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, 2015, 2016

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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!).

Wednesday, April 18, 2012

Why I (almost) never downloaded my Dexcom CGM

Boxes. Triangles. Circles. Xs. Stars. Crosses. Psychedelic colors. It doesn’t look biological. It doesn’t look medical. It looks archeological. Or forensic. A map of the scattered pieces of a downed airliner.

We all know CGM should more properly be called PCGM—for Pseudo Continuous Glucose Monitoring. There’s nothing continuous about it at all. It checks every five minutes. I guess someone at Dex decided it would be more honest to make graphs that plot only bona fide readings. But the result is a statistically proper scatter plot that’s fucking impossible to read.

Med-T software engineers went the fill-in-the gap route—connecting the dots to create smooth trace lines (albeit often with insanely steep slopes and valleys). To me, at least, these are much easier to read.

Hmmm…. Wait a minute. That’s not really an accurate statement. Because you don’t really “read” a CGM download. Not the way you read me, or a book, or a magazine, or your iPad.

You “read” it more like a radiologist “reads” an X-Ray. It’s visual, yes, but in many ways more visceral than cognitive. More interpretive than intellectual.

You need to “see” the ebb and flow of your body’s glucose rhythms—not so much as think about them. Perhaps it’s more akin to art than science. When I look at a Dex download I see Picasso. When I look at CareLink I see Monet. I have nothing against Mr. Picasso, I just find Mr. Monet easier on the eye, that’s all.

To me, the whole point of downloading a CGM is to give me the big picture of the little things that are happening in my body. I need a clean look. Yes I need other info too: what was my basal? When did I bolus? But I like the clean trace lines that let me focus my mind’s eye on the real story—what are the trends?

And I find trend spotting on Dex software so difficult I’ve given up trying. Med-T connects the dots. If some dots get lost in the real world, the seashell stores them. That doesn’t help you in Real-Time if you lose telemetry, but the historic data is there for you later.

Lost Dex data goes to the Bermuda Triangle. When I download the Dex of my youngest, bounciest peds patient, I have to get out a sharpie to connect all the gaps to try and get a clear picture of just what the hell is going on. (Just try doing that with a Picasso at the Louvre!)

I’ve also made some basal adjustments straight from Sentry, too. After the third morning of opening my eyes and starring at his six hour screen—my personal favorite—I recognized the three-AM dip. Tweaking the basal an hour up-stream flattened it out. I’ve never really been able to do that off a pump or Guardian or Dex monitor before, the screens are too small and too low res for that.

As for color—I get Dex’s intent. The thought, no doubt was to make it easier to follow one day. There are times that might be nice, but the combination of both a riot of color and a riot of shapes creates a visual jumble that nauseates me. CareLink looks clean by comparison. Overly clinical, perhaps, but in a comfy and Star-treky way.

When I look at my Dex downloads I see chaos.

When I look at my Med-T downloads I see problems.

Problems I can fix. Chaos? Not so much so.

No pump alarms today.


Blogger Jonah said...

I love the Dexcom software as compared to Med-T! I can see an average day! I can see my days wth box graphs. I can comare days of the week to see if I want to be taking more Lantus on Fridays and Saturdays, and if that lunchtime low is limited to my workdays.
I can play around with the target range on the Dexcom software, although not on the monitor, which is the opposite of Med-T.

The thing I hate is that I totally forget which of the days had bogus off readings that mess my averages up.

10:45 AM  
Blogger Sara said...

I also love my Dexcom downloads - except for the fact that I have to bust out the laptop that takes 20 minutes to start up (I actually timed it) to actually do it because the software is not compatible with my Mac.

10:29 PM  
Anonymous Anonymous said...

I agree with you on the Medtronic reports compared to Dexcom. IMO Medtronic is miles ahead of Dexcom in size, reports, displays on the pump, pump integration, etc. However for me the Medtronic sensors are painful and totally inaccurate, even for trends. I used them for 2-1/2 years and tried every trick in the book to get good results. I still wince in pain at some of the goose egg bumps and raises I got from them.

So I love my Dex because it gives me reliable results and trends. I love that my Dex is virtual painless, lasts 2 weeks for each sensor, and never leaves bruises. However, I am frustrated daily by its limitations. I hate keeping the huge receiver in my pocket rather than having it integrated with my pump. I hate that I can only see the current number and no previous numbers without downloading it. I miss the reports that some from pump and meter integration.

Unfortunately I'll probably be at Medicare age before someone gets it all right. Fortunately I have enough years until then that maybe CGMS will be a covered expense. It is a fabulous tool that helps protect me from serious lows. It also gives me information to improve my overall diabetes care and hopefully help ward off complications.

6:41 PM  
Anonymous Anonymous said...

Oops, it was bruises not "raises" in the above post.

6:43 PM  

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