Living Longer with Diabetes

I will soon have had insulin-dependent diabetes for 48 years, commencing during my third pregnancy. Fortunately, I have seen the improvement in my ability to control my diabetes with the advent of fast acting insulin and a continuous glucose monitor (“CGM”).

Diabetics do not produce sufficient insulin to convert glucose into useable nutrients for cells. If there is not enough insulin, the amount of glucose in my blood will be higher, putting me at risk for literally crippling side effects.  If there is too much insulin, the amount of glucose will be too low and I could die unless I immediately increase the glucose in my blood. Good heath is therefore initially dependent on the accurate measurement of glucose in my blood because only then can I properly adjust my insulin dosage. That measurement is provided by a continuous glucose monitor.

In the beginning of my journey with this disease, there was no short-acting insulin and, even more consequentially, no accurate way to measure my blood glucose. I could dip a stick in urine and then watch the test strip turn a certain color, which would very roughly tell me that my glucose level was normal, very high, or very low.  The test strip would not give me an exact reading, making it more difficult to adjust my insulin to increase or decrease the amount of glucose in my blood.   However, because there was no fast-acting insulin, there was little I could do about my level even if I did have an exact reading. Next came strips that required me to stick my finger, put blood on the strip and look for special colors. That process provided the same inexact reading as the strip for urine.  A little progress, but not much. Finally, the strip was enhanced to provide an exact reading, but that involved sticking my finger, putting the sample on a strip and placing the strip into a meter. It is a challenge to do this discretely, which was a problem for me when I was in a meeting, eating at a restaurant or at an entertainment venue.

Diabetes control today is very different.  There are fast-acting insulins as well as continuous glucose monitors. Below is a list of the features that have led my endocrinologist to predict I will live to be a 100. (As an aside, that is not my incentive).

The CGM that I use is Dexcom G-7.  There are two others:  Freestyle Libre 3 and Medtronic Guardian 4, which can only be used with Medtronic pumps.  I do not use a pump, mostly because I am a control freak.  My comments are limited to the Dexcom G-7 because I have never used the competing brands.

1. Accurate and Instant Reading of Glucose at That Exact Time.  My CGM enables me to see the amount of glucose in my blood every five minutes on a meter or on my iPhone. I can then use short-acting insulin to begin bringing my glucose to a lower level or taking sugar tablets to increase my glucose to a higher level. The goal is to keep my glucose reading between 80 mg/dL and 120 mg/dL.     
   
   Accuracy is very important.  MARD, Mean Absolute Relative Difference, is a standard that measures the difference between the reading on my iPhone and the actual amount of glucose in my blood.  The lower the number, the more accurate. The Dexcom G7 has a rating of 8.2% and the Freestyle Libre 3’s rating is 7.9%-- both of which are very good in my book. The results of a recent study appear to show that the Freestyle Libre 3 is even more accurate than the Dexcom.
2. Beeping Reminder If Glucose Reading Out of Normal Range.  I am not interested in staring at the app on my cell phone every five minutes to see my glucose reading.   However, my cell phone makes an obnoxious beep if my glucose reading is too high or too low so I know to take action to lower or raise my glucose level. That piercing noise requires me to silence my phone at the theatre after first making sure my glucose level is higher than normal to prevent a low at a time when I will receive no alert. Thank goodness for the ability to stop audio on Zoom calls!
3. Importance of at the Moment Readings for Older Adults.  As I grow older, it is harder every year to sense lows, and that is especially frightening at night. The most important feature of my CGM is that the alert is sufficiently obnoxious to wake me up at night when I often have lows.
4. Ability to See Trends. My CGM enables me to see not only my glucose reading at the moment but also to see my readings over the prior several hours, 3 days, 7 days, 14 days, 3 month and 9 months. This helps me to make more educated adjustments to my insulin dosage.
5. Self-Monitoring.  As you can see, my CGM enables me to make insulin dosage adjustments without going to urgent care or every day to a doctor. Most important to me, it alerts me to handle my lows so I don’t have to be taken to an emergency room. So far, fingers crossed, no emergency room visits in equal part due to my CGM and my compulsiveness.
6. Easy to Insert. My Dexcom G-7 is about the size of a quarter and needs to be inserted on my arm every 10 days. It does not require a finger stick, it takes only 25 minutes to warm up, needs no calibration and is disposable every 10 days. Earlier models required long warm-up times, calibration (stick my finger with a lancet to obtain a blood sample, put the sample on a strip, insert the strip into a separate meter and adjust the reading on the sensor to that on the meter). In addition, the older versions of the sensor were not disposable and had to be changed every 90 days.
7. Sharing Glucose Readings with My Doctor. Using the share feature on my cell iPhone, I can share my glucose readings with my family and with my doctor when I am most places in the world.  Then my doctor can see the trends of my glucose readings and help me refine my insulin adjustment.
8. Covered by Medicare. My CGM -7 is covered by Medicare but not for pump users, who must use a G-6.

If you or your loved one has diabetes, I strongly suggest you discuss this device with your doctor. My CGM has been a real difference maker in my living with diabetes.