LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Thursday, November 15, 2012

The big event


“On top of long commutes, multiple jobs, shopping, getting the kids here or there, and all the daily grind of life, we must contend with counting the carbs of every bite we eat, taking insulin, checking our blood sugar, dealing with lows and highs… And you want us to punch all of this crap into yet another device? I don’t think so.”

--Beyond Fingersticks


I always forget that CGMs have a helpful feature to let you add yet more information to your download. Because, you know, there’s not really enough to look at when you pull up two thousand blood sugar readings for the week.

I always forget about it because I’ve never really use this feature, but like the last few generations of CGMs, the G4 lets you place event markers into the system. But let me be clear: the info is buried. You can’t see it on the receiver.

And as if it weren’t inconvenient enough to actually enter event markers into any CGM, Dexcom has not made it any easier by requiring a minimum of six button pushes to even get into the events screen. (They probably know none of us will ever use it.)

But just for fun, what if we were gonna try? What kind of events do the Dex folks think we engage in? Well, events that could affect our blood sugar, anyway.

The broad categories are Carbs, Insulin, Exercise, and Health.

When you open Carbs, the default is 50. Interesting choice. I almost never eat 50 carbs in a sitting, but I guess that’s the non-diabetic average carb intake. On the bright side, the system remembers the last value you entered. For fun I had put in 29, and the next time I opened the carb screen it was at 29, rather than 50. So if all of your meals tend to be about the same, your scrolling will be limited. But here’s the rub—isn’t there always a rub? Once you enter the carbs, you’re next taken to a day and time screen. What the fuck is up with that? Ya gotta press a couple of more buttons to enter the current day and time. Or you can enter a carb count from two years ago with only a few more presses of a button, although why you would want to is beyond me.

Although… I just had a great idea for a spy novel where secret information is smuggled in a CGM receiver as retro-active carb data.

Now in theory, it might be useful to record your food and insulin at every meal. It would allow you to really see what a given carb load and insulin bolus does to your blood sugar. Many CGM-enabled insulin pumps have this kind of data reporting, and it can be amazing for nailing down insulin to carb ratios, correction factors, and more. So for an insulin-pen user like me, entering carbs and insulin into a CGM could really help me see if I’m on my game or not. But already my food is getting cold just getting the carbs into the Dex, and I haven’t even calculated my bolus yet, much less taken it, much less entered that info into the fucking CGM, too.

And just how hard is it to enter insulin? Well first you gotta make eight button clicks, then you scroll your insulin up or down to the right number, first in full units, then arrow over to tenths—no shit. My eyesight isn’t that good, even if my syringes and pens were. And I can’t see a pumper bothering with using this.

Oh and you better stay on the ball. If the screen times out, you have to start over.

And just like food, you have to set the time and date for your insulin bolus. Even if you just want to use RIGHT FUCKING NOW as the time and date, it takes two button presses to enter it, and get this, yet another button click to confirm the entry.


It’s as frustrating as an insulin pump, but all it’s doing is placing a data marker on the CGM’s download. Once the data is in, you can’t even see it from the receiver (which might be useful to some people for tracking of insulin, and avoiding the stacking of insulin). But these are just dumb markers. No power, no visibility. So why make it so hard to do? If we had real-time insulin onboard tracking, which would be an awesome addition to a CGM receiver, all the checks and balances and safety screens would make sense. But all of this just to add an icon to an already over-crowded graph?

Anyway, the next type of event is exercise. You can choose between light, medium, and heavy. Then you have to choose how many minutes, and then—you guessed it—you have to choose the time and date, any in history that appeals to you, and then you have to confirm that you really meant it. Just for fun, I tried to go back to V-J Day to enter some heavy kissing-of-nurses action in Times Square, but as a time machine, the Dex G4 really sucks.


I could only go back to 2009. I guess that’s when they wrote the software. I could be wrong, but I don’t think anything overly memorable happened on August 14, 2009 in Times Square. On the bright side, I can go as far forward as 2029, so I’m guessing that Dexcom is planning to support this product for many years to come.

Health events sounded like they might be more interesting. Or so I had thought. From a social anthropology perspective, this should tell us a lot about what device manufacturers think we dFolk do with our time.

The choices are…. drum roll… Illness, Stress, High Symptoms, Low Symptoms, Cycle (presumably a female’s period), and Alcohol. Congratulations. There’s your life summarized. At least your life according to Dexcom.

When you navigate into each Health Event, you jump straight to time. You can’t say how much stress. How bad your High Symptoms are. And Low Symptoms… you know I’ll have to slap you if I find you’re taking the time to enter these into a CGM rather than fixing the problem, right? Under Cycle, we are not given the option of saying who’s period is causing our blood sugar problems and you can’t even record how many drinks you had after being ill, stressed, high, low, and dealing with someone’s period.

But at least you can record them from 2009 to 2029.


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