Sue, who has Type 1 diabetes and uses an insulin pump, had been asking about a continuous glucose monitor for about the last year. She previously wore a CGM that paired with her insulin pump prior to having insurance through Medicare (Medicare would not cover CGM for Sue). She really wanted her CGM back. Due to Medicare not covering the CGM that Sue previously wore, she and I discussed the Dexcom G5 CGM system (how it works, benefits, etc.) and the possibility of Medicare paying for this system beginning in 2018.
For those of you unfamiliar with CGM, CGM is a tool that tracks trends in glucose. The sensor reads the glucose every 5 minutes, which allows the person with diabetes to see in real time the pattern of their glucose. This valuable information is particularly useful for those who wear an insulin pump as they can make adjustments to pump based on the current glucose pattern to prevent highs and lows.
During the process of investigating the Dexcom G5 for Sue, I became curious as to what it would be like to wear a CGM. As a diabetes educator, I find it essential to the extent possible to walk in the shoes of those with diabetes in particular those who wear insulin pumps and/or CGMs. Having had an insightful experience wearing an insulin pump (using normal saline of course) previously, I was eager to wear a CGM for at least a week. When I reached out to Matt, a rep for Dexcom, on behalf of Sue, I shared with him about desire to experience wearing CGM for a week or so. He was agreeable and made it happen!
Time to Hook Up
Guess what…I wore a dress (not such a good idea when starting a CGM in clinic) the day I was supposed to start wearing CGM so I had to wait to hook up the CGM until the evening. The company representative was gracious and reviewed with me the details of the CGM. I thought, this is pretty simple and should be easy to hook up and use. I planned to attach CGM and start that evening, except that I got distracted, so I actually started the next morning. I had difficulty remembering how to attach the CGM to my body; however, I recalled the “how to” video on the app. After about 20 minutes (should have only took 1-3 minutes…user challenge), I had the CGM attached and working. Now I needed to remember to calibrate in two hours (thank goodness for the reminder).
Oh My…First Nighttime Low
My friend, Pati (who has Type 1 diabetes and currently wears an insulin pump and CGM), said “at least you do not have to deal with nighttime alarm for low or high glucose when I told her I was wearing CGM. “ So much for not having a night time low…it slipped my mind that a couple of glasses of wine with dinner and no bedtime snack might cause me to dropped low. Around 3 am, I almost jumped out of bed when my phone alarmed. I grabbed my phone quickly to find my glucose had dropped to 48 mg/dL. Not only did it wake me, I also awoke my husband had no idea that I was even wearing the monitor! Needless to say, I watched the wine more closely and had a bedtime snack after that experience.
At this point, I must admit that I love to eat sweets especially around Thanksgiving and Christmas. Well, what a perfect time of year, Thanksgiving, to be wearing CGM to see what these “yummy” treats really do to my glucose – especially if I overindulge! My office had an “international” Thanksgiving lunch with lots of diverse delicious food. I ate more than usual in process of sampling as much of the various foods. I “hit the ceiling” when my phone alarmed with glucose of 188 mg/dL (keep in mind I do not have diabetes so 188 mg/dL is too high for me). I immediately racked my brain in attempt to recall everything I ate over the last several hours. I felt guilty and frustrated at that moment. Ah… for just a moment, I felt in a small way what a person living with diabetes feels when they have a “high.”
Obsessed…. Constantly Checking iPhone
During my two week experience of wearing CGM, I constantly grabbed my phone to see what my glucose was trending. This impulse comes from my obsessive tendencies and eagerness to see the actual numbers themselves. As background, I previously had prediabetes and took metformin however thanks to lifestyle changes I no longer have prediabetes. Based on the many glucose values and trends that I saw on my app, I can confidently say that I no longer have prediabetes (also, my A1c is < 5.7%). Having the numbers (data) from the CGM is invaluable, I can not even imagine what it must be like for a person living with diabetes to have this information.
As my two-week trial came to an end, I was saddened to remove the CGM as I found the real time numbers and data it provided plus the bonus of seeing what impact various foods have on my glucose. I downloaded my glucose report for the two weeks, which left me feeling thankful for this experience. To finish the experience, I had to remove the transmitter and sensor, which proved to be a challenge. Needless to say, I did not remove it appropriately, however, I did get it removed.
Back to Sue, she is still pursuing CGM specifically Dexcom G5 system as Medicare will reimburse for this in 2018. Wishing for Sue to get her Dexcom G5 system in 2018 as well as for Medicare to reimburse for various CGMs for those living with diabetes on Medicare insurance. Happy New Year 2018! #wearing CGM #hand on experience #Medicare