My Dexcom Learning Curve: Better Diabetes Management
Over the years, I have been fortunate to be active and body conscious, which in the long run has paid off with no diabetes complications. While many people say complications are looming around the corner, I have yet to experience them. With the invention of the insulin pump, many people with diabetes have changed their lives for the better, because they could better adjust their insulin needs by a finite amount, making for a huge difference in their A1c hemoglobin. But is it the pump or knowing the pattern of blood sugar that makes the change for the better?
For people like myself, a 40 year veteran of diabetes, the magic A1c number desired by doctors appears to be from around 6.2 to 6.5. Most of the time, I have been between 6.5 and 6.8, which is still a healthy range. But, I hit a snag when I moved to the pump and I rose to an A1c of 7 and then when I transitioned back to the pump, I failed to do the work and rose again to 7.9. For me, that is unacceptable! So, last month, I called my CDE, Judy, and said, "Let's start with re-educating my brain to work with my diabetes." During that discussion, we decided that it wasn't the pump that I needed, but a continuous glucose monitor (CGM). I chose a Dexcom, and must admit that my experience was seamless and I want to share with you what I've already learned.
After 40 years, I'm taking roughly 30 units of insulin a day. At the moment, I take 7 units of Levemir in the morning and 6 units of Levemir at night. The rest is Apidra, or short acting insulin, depending on carb counts and other factors. On a bad day, I can double a short-acting dosage. Insulin sensitivity is always a crapshoot for me, which creates the variation in short-acting insulin requirements. More exercise, less insulin, more blogging, more Apidra!
Sometimes, a low-carb day with exercise can often mean no Apidra for most of the day. When I hiked Mount Washington several years ago, I remember stopping and eating a power bar and a peanut butter and jelly sandwich and an hour later on the trail, I was at 110. I made it through my day with only basal, or background, insulin. I tested a lot because I was blind to the trend to know when I needed something, but every time I tested, the meter indicated that I was not having any spikes, just a low threshold of 70-122. My endo was sure there had been spikes I missed and I probably had needed some amount of short acting insulin, but if I did, I never saw it in the test! This is what I call the "blind side" to diabetes management.
I've been wearing my Dexcom for about 10 days and I must confess, I'm sold! The first two days I wore the Dexcom, my trend wasn't a "trend" - it was a roller coaster. At my CDE's suggestion, I set my target range for 70-240. The first day, my graph looked like a random setting on a treadmill for someone training for a seriously hard event! (A good analogy when you think about diabetes and what it can do to your body).
But what I have learned has helped me adjust my eating and corrections, and now, I am within my target range all day, and for a few hours I'm looking at a flat line. Woohoo!
Once I started staying within my target range, I adjusted my high number of 240 down to 220 and I've made my goal of 180 as the "high" number. This is what tight control looks like.
By seeing the trends, I have learned something that has been a mystery to my endo and CDE. For the past five years, I have had lows at night 3-4 times a week. Between 1 am and 3 am, my blood sugar tends to plummet and I often hit lows like 30 and 40. By seeing the trend, Judy and I decided to move my evening dose of Levemir from 6 pm to 9 pm and cut it by one unit. Since this adjustment, the lows between 1 am and 3 am have disappeared. This feels like a small miracle!
Another learning curve is how fast some foods affect me. When I see the double arrows going downward, I know it's time for a snack, and I can address the problem before I hit a number like 40. Double arrows going upward tell me that I either didn't take enough insulin, or I need better timing on when to take the insulin before I eat. For example, I need to take insulin about 40 minutes before eating Chinese food and I learned that I need to lower my carb ratio to deal with rice; I actually use 1:8 when eating sushi, normally, 1:10 or 1:12.
I've also learned that my blood sugar likes my breakfast choice of greek style yogurt or oatmeal with banana and two tablespoons of vanilla ice cream the best! Yogurt and oatmeal don't give me spikes. My body loves green tea over coffee and Starbucks is a great way to reach outside my range, so I have a little Starbucks before I go for a run. As it turns out, a salad with chicken slices requires no bolus. It is a scary feeling not to inject for food, but the trends tell me that I don't need it. As a result of ten days with my Dexcom, I've not only tweaked my insulin needs, but I've reduced my daily insulin requirements.
Last week, I met Beth McNamara and Dr. Cogen at a HealthCentral event and I pulled out my Dexcom so they could coo over my new baby. I showed them my three hour, six hour and twelve hour trends. Dr. Cogen said, "Ann, take a picture of that flat line and post it to the site! This is fabulous!" My Dexcom has not replaced my meter, but has instead added valuable information to allow me to tighten my control. I have been doing blood sugar checks for years, but my Dexcom has given me a bigger perspective, and the tiny tweaks have made a huge difference!
If you cannot afford a CGM, I highly recommend seeing if your doctor can access a week-long trial with any CGM company. You can also call Dexcom and ask about their Dexcom diagnostic sites. They have a blind system that takes the information and you can review the results after your three-four day trial. Then, they can switch to real-time data, so the wearer can see the data and make the necessary changes. This is real diabetes education, versus guessing what might be the problem!
Read the whole series!