First Month on the Dexcom G5 CGM

After wearing a Dexcom G5 for the past five weeks, I can definitely appreciate why so many people within the DOC feel that it is such a game changer.

I’ve been using FreeStyle Libre intermittently for the past two and a half years. In that time I’ve become accustomed to the nature of continuous glucose data, and learned how to utilise this tool in managing my diabetes. It was extremely convenient, particularly since the launch of LibreLink which allowed me to scan the sensor using my iPhone. It was also a more affordable option than CGM, with less of a commitment out of my wallet (i.e. no transmitter needed).

But the Libre was still a costly option. It wasn’t perfect, either. There were sensors that were consistently out by 1 or 2 mmol, which was a bit frustrating. The device had a knack of accentuating movements in blood glucose after I’d eaten, and in those instances the device was difficult to trust. It was also extremely sensitive to environmental factors. Things like getting up out of bed in the morning, or shifting from a dark room to a bright one.

Taking all of this into account, I always felt that I benefitted most from using Libre intermittently, supplemented by an AccuChek Guide.

I knew that CGM would give me more options going forward if I wished to explore any commercial or DIY closed loop options in the future. I was also sick of spending money on things that I didn’t want to be spending it on (hello, bills) and not so often on things that I actually wanted. I was at a point where I really did want to at least try CGM for myself, hoping that it might offer me a little more convenience over having to prick my finger 15 times per day. I knew that there was an affordable option out there thanks to some very bright diabuddies and the Diabatteries Down Under community on Facebook.

I got myself set up on the Dexcom last month, which I wrote about in my last post here, and I was able to trust it pretty quickly. Within a few days, I quickly realised that I no longer had to worry about all of those imperfections that accompanied the Libre. It was just accurate 95% of the time. That definitely improved my attitude towards my blood sugars, because I wasn’t seeing so many false upward arrows or accentuated blood glucose readings.

The system requests two calibrations every twelve hours with a finger prick, and I would say that this is the most important piece of maintenance that the system asks of me. I learned the hard way not to over-calibrate my CGM, even if the reading was a little out from my meter. Quality over quantity wins out here. I think it’s important to calibrate with clean hands, and when my blood glucose is in range and not moving too much. For me, that’s first thing in the morning, and just before dinner. The system learns from each and every calibration, and a new calibration does not ‘replace’ your last one.

The sensors are technically only approved for seven day wear, but can simply be ‘restarted’ at the end of their life. I got 21 days out of my first sensor on my tummy with great accuracy. It was a good choice for a first placement, however it did tend to annoy me while I was sleeping and I can’t say I liked the sight of it there. Sensor number 2 is on my arm, and I love how out-of-the-way it is there so far.

The alerts don’t bother me too much, as I’m generally able to manage my blood glucose quite well. It is nice to have the alert wake me up if I go out of range at night, which enables me to correct it rather than wake up high and struggle to bring it down. The low alarm is also a nice reminder for me not to put off treating my low.

So far, I am absolutely loving the convenience that CGM offers. I acknowledge just how privileged I am to be saying that. It’s so nice to simply glance at my phone at any given moment to see what my blood sugar is doing. I appreciate this more than anything in the middle of the night, when I don’t have to haul myself up and prick my finger. It’s also nice to be able to leave the house for a short time with nothing more than my iPhone and glucose tabs. It definitely doesn’t feel as hard as it previously did to keep my blood glucose within my target range of 4 to 8 mmol.

On a final (and more personal) note, I just wanted to say a massive thank you to the Diabatteries Down Under community and the kindness of strangers that have helped make CGM much, much more affordable than I ever thought was possible.

So far, I couldn’t be happier to have taken this leap.

t:slim-aversary

At around 8 o’clock on Friday night, as I was sitting in front of my MacBook revising through Company Law notes trying to stifle my yawning, it dawned on me that I had marked one year on my t:slim.

Pump fatigue had accompanied me for the majority of the two and a half years that I had been pumping insulin prior to the t:slim. That could be partly attributed to the significant adjustment and learning associated with a new method of insulin delivery. The high personal expectations that I’d set for myself probably didn’t help my cause, either.

But the other significant reason for that pump fatigue was that I was bored. Diabetes is such a monotonous condition to live with. Waking up and doing the same thing every day, over and over again does little to excite me. When my long term health is on the line, I need my diabetes tools and technologies to motivate me to keep doing this for the rest of my life until the cure arrives in five years’ time.

My late Animas Vibe was doing little for me in that department. Quite frankly, it was something that belonged in the last decade. Quite possibly even the ’90s. It was chunky. It’s clip wobbled all the time. It’s skin quickly began to peel in various places. Navigating that pump was like navigating a game of Tetris.

There were times where the pump itself really bothered me towards the end. I so badly longed for something new and exciting. The market here in Australia was looking extremely dire of choices at the time, and never in a million years did it look like there was even a remote possibility of Tandem’s beautiful little pump hitting our shores.

Thanks in part to the demise of Animas, the t:slim finally landed Down Under last year – and it was everything I had been longing for in an insulin pump for such a long time. Small. Modern interface. Highly customisable settings. Could easily be mistaken for a smartphone. By far, my favourite thing about this pump is its size. I did miss having a clip in the beginning, but now I love being able to discreetly tuck the pump into my waistband when I’m dressed for work with ease.

Like any new piece of diabetes kit, it was definitely an adjustment. Particularly learning how to fill those black cartridges and developing a sixth sense for fill flaws.

Reflecting on the past year, I think the biggest change I’ve noticed is that the pump fatigue is all but gone. I can honestly say that I still love picking up this pump and administering insulin just as much as I did on day one. My pump definitely supports my motivation to manage my diabetes, and that is definitely something that Iā€™m keeping in mind with a pump upgrade on the horizon in the New Year.

#TslimForFrank!

P.S. No disclosures to report here – I just really love my t:slim!

I Never

I’ve never pricked my finger without washing my hands first.

I’ve never swapped an infusion site without rubbing an alcohol wipe over dry skin first.

I’ve never thrown a syringe in the bin because a sharps container couldn’t be found.

I’ve never left an infusion site on my stomach for longer than three days.

I’ve never pushed a pen needle beneath my skin more than just the once.

I’ve never seen a purple bruise from injecting into the same spot.

I’ve never had more than two hypos in a single week.

I’ve never treated a low blood sugar with chocolate, biscuits or cake.

I’ve never given more insulin than what my bolus calculator suggested.

I’ve never worn a sensor on my arm, or Libre on my leg.

I’ve never refilled a cartridge that’s already been used.

I’ve never filled my reservoir with more than three days of insulin that I would use.

I’ve never left the house before without my backup gear.

I’ve never forgotten to write down in my logbook a single blood glucose reading.

I’ve never walked off to the bathroom to test or give myself an injection.

I’ve never attempted to minimise the impact of diabetes when talking to family and friends.

I’ve never lied to a healthcare professional, for fear of their reaction.

I’ve never trusted another person with diabetes, especially those I know from the internet.

I’ve never failed to correct an ignorant diabetes comment.

I’ve never used diabetes as an excuse to get out of something I didn’t want to be doing.

I’ve never for a minute doubted that diabetes might be able to stop me.

I’ve never wavered in my faith of a cure being just five more years away.

Keeping My Options Open

I walked away from my third Diabetes Congress last month thinking about how damn bright the future of diabetes treatments are looking. That’s not something that I could have said so easily 24 months ago. I can’t go any further before acknowledging my privilege in being able to feel this way. Today we have new pump choices, competition on the horizon for CGM, interconnected smart pens, nasal glucagon and hybrid closed loop systems (both commercial and DIY) to name a few.

Continuous Glucose Monitoring is something that I never, ever, ever thought would be an option for me. The system is extremely expensive to use, and unfortunately I don’t qualify for any government subsidies here in Australia. But the more I thought about that bright future, the more I knew that at least trying a CGM would undoubtedly give me more options.

Thanks to Diabatteries Down Under, a community on Facebook that is helping to facilitate cheaper CGM access here in Australia, I am now up and running on the Dexcom G5 system. (If you’d like to learn more about cheaper CGM, you can join the group on Facebook). The Dexcom consists of a sensor that sits just underneath the skin on my stomach, measuring my blood sugar every five minutes. A transmitter sits on top of the sensor, and sends my blood glucose data straight to my iPhone.

Like every new piece of diabetes toolkit, the Dexcom was definitely a learning curve. I’m glad that I chose a quiet weekend where I had the time and patience to get it all set up, and equally I’m glad that I’m over the hump.

It did take me a few days to trust the accuracy of the device. The system requires one calibration every 12 hours with a finger prick. One lesson I learned the hard way was that my over-calibrating did more damage to the accuracy of my CGM. My understanding is that the system’s accuracy is formed from each and every calibration, and not just the most recent one. More calibrations do not equal greater accuracy. After I stopped and restarted my sensor on day 3, the accuracy was superb.

Another big mistake I made was integrating the CGM with my t:slim in addition to my phone while this was so new to me. With every alert, I had two devices needing my attention. Suddenly my pump had come alive with beeps and alerts, and given the nature of our attachment, it was clear that this was the one that had to go. A shutdown and restart of the pump thankfully restored my t:slim to the pump I know and love.

I’m loving the novelty of being able to see my blood glucose readings from a glance at my phone. I’m pretty lucky to come into this in a position where I already manage my blood sugars quite well that the system’s alerts don’t bother me too much. After three years of intermittently using FreeStyle Libre, I’m also confident that I feel comfortable with the continuous stream of data.

This is still very much an experiment. I’ll be looking to see how feasible this system will be to run in the long term, how much benefit I’ll be able to reap from it and of course how much I like using it. Stay tuned.

Hypo Hunger

I could feel it coming on as I approached the front of my house, failing to steer the car closer to the kerb as I usually do to reverse onto the driveway.

‘I’m going low again,’ I thought to myself as I pulled myself out of the car and locked it behind me. I’d already pre-emptively treated with two glucose tabs around an hour ago, but I knew that my blood sugars weren’t quite able to hold on.

I knew that the sensible thing to do would be to open my bag and pop another two glucose tablets into my mouth. But I wasn’t thinking clearly. I guess it didn’t help my case that I was already feeling a little depleted after an extremely busy day at work and in need of some fuel.

I got dressed as quickly as I could and prepared my usual milky afternoon coffee. I gulped it down, rather than savouring it, almost as though I was using it to quench a thirst that I didn’t know was there. I opened up the cupboard and grabbed an Arnott’s Royal from the biscuit container. I pulled my pump out of my pocket, registering the low blood sugar and entered the carbs that I’d eaten so far.

But it still wasn’t enough.

I opened the cupboard once again, this time eyeing an already opened packet of Honey Soy Chicken crisps. Normally, crisps aren’t something that I indulge in. After years of eating them after school, I miraculously managed to evolve this habit into an afternoon coffee. Which is excellent, considering how terrible they were on evening blood sugars.

But today I opened them, with the intent of just eating a few. Just enough for a taste, without the need for a bolus. But the more I ate, the harder it was to stop. I must have had a few decent handfuls, at the very least. All the while, blissfully unaware of the realisation that I’d need to bolus.

Safe to say, my poorly timed boluses weren’t able to catch up to my rising blood sugar for quite some time. I probably spent a decent few hours attempting to repair the damage I’d done.

Most days, I can fix hypo with nothing more than a few tabs of glucose.

But on those days where hypos and exhaustion collide, I’m compelled to raid everything but the kitchen sink.