#DBlogWeek ’15 – Day 3 – It’s dirty

Pic 20This, I think, is the amount of BG meters I’ve acquired over the years that are stashed away on the top shelf of the linen closet. I was planning to make it the topic of today’s DBlogWeek post.  But a better idea came to me at 2:15 on Tuesday morning while engaged in a bit of a dispute in a diabetes-related Facebook group over something that really isn’t relevant here. I was also awake at 2:15 am surfing Facebook because an hour earlier I had mistakenly rage-bolused one-third of my normal Total Daily Dose of Novolog to bring down a stubborn BG of only 260 mg/dl, and therefore had to stay awake to chow down on a dozen glucose tablets and patiently and fearfully wait for my CGM to roll back to an upward-trend. For some reason, these are the times when I come up with my best blog posts.

DblogWeek-2015

It must have been karma, that self-administered overdose of insulin. That worry of “what have I done?” and “what’s going to happen to me?”, simultaneous to the implication I made in that online discussion that someone else isn’t doing “it” right. Do unto others as I did, and something bad will happen unto me.

I emerged from the insulin-overcorrection incident with little physical evidence other than the chalky, orangeyish residue in my mouth. The opinion-overcorrection left a scar — a scar in a place that has seen many other scars develop lately.

My conscience.

In response to today’s DBlogWeek prompt (click here), the thing that needs a thorough cleaning the most is not my museum of blood glucose meters, nor is it my collection of unused pen-needles from eight years ago (“just in case”), nor is it the bottom of my backpack which is coated with the residue of an exploded Level-life gel.

It’s my conscience. I have a dirty conscience, and it’s been weighing heavily on me lately.

Over the past year or so, I’ve not been as warm within the diabetes community as I’d hoped to be. Some of my posts have been increasingly critical. Some of my tweets have been outwardly confrontational. Some of my comments have been borderline condescending.

It hasn’t gone unnoticed by me. I’ve been making a concerted effort to change and to be more welcoming and more accepting. But so far it hasn’t worked, and the regret reprises itself moments after I click “Publish” or press “Send”. The unpublished drafts on my own blog, you’ll see that it’s filled with these types of examples, but my published comments on some other blogs are out there for eternity.

As I make my short-lived cameos lately within the DOC, it’s as if a dark cloud hovers over me and drives me to retreat back to seclusion and isolation. I’ve really grown to dislike who I’ve become sometimes, and I’m troubled by the perception I expect others to have of me.

If this has gone unnoticed by you, wonderful. But I know some of you have seen my improper statements, followed by a feeble attempt to un-say whatever it is that I had just said. At one point, a d-blogger for whom I have tremendous respect and admiration noticed my sudden streak of negativity and called me out on it (thankfully, in private via email). I still haven’t forgotten it, and if that blogger is reading this, Thank You. I needed it (and perhaps a few more doses of it as well).

But it’s not only the things I’ve said and regretted that weigh me down, it’s the things I’ve thought and not said. The opinions I keep in the privacy of my own brain. After all, I am my own worst critic.

Now, I am committed to finding a way to making my conscience clean again.

Somehow.

I recognize it won’t come from changing my behavior; it must come from changing my thoughts.

How do I do that? One possibility is to step away from these situations (as I’ve been toying with doing) and take an extended and forced break from the DOC. Another possibility is to immerse myself so deeply in the community that I grow to love everyone in such a real and non-superficial way that a mean thought never crosses my mind again. That’s probably not realistic. I’m not sure there is a right answer – but it’s got to be somewhere in the middle.  I’ll try to find it.

In the meantime, I still seek a clean conscience.

So — if I’ve said anything to you that was upsetting, offensive, rude, or demeaning, or if I just made you uncomfortable, I’m sorry. I won’t link to those spots on the web (why open old wounds?) but trust me when I say that I haven’t forgotten, and I haven’t forgiven myself yet.

 

#DBlogWeek ’15 – Day 2 – Feeling secretive

I just found out my latest A1C on Thursday, and though it’s not totally unexpected, I’m not happy about it.  It went up by 3/10 of a percent. No, I won’t tell you what it went to. I’ve discussed my reasons for the secrecy around it before, and though I’ve wavered on that stance a bit lately, I’ve managed to stand my ground. But that’s not what I’m here to talk about today.

DblogWeek-2015

Yeah, this topic was was my idea (there are eight other great DBlogWeek topics – learn about them here!), and given the level of effort it’s taken to come up with a response, I’m not sure what I was thinking when I came up with the question.

But my answer to the question ‘What are some of the aspects of diabetes that you choose to keep private?’ comes more as behavioral observation than of thought.

Needless to say, this is a very personal topic. I don’t expect everyone to nod their heads in agreement. In fact, I don’t expect ANYONE to nod their head — these thoughts are mine and mine alone.

And that answer is this:

You will never hear/read me discuss my deepest, darkest, recurring feelings about diabetes.

Yes, there are certain fleeting moments that will make me feel some sort of _____. (pride, anger, joy, resentment, frustration, jubilation….take your pick). I’m happy to discuss them, but these are superficial feelings that come and go, not the underlying feelings that manifest themselves in all sorts of actions and behaviors.

This may come as a surprise, given the DOC’s wholesale endorsement of feelings. We have Twitter chats about feelings, we have hashtag campaigns dealing with feelings, Tumblelogs rooted in feelings, we even have game-cards that probe our inner feelings.

But I feel like there is such a thing as over-sharing feelings. For me, personally, the threshold that defines “over-sharing” is rather low.

I find it tough to go into deep thought about feelings, much less discuss them. To me, there simply is no point. It’s an investment that pays me no dividends. Sometimes, they’re tough to comprehend, and thinking about them to the point that I can put them into a coherent sentence structure requires an incredible amount of focus.

An incredible amount of focus…on diabetes. Focus on diabetes to a magnitude beyond what is required to manage the disease itself. (Isn’t the “required” amount enough?). Quite simply, oversharing feelings on diabetes can only lead to one thing: accelerated burnout. For me, that can happen quickly. So I prefer to deal with the details of the superficial or the technical, but not the emotional.

My thoughts are my own. Your feelings may vary.

But to take it a step further, it seems to me that the oversharing of d-feelings within the community tends to be morphing into an implied prescription into how a PWD should feel in various situations: afraid, angry, sorry, obligated, victimized, categorized. (In fact, my use of the term “PWD” in the previous sentence is a perfect example; it never bothered me before, and now I’m trying to de-program myself to the point where it doesn’t bother me again).  When a community develops a collective set of feelings, any thoughts or feelings to the contrary could make someone feel like an outsider.

To the point, there seems to be little acceptance of the feeling of indifference (which, contrary to the topic of this post, is fleeting, and therefore appropriate to discuss. My “rules” have lots of quirks and exceptions). Yet the feeling of indifference is the easiest for me to deal with. If I don’t have to discuss it or think deeply about it, it won’t overwhelm me.

There’s enough in my life that overwhelms me. I don’t need to voluntarily add more.

So, by not spending the time to talk about or think about feelings, I have more time to go about my “real-people” activities. I can attend real-people parties, go real-people shopping, and do real-people yardwork. Depriving myself of real-people things (except, perhaps, for the infamous “real-people sick” thing) is worse than depriving myself of honest feelings.

That’s just how I feel.

#DBlogWeek ’15 – Day 1 – (Un)grateful

 

How on Earth am I supposed to put up seven posts in seven days, when I’ve barely done that in the past two months? Maybe the Sixth Annual Diabetes Blog Week (affectionately DBlogWeek) will motivate me. Learn what this is all about here.

DblogWeek-2015

* * *

What can I do, thanks to diabetes, that I probably couldn’t have done without it? That’s the gist of our lead-in topic, isn’t it?

It’s a tough question to answer. Because, while it’s easy to say how diabetes has shaped the person I have become, I haven’t the foggiest idea what kind of person I would have become if not for my natural insulin-deficiency.

I like to think that diabetes played a role in my shyness and introverted nature in my younger years. But maybe I would have shunned large crowds simply because I’m my mother’s son, and it runs in the family.

I like to think that diabetes made me a more sensitive and compassionate person. But maybe I would have been equally sensitive and compassionate because I have a brother whose medical condition is much more restrictive than my own.

I like to think that diabetes gave me a tremendous respect for parents and teachers who constantly look out for the young ones within their care. But maybe I would have had that same respect because I was lucky to have some of the world’s best parents and teachers as part of my life.

I like to think that diabetes forced me to place more value on people’s well-being than on places and things. But maybe I would have put people first anyway after my family’s brief bout without a home to call our own when I was twelve years old.

I like to think that diabetes has given me reason to learn the value of patience. But maybe it was show-moving New Jersey traffic, and not slow-acting insulin, that made me learn to accept what I can’t change.

I like to think that diabetes, and my interactions with others in the online community, pulled me out of my shell and gave me the confidence to speak loud and proud about things I care about. But maybe I would have developed that confidence anyway after finding success in my professional life.

The point is this. If not for my early shyness and my compassion and my respect and my values and my patience and my emerging confidence, I wouldn’t be the person I am today. I wouldn’t have maintained strong ties to my extended family as age takes its toll and those bonds elevate in importance; I wouldn’t have remained single and unattached through my late 20s; I wouldn’t have sent that email to that girl from New York that I met one weekend in Virginia; I wouldn’t have married her; I wouldn’t have the two greatest kids in the history of the world as my sons; and I wouldn’t be writing this post.

I can’t say that diabetes has mapped every step of my life’s path, but I can say that the path would have not been the same without it.

And I’m happy with where I’ve ended up.

So I can thank diabetes for where it’s gotten me so far.

.

.

.

But now, diabetes, I don’t need you anymore. I’m done with you. Please go away.

 

Dexy’s midnight run, part too (ra-loo-ra)

Say, come on Eileen
These things they are real and I know
How you feel
Now I must say more than ever
Things round here have changed
I say, too-ra-loo-ra, too-ra-loo-rye-aye
    –Dexy’s Midnight Runners

Initially, I thought switching CGMs would be effortlessly simple – like performing the same familiar dance to the same cheesy 80s song, just in a different discothèque.

But now I must say, more than ever expected, things have changed with my venture into a new Continuous Glucose Monitoring venue. Even the little things, which I thought were insignificant and irrelevant, turn out to be real and to really matter.

The obvious changes are procedural. The not-so apparent changes have to do with the feelings the different device evokes. Since I’m not such a touchy-feely type of guy, I never gave much thought to this aspect of things. Needless to say, the change in my mental-state over the past week or so has really caught me by surprise.

(Missed Part 1 of this series? You can find it here.)

LONGEVITY

May 2014 prediction: Not considered.

Warning: this section deals with a common, yet still off-label use of CGMs. If you are the type who prefers to operate “by the book”, or if you are tasked with enforcing the book, you may wish to skip this section.

The Enlite “lasts” for six days. It can be re-started, but the Minilink transmitter holds enough charge for seven. So by the seventh day, I would find that I need to carefully unwrap the layers of adhesive, charge the transmitter for about 20 minutes, then re-connect, go through the menu sequence, and wait a two-hour warm-up period. In my overall experience, the sensor would last about ten days, though once I had a sensor last nearly two weeks.

I’m still wearing my first “seven-day” Dexcom sensor, completing day twelve as of this writing. It seems the back of the sensor-pod is now lifting from the adhesive, and I did need to call in reinforcements for the adhesive on the sides on Day 9. But it seems to be going strong with no sign of slowing down.

What does this have to do with feelings? Well, as nervous as I may be about knocking the monstrous bulge off of my body, it’s comforting to know that I’ll always have spares. With the Enlite, I felt it was pretty much an unwritten requirement to extend the life of my sensors beyond the on-label duration. It would ensure that I wouldn’t run out of sensors in case one didn’t work quite right and I needed to insert a new one prematurely. It made me nervous not to have an ample stash.

My Dexcom supplier only ships one month’s worth (actually, 28 days worth) of sensors out at a time.  Stupid, if you ask me, because they called me to tell me it was time to re-order just three days after I received my initial shipment. (I declined the re-order at that time, because I needed to “feel-out” the system during my 30-day return period). But knowing I can double (at least) the length of just about every sensor I use makes me comfortable that I’ll never run out and I can survive any sort of shipment delays.

Verdict: Unexpected source of peace and comfort.

HYPOCRISY / INTIMATION

I miss my predictive alerts. I miss them dearly. It’s shifted my whole method of CGMing from one of being proactive to being reactive. No longer do I adjust a basal, take a correction, or enjoy a nosh because of an impending low or high BG. I generally always wait until the alert comes, and then I curse myself for not catching it sooner.

In my attempt to “catch it sooner”, my low threshold is a bit higher than it was on my Medtronic. Only by a little — my low threshold is 85 mg/dL instead of 80, but when the brilliant color display shows 84 mg/dL in “rage-red”, it angers me. 84 mg/dL is pretty damn good, especially if it comes with a flatline. But because it’s close enough to a low to warrant notification, the Dexcom congratulates me with a blood-curdling Everything Is Horrible visual. Surprisingly, it affects me and my self-perception of success and failure. I’m contemplating lowering my threshold – allowing me even closer to danger – so that I don’t get scolded for walking the tightrope so well.

LOW graphYet, with the absence of Predictive Alerts comes a dramatic decrease in alerts overall (and more restful nights as well). It’s a really nice feeling to wake up after my first night with the Dexcom to realize it hasn’t woken me up once all night. I’ll go hours during the day without an alert as well, which makes me happy and was unheard of with the Medtronic. Yet, I think I spent more time “in-range” with the Enlite system. So which is better? That’s what I need to figure out…

Verdict: Perhaps I ask for too much.

 

ACCURACY / MECHANICS-revisited

May 2014 [before algorithm upgrade] prediction on accuracy: “Never used it [G4] myself, but anecdotes and MARD statistics (whatever that is) say it’s better.”

It may seem unexpected to see me couple accuracy and mechanics into the same discussion. Trust me, there’s good reason for this.

It may also seem unexpected to read these words that I am about to type from my fingertips: So far, I find the accuracy of the Dexcom G4 and the Medtronic Enlite to be about the same.

You read that right: I find the accuracy of the Dexcom G4 and the Medtronic Enlite to be about the same.

When both systems are working at their best, they both work well. Or well enough to be useful, anyway. I haven’t compared them side-by-side.

BG-CGM-arrow-match

On Day One of a sensor,  I actually find the accuracy of the Enlite to be better.  This goes double for the 24-hours after a sensor-restart. I feel like the Medtronic can perform well with one good calibration. If you calibrate to tell the unit what interstitial measurement means a BG of 100, it doesn’t need another calibration to tell it what 200 looks like. I really loved this about restarting sensors, because it picked up with the same level of accuracy at which it left off.

Dexcom, on the other hand, seems to require many calibrations, especially at first (heck, it requires two calibrations within five minutes just to get started!) I’m not sure what it does with them, but I know it takes four or five calibrations to get it trending accurately. Again, this is based on VERY limited expereince. I do also find that the Dex tends to “drift” more than Enlite, requiring a correction-calibration to get it on track.

So why do so many folks (myself included, I admit) have such trouble with the Medtronic? Well, it is my personal (and unvalidated and unsubstantiated) belief that the Enlite sensor is just fine. They put the same care and effort into perfecting that little subcutaneous wire as Porsche did in designing their flat-six engine. The engine is a work of art and engineering precision. But if you take it out of the Porsche 911 and drop it in a Volkswagen Beetle, it won’t quite work right.

What I think happened with Enlite is that they took some beautiful sensor technology and housed it in a haphazardly-designed shell. The shell would not keep the sensor firmly implanted beneath the skin by itself, so the work-around became, quite literally, tape. Any DIYer can tell you that duct-tape fixes everything. But fitting a Porsche engine in a VW requires more than just tape — it needs careful positioning and manipulation — this is where I think many Enlite users (or former Enlite users) have encountered trouble.

Sensor in Serter

The required size of the “flat-spot”, centered around the needle. The other part (the more weighty part) should NOT be as firmly taped against the skin.

Actually, it’s unfair and incorrect for me to say that the shell was a haphazard design. I do think they put some honest effort into the design of the Enlite shell (evidenced by the comfort-improvements over the Sofsensor). But the improvements were geared too much towards the wearer’s needs, and the sensor’s needs got neglected. It is crucial for the Enlite introducer-needle to fully go into the skin, which is something that can’t be controlled, seen, or maintained with the spring-loaded inserter, and then for the sensor to remain beneath the skin. With very little adhesive underneath the sensor, this is accomplished by applying extra tape over the top to keep the sensor firmly in place.

The problem is that you have a(n older-design) transmitter hanging off the side, and together the sensor and transmitter take up a lot of surface-area on the skin. But there is not enough flat area on the skin to accommodate that surface area, so to the contraption tends to rock. The rocking motion pulls the sensor (which is off to the side, not in the center) in and out, which can result in erroneous readings.

Try taping a quarter flat and firmly against a softball. It’s essentially the same challenge. Unless you find a flat part of the softball or you find something to stuff underneath one side of the quarter, it can’t be done.

(Sidebar: I’ve been told by a Dexcom rep that the 90-degree sensor wire is actually detrimental, and that the angled-insertion used for the Sofsensor and the Dexcom helps to better anchor it in the skin. I can neither confirm nor deny this, nor can my engineering mind make any sense of it. Maybe it’s true, maybe it’s not).

Fortunately for me, my body is not too curvy, especially in a certain location on my upper-butt, so I’ve come close to getting it right (after a l-o-n-g learning curve). When a good site is chosen and the taping is effective, Enlite is as good as, or perhaps even better than, Dexcom in terms of accuracy. But combining a workable site (along with proper rotation) with a proper taping technique is arduous, and knowing that a bump to, or roll over of, the transmitter could easily lift out the transmitter is discouraging. If MedT could design a sensor/shell/transmitter that is physically balanced; with sensor wire in the center, and a low-profile transmitter surrounding it (use the QuickSet as a model); they’d have a real indisputable winner in my book.

Verdict: Dexcom accuracy is very good; but I had very high expectations and it didn’t “wow” me.

 

* * *

Still to come: talk about data reporting, landfill-contribution, trustworthiness, and some other stuff I didn’t get to…

Dexy’s midnight run, part 1

These people round here
Wear beaten-down eyes sunk in smoke-dried faces
They’re so resigned to what their fate is
But not us (no, never)
No, not us (no, never)
We are far too young and clever (remember)
Too-ra-loo-ra, too-ra-loo-rye, aye
And you’ll hum this tune forever
    –Dexy’s Midnight Runners

Resigned to what my fate is? Not quite. But I am willing to see what the powers-that-be have in store for me before deciding if I want or need to change it. And if a change is in order, I’ll find a clever way to make it happen.

I decided it’s time to give “Plan B”, A.K.A. Dexy, a try

New Blue DexRather than continue to fight the insurance company battle, I went ahead and ordered the Dexcom G4. (yes, it’s the one that also has “platinum” and “share” in its name, but “Dexcom Platinum G4 with Share” is just as much a mouthful as “Medtronic Minimed 530G with Enlite”, so I’ve decided to shorten the name).

I had weighed the options almost a year ago. Some things have changed since then, some have not.

Still, it seems that so many others have tried it and liked it. And those who didn’t like it? They loved it. So I can’t lose (despite my hesitations), right? After a year of using a loaner 530G (disclosure here), I figured I could commit to a year (the insurance-eligibility period) of the Dexcom G4. Or perhaps 30 days, given the return policy, if I didn’t like it — though that would lead me back to my initial predicament.

The order-process was pretty much painless, and as I expected. The insertion, guided only by the Dexcom-provided videos (because I’m too cheap to pay the $40 copay to visit my endo’s office for proper training) was also pretty much painless. It was still a bit weird-feeling at first, but either the feeling dissipated or I got used to it.

As for my reaction (after wearing it for six days, as of this writing), it’s not exactly what I had expected.

OUT OF THE BOX / CHARGING

I’d suspected that I would need to charge the receiver. The documentation said I needed to charge the receiver. The documentation said that the battery icon would appear “fully green” when it was charged.

I spent about a half hour trying to figure out if my receiver was charged or not, because all I saw was a vertically-oriented, FULLY WHITE, battery icon. I let the thing charge for three hours, and still had the same thing, so I concluded that either it must be either charged, or broken.

Apparently, the old G4 has a nice-sized horizontally-oriented battery icon which turns GREEN when it’s charged (and has an easy-to-see lightning-bolt symbol on it when charging). But the G4 with Share has a tiny vertically-oriented white icon (which goes to black as the battery drains), I guess to make room for the new Bluetooth icon that may sit next to it.

The documentation hadn’t been updated, and though I’ve seen a zillion Dexcom G4 photos in blogs, I couldn’t find one of the G4 with Share online – presumably because everyone just takes screenshots of their iPhones, which is much easier to do.

Also, over the next few days, I discovered that the Dexcom receiver can’t be charged by a normal USB cord, and my phone won’t charge with my Dexcom charger — which is really frustrating considering I have two identical-yet-incompatible micro-USB cords resting on my nightstand. It also explains why my phone battery is presently dead.

Verdict: disappointing

INSERTION / MECHANICS

May 2014 prediction on Insertion: “Intuitive, relatively painless. My CDE says that most patients can do it well without training”
May 2014 prediction on Transmitter Mechanics: “Big and boxy, snaps securely into place. Visually hides sensor.”

This may be true. I took my time to do it right, watching the video with my laptop resting on the bed (I haven’t yet joined the iThing-generation, hence you will find nothing about Share here. Also, the “offical” tutorial videos come with the unit on compact disc, and iThings don’t have CD-ROM drives).

Immediately after insertion, I looked down at the thing and thought to myself:

Big Dex

THIS THING IS FREAKING HUGE!

It stood out from the skin like a brick, and had that ugly, gigantic white football-shaped adhesive (imperfectly applied; hence the wrinkle) surrounding it. And this is with the newer, slimmer transmitter! Turns out, the “sensor pod” that it snaps into adds plenty of bulk itself.

Compare this to the Medtronic transmitter which sits off to the side.  After my Enlite sensor expired, I tried to tape it next to this one just to illustrate the comparison. The tape-job is awful, but the Enlite is noticeably much flatter.

Dex vs Enlite

I had been in close contact with (No More Shots For) Shannon during this process, since she was just beginning a week-long trial of the G4 at the same time. She had just inadvertently knocked her sensor off around the same time I put mine on, so I didn’t have a good feeling about this oversized CGM. I’ve heard of this happening before, and it only happened to me once in four years with the MedT system.

It was easy to insert, though. And I could see how it can be done one-handed on “alternate” sites; something that is quite difficult with the Enlite.  In the end, the size difference is a trade-off of one dimension for another. The larger surface-area of the Enlite causes problems as the body moves and the skin twists and stretches, yet the height of the Dexcom makes it more delicate and prone to damage.

And one more thing — after getting an hour of ???’s on my Dexcom screen following my shower for the next two days, I discovered that the transmitter wasn’t fully snapped into place. I guess the self-training wasn’t as effective as I had thought. But after I snapped it in (hoping no moisture was trapped in there), I was back in business in about half an hour.

Verdict: undecided.

RECEIVER / GRAPH

May 2014 prediction on Receiver: “Extra device to carry around — carefully, or the buttons fall off.”
May 2014 prediction on Graph:”High-res, easy to read. Not a fan of using “red” for high, as the color incites rage on top of the inherent high-BG frustration. Three levels of trend-up arrows and three levels of trend-down arrows.”

I wasn’t sure how I’d feel about carrying an extra device around. But I find that at work and in the car, I kinda prefer it. It’s small and light enough to slip into a shirt pocket, and I can easily access it (or set the receiver on my desk) without fiddling around with the pump clipped near a more private part of my body. When I found myself refereeing my son’s soccer game over the weekend (because the ref never showed up), I used the included belt-pouch clipped to my belt. The way it opens up, orienting the display in a manner suitable for looking down at it, was nice. But the pouch was very tight, and I suspect it’s responsible for so many of those those USB-port covers popping off.

The display is, without a doubt, magnificent. I didn’t think I’d much care about it, but it’s really nice and pleasing to the eye. I can now see myself letting the display factor into my choice of D-devices. I was mistaken, though, when I said last year that the red color was used for a high. In fact, it’s used for a low, but I still don’t like it. Red-on-black is difficult to read — and it still incites a Holy-shit-I’m-gonna-die-gotta-do-something-NOW! response, which I don’t like. Especially since, without predictive alerts (more on that later), the threshold is set where I want to know about it, not where I’m really in trouble.

I miss the ability to scroll-back to see prior BGs.  The trend-arrows give an idea of what’s going on, but I used to like to look back 5 or 10 minutes to assess for myself which way I’m trending and at what rate. Perhaps over time I’ll grow to understand and trust them, but not yet. And the horizontal (east) arrow is misleading, because there is ALWAYS a subtle rise or fall with my BG. Always.

Verdict: pleasantly surprised.

ALARMS

May 2014 prediction: “Only one high- and one low-threshold. No predictive alerts. Dex-in-a-glass workaround.”

First things first; I have my Dexcom receiver set for audible alerts (“Attentive”, to be exact.)  Never in my wildest dreams did I expect to do that — but there are enough vibrating alerts that precede the audible alert, in any profile, that I’m comfortable doing so. The vibrating alert is stronger than expected, with different patterns (which I’m still learning) for different alerts, and the audible alert is plenty loud for me.

Clearing the alerts is easy. Just press the center Select button. Since the receiver is a CGM only, it always works. I did catch myself once pressing Select-Right, to mimic the ESC-ACT sequence of the Medtronic. (Also, the Medtronic sequence is awkward; sometimes the alert doesn’t clear on the first shot — it depends what’s shown on the screen at the time.)

But that’s where the pleasantries end.

This is what a low alert looks like: (that white rectangle in the top corner is actual a gray area with some white trend-line dots that just didn’t come out in the photo).

LOW alert

That is what EVERY low alert looks like.  Whether my sensor glucose level is 85 or 65.  It shows the threshold limit, not the actual sensed glucose level, and an icon of a trend-line that seems to be flattening out.  A high alert is similar. It shows a giant 165 mg/dl (which is my set threshold), even if my sensed glucose level is really 265.

If I was 85 and my trend-line was flattening out, and perhaps making an upward tick, I’d be comfortable.  But this was the reality of the situation at that time:

LOW graph

Quite a different story, and quite a different response.

I appreciate the gigantic number in the alert, but for God’s sake, why can’t the number be correct!?!

But that’s not my biggest complaint about the alerts.

The beauty of the Medtronic CGM system is that there were NO SURPRISES. I was never caught off-guard by a high or low glucose reading, because I had a “Predicted Low” or “Predicted High” alert that preceded it. I’d also gotten in the habit of acting on those predicted alerts, in hopes that the actual BG-excursion wouldn’t go too far. But with the Dexcom, I’ve had plenty of surprises. I’ve found myself, more times than before, frustratingly trying to recover from an out-of-range BG than avoiding one.

I’ve tried playing with the settings, moving the thresholds tighter so that I get alerts earlier. Adjusting the “Snooze” settings (which will re-alert if the BG is still out of range) to be more frequent. Tweaking the Rise-Rate and Fall-Rate settings (which only have two settings, by the way: 2 mg/dL/min or 3 mg/dl/min). But I just don’t think I can make up for the loss of predicted alerts. But I’ve got time left in my trial, so I’m going to try…

Verdict: I can honestly see the absence of a Predictive Alert leading to my A1C rising or to more severe low BGs. We’re not talking convenience or niceties anymore. This could very well prove to be a reason for me to want to switch back to the Medtronic system.

***

Next time… I’ll share my observations on accuracy, data reporting, landfill-contribution, and trustworthiness.

 

Follow

Get every new post delivered to your Inbox.

Join 1,885 other followers