman can. It's why I stress that I AM NOT A DOCTOR. (See? I did it again.) You need to be talking to the person helping you manage your diabetes to refine your personal care. I've encountered too many Type 2's who simply don't care that they're diabetics and are casually dismissive when I try to explain the dangers of not caring. And if you're one of those kinda of people...? Well, I'd essentially consider you a 13.0, too.

Yes, I indirectly referred to you as being suicidal. Prove me wrong.

And now, no more dilly-dallying, the beautiful young woman, scantily clad...

OMG! That's her! The one I've

been trying to share! But she's

thoroughly clad, not scantily clad.

Well, maybe some day soon, right?