In a moment of weakness

a week or two ago, I actually spent about 30 seconds wondering if I should use a CGMS. Silly me. I now have 5.7 reasons (at least) to argue against any future thoughts in that direction.

That’s my latest, a1c, of course and it came after spending nine weeks on the road covering campaigns in every corner of the country and a full year of high-stress existence.
So, my question: To those of you who have considered but declined to use CGMS, how did you arrive at that decision?
For me, it was simple. I've had D a very long time and have no complications; never had a seizure, never gone to the hospital for a D-related reason; never been incapacitated by a high or a low.
My control is great and my life is even better.
I know there are a lot of people who swear by CGMS and have better lives because of them. That makes me happy. But we don't often hear from people like me, so to all of you out there, I'd love to hear your reasons/thoughts.

John,
You are absolutely correct and I never discount my good fortune. I guess my larger question focuses on how people weigh the benefits and costs (both financial and other) of technology. I got my first meter in 1975 (or thereabouts) and my pump 12 years ago so I’m open minded. Both were easy decisions and have improved my life immeasurably.
But in those cases where the calculation isn’t so clear I’m curious to hear how people evaluate things and decide. It’s especially true for the people in the middle as you accurately pointed out.

In general, DC, I absolutely agree with you about technology…it should be evaluated and chosen…very few people do that anymore, they just grab it and go and never look back to ask if their life has been improved. At my age when I tell people I don’t use a cell phone they think I’m a technaphobe Luddite. Then I show them the complexity of the Course Management System I use to teach online and they understand I decide if something will enhance my life, add nothing, or make it worse.



Ok, enough of that rant. When I first started on insulin I was being treated in a Third World Country which continued my First World misdiagnosis of type 2 so they prescribed me too much insulin and I, with a little knowledge, took it incorrectly and had a frightening low where I was unconcscious until my liver kicked in and raised me so I could test at 38 and take glucose tabs. I live alone and after that experience had every intention of getting a CGMS. I then got my correct diagnosis, got on the right insulin regimen and haven’t had a low I couldn’t handle easily myself since then.My A1C is 6.3; not as good as yours, but acceptable. I haven’t pursued the CGMS. I’ve also thought about a pump but I’m partly retired, and so have more time than money and MDIs are working fine. If things change I’ll reconsider. If I was still working fulltime I’d definitely have a pump. If I had your schedule, would I also have a CGMS? Hard to say. I currently test a lot. If I have a low I treat and test again. If I were busier, would I have time for that or would my lows get away from me? I find when I’m busy I actually am more aware of my lows, because they keep me from functioning optimally; if I’m lying on the couch reading I’m less aware. If you have a lot of lows, or spend time you can’t afford testing to prevent or treat them, then maybe a CGMS would help you see a trend and act on it. From what I understand though, people still have to test a lot with them, so would it be just another piece of technology to keep checking? Will it save time, energy and improve numbers or will it just be another thing to think about? Those would be the questions I’d ask. What would a CGMS give you that you need (and at what price)Sorry if I contributed nothing but vague ramblings here!

I’m one of the odd ones who doesn’t want a pump or a CGMS. While the expense is an important factor, being hooked up to a device seems incredibly inconvenient & intrusive given the inaccuracy of a CGMS. I can see how they’re valuable under certain circumstances, but not for me. Have to admit that I’m also not a lover of technology for technology’s sake. Simplify is my motto.

Reading here about sensor issues also helped with my decision.

With your great control it seems it would be difficult to get insurance to cover this.

I know you said you wanted to hear from people who didn’t choose to get one, but from what you said, I think you probably don’t need one. I was diagnosed type 1 at 12 yrs old in 1984.



If I were you, I wouldn’t have purchased one, because it is pretty expensive. My insurance doesn’t pay for it b/c my A1c is too good. I got it because I was having too many lows during the night (3 seizures in 2 months). It is easier to go to work if you get awakened by an alarm, versus having a seizure. It helped me miss less work. I didn’t know how to control my diabetes. I have since educated myself more and I have started to read Bernstein’s book to see what he has to add. If Dr B is correct about what I have started reading, I won’t even need it soon. = ) Then I can stick more $$$ into my retirement.

DC Reporter,

Many roads lead to Rome. I got my first meter in 1984 and only tested at home for the next 15 years. I never did MDI, only conventional insulin therapy with 2 shots per day. I remember telling my wife about CGMs, the problems, the hassle and how it was very unlikely that they were worth the effort. My wife is not as analytical as I am. She just said: “Try it out. Give it back, if you don’t like it. What do you have to lose?”. Things are not that simple for me. I was stuck in analysis paralysis for another year. Eventually I ventured out, hoping that the insurance would deny my claim since my A1C was too good (5.8%) and I had no history of severe lows. The stars were not aligned and my DexCom 7+ was in the mail a week later. Whenever I resist in doing something that turns out to be good and my wife acted as a catalyst in getting me to do it anyway, I have to say to her “You are the Queen, you are the Queen, long live the Queen.”. Getting my DexCom 7+ was one of these occasions.

In my book anybody with an A1C in the 5s does just fine. Since it is possible to achieve this goal with or without pump, with or without CGM, it all comes down to person preference. I would give up my pump in a heartbeat. I would fight tooth and nails to keep my DexCom 7+.

Alan,

I have seen my BG stay flat for 3 hours and then drop 50 mg/dl in 15 minutes. I am not eating low carb and any mix of carb/protein/fat is utterly unpredictable for me. I agree with you that low carb is the best approach. For people like me who are not attracted to low carb a CGM is very good alternative.

On-line Friends were bugging me to get a pump through the years. I observed many People who got a pump from start to present. I had even mentioned the pump to my Endo and he set me up promptly. My Hubby and I asked all of our questions, listened to the pump educators offerings of information, the process, hospital stay and the demo of each. I liked one of them but in the end, I told her I wasn’t interested. She knew that I was doing Good(still am) without it but if I did change my mind just to give her a call. At the end she said, “Using the pump could make Life easier for you but it won’t make you live longer”.



I also asked my Endo about a CGM and he obviously doesn’t think much of them since he said that they are not accurate enough yet plus sensor problems.



I am doing Good, find my system easy and do not feel that I need any of these instruments. I test, take my shots, have something to eat and off I go. Nothing tugging or irritating me. Nothing kinking or worries if I’m getting enough Insulin. No extreme gushers or alarms going off when I sleep, etc. A Type 1 Friend is going to be bugging me about a pump again when we visit them this week. Give it your Best shot. :stuck_out_tongue:

Same here, I would dump my pump before I ever gave one thought to dumping my CGM. Yes the CGM is not 100% accurate, but remember you can test with your meter 3 times and getting 3 different numbers. But one thing the CGM is very accurate at is knowing which way you are trending. My meter only gives a point in time snapshot, and provides absolutely no information after that point in time. If my meter says I’m 85 and my CGM says I’m trending down, then I know I may need to do something. If my meter says I’m 85 and and my CGM says I’m holding steady then I know I’m good to go. At work I spend a lot of time in meetings, so this trending information provides me with a level of comfort rather than sitting there wondering where the heck my BS is heading. I don’t think I have experienced where the trending on the CGM was wrong (except at the end of the sensor life, and that is usually very obvious).



Anyway I think it is understanding the information the technology provides and learning how to interpret that information. If you don’t find the trending information helpful or you are looking for something where the BS will 100% match your meter (depending on which of the 3 readings you choose to use:) ), then the CGM is probably not for you. Now that I have experienced the CGM and the level of comfort it provides, I don’t want to be without it.

I love my pump and am currently hoping to be able to fund a new one when the warranty is up.
I have zero desire for anything else.
Number one, hard enough to fight the HMO for an affordable pump. Why add in more headaches?
Number two, I would choose the Dex and it wouldnt like my arthritis tylenol.
Three, dont want another needle site.
Four, I do not have severe lows or highs requiring assistance. If I did, I would say yes the CGMS is the answer. But no, I really dont need it. My lowest low is usually 60, rarely 50.
Frankly, I wish I did better than I did on MDI because I loved my insulin pens when I used them and not being tethered would be an awesome feeling. But alas, need the benefit of being able to turn my basal down and you cannot do that on injections.

It was funny to read my own response above last November, because at that time I said I didn’t need a pump. I got one in January. The reason was I changed from thinking I didn’t “need” one to realizing I “wanted” one. So who knows I could change my opinion on CGM’s one day - though really I’m content to wait for the artificial pancreas (if I live to see it!)

But for now, I don’t want to wear a CGM for the same reason I’ve gone all my life without wearing a watch (in pre-cell phone days too!): I’d be looking at the darn thing all the time! I’ve got enough to obsess about already!

Why would it be weak to use a CGM? I mostly got it b/c I like knowing what my BG is when I’m running. In the winter, I have more pockets to lug meters, etc. along but I don’t have that much room in the summer. It’s much easier to peek at the CGM reading.

CGM has its imperfections and I totally get why people don’t bother with it. It is emotionally and psychologically more nuanced compared to pumping which is pretty easy to imagine what it would be like to be free of daily needle jabs. The value of CGM on paper is one thing but the actual experience is eye-opening. The cost is obnoxious but it frees me from constantly worrying about where my bg is headed.

All of that may be true but for me the reason is very simple: I don’t need it. I’ve been T1 for nearly 52 years and I’ve never had a seizure; never gone to the hospital for a D-related reason; no complications; never had a sticky moment. Never. D has a tiny footprint in my life; I feel my lows; I don’t eat crazy stuff so I have a built-in CGM that has not failed me yet.

I love my Dexcom 7+ and would not want to be without. I am anal. So what. My BG is near normal. Some T1s prefer low carb. Others like me use high tech. I am glad that T1 has been transformed from a life-shortening disease to an inconvenience. I applaud T1s who maintain good control at low cost.

I must be anal too. I drive with my dexcom mounted on the dashboard. I usually have very tight control, mostly because I use the tools I have. I can go low quickly, I want to know, especially if I’m driving. Low carb AND high tech here :wink:

No intention to twist anything. I have seen my BG drop by 50 mg/dl in 15 minutes. Mounting the remote to the dashboard is a good idea. Why not? Low carbers don’t experience such wild BG swings. I rather err on the the side of being too cautious than putting myself and others lives at risk.

And your money, it’s not unheard of (at least in Illinois…) to have counts for punitive damages, not covered by your insurance, filed in hypo cases. That being said, I don’t usually use it driving, more running and bicycling, to make sure I have enough gas in my tank?

I despise lows and Dex gives me advance warning. That’s reason enough for me to want it.

I think, those of us who have had diabetes a long time and who are doing well are not as concerned with the perfection diabetics are trying to achieve today.
We grew up with glass syringes, urine testing, no meters and no carb counting and many of us are doing quite well.
I know people who have had diabetes for years, and died from totally nonrelated conditions.
I also know people with good control who have gotten sick from diabetes.
No matter how perfect people try to be, we still have a medical condition.
And no matter what tools you think you cant live without, people who are veteran diabetics are quite often doing just fine with the basics.

Congrats on 52 years!