Controversial thought - are we becoming too dependent on CGMs?

[martindt1606]

I've been thinking for a while that my Dexcom is taking over. Even when i'm feeling OK i'm checking it and if the blood glucose isn't where it should be and the arrows are not pointing in the way i want my BG to be moving I'll give a small bolus or have a sneaky jelly baby. I think staying in range has become more important than waiting to recognise the hypo. It seems to be worth the effort with HBA1c under 50 for the first time.

 

[SB2015]

I am now a closed looper.

When using a Libre alongside a pump I think initially the amount of information led me to over manage my diabetes. Not relying on the pump to ‘do it for me’ but definitely micromanaging in response to the information that I was getting from the sensor. That led to burnout As I set myself unrealistic expectations of my TIR. So any tech can have pros and cons. it was not the Libre that caused my burnout, it was how I chose to use the data.

As a looper, my pump and sensor check in with each other every 5 min and make any necessary adjustments without my intervention. Generally I necessarily finger prick once a week to calibrate my system, and then only when I am hypo. My sensor alarm is set to warn me at 5 and I ‘jelly baby’ (apologies to any English teacher for using a noun as a verb) if the arrows are also showing that I am dropping. As a consequence I rarely hypo now, relying on the sensor.

As a precaution the system asks for info from me if it is any doubt about what is going on. That is fine by me as it is now doing most of the work for me. I get involved at meal times, as well as exercise sessions as the changes are quicker than the pump copes with. That just involves employing some of the strategies I used when running the pump in manual.

Psychologically the use of the closed loop has had a massive impact on me. I am so much more relaxed about it all, and now trust the system to ask for help when it needs it. It will soon tell me if the sensor is having a strop.

So I guess I am a lot more dependent on the sensor, and content with the precautions built in to the system.

 

[Amity Island]

As part of the "old school" finger prickers (but not the old old old school wee testers), I have made a concerted effort to maintain my hypo-awareness: when I get too many, I run my levels higher for a couple of weeks to reset to baseline. I do this because my diabetes-self grew up with nothing apart from my body to tell me I need to prick my finger.
Now we have CGMs that can alert and tell us when our levels are heading downhill. This is amazing - I can catch a hypo before it happens. However, I still have the thought that hypos are to be avoided - if I need a dextrose to maintain my levels, I must have taken too much insulin so need to check my dosing. I live my life as if my CGM could fail.

I am sure many members feel exactly the same thing. So why this post?
I have read a few posts recently saying something like "my Libre failed so I didn't know I was having a hypo" or "I had a hypo because my Dexcom didn't warn me my levels were falling".

Hence the title of this post - are we becoming too dependent on CGMs?
They shouldn't fail but if it does, is the CGM the reason we hypo? I still think it is because I gave myself too much insulin. I know very well how complex insulin dosing is and how challenging it is to get it right. I but I still have the desire to do so.

Are we training ourselves to rely too much on our CGMs and worry less about insulin dosing?
Or, with the future of closed loop pumping getting closer, should we stop worrying about accurate carb counting and responses to exercise and let technology take the strain?

What do you think?

Hi,

I agree and that thought could equally be applied to many other aspects of modern living.

Have computers made life easier, slowed our pace of life? No, they've taken over. The switch from typewriters to PCs has seen our workloads increase exponentially. From what used to be a slow thoughtful process has now become overwhelming. Reading and trying to respond to dozens, hundreds of emails each day.

 

[everydayupsanddowns]

I've reflected on this myself too.

Partly because I'm aware I have become far less disciplined in how I run my levels since wearing CGM full time (with or without alarms). As soon as I had a constant trace of glucose I no longer needed to aim to have my levels behave predictably enough so that I could be fairly sure that I'd be roughly in range between breakfast and lunch. And have a ready-reckoner of precautions I'd take around exercise/activity that kinda worked.

These days I can just glance at my levels and adjust more 'on the fly', which is reassuring, and freeing - but it does mean I felt quite 'lost' the other day when I was 2-3 days between transmitter deliveries due to, ahem, a slight admin oversight!

I also worry slightly for those being diagnosed in the CGM era, who haven't had to put in those hard yards. Because tech does fail, and some people do forget to order their transmitter when they meant to (not me, obviously... definitely not!).

Lots of us did a lot of learning about how to work around the limitations of only occasional fingersticks, but lots now won't have that to fall back on?

 

[SB2015]

Up managing wobbly levels after a sensor failed yesterday, so in manual mode Overnight.

I had forgotten to take test kit up with me, then wondered why I couldn’t get to sleep, ……...
Then eventually got up to go and get test kit.
Oooops! 16.8 and no Info available to explain why.
Correction done.

Yes I definitely rely on my tech, and (through gritted teeth) it is good to have the odd reminder of how reliant I have become. Some sleep now.

 

[martindt1606]

I also worry slightly for those being diagnosed in the CGM era, who haven't had to put in those hard yards.

I agree. I have had a number of people referred to me who have recently had Total Pancreatectomies - I advise them that the care pathway they discuss with clinic should incorporate access to CGM and then closed loop at some point in the foreseeable future....BUT NOT until they have had the opportunity to build up the knowledge that comes with MDI and self calculation. Having suddenly become diabetic they need to understand life as a diabetic,