Why CGMS?

In these early days of CGMS, these dark times before widespread insurance coverage, people have all sorts of reasons for choosing to fork out thousands of dollars each year for this technology. Besides medical research suggesting that people who use CGMS have improved glucose control, here were my reasons:

1. Unexpected highs, often overnight, which meant they lasted for hours before I caught them. After 11 years I have pretty much figured out my dawn phenomenon, but I'm not as adept at bolusing for high-fat Indian food right before I go to bed.

2. Severe hypoglycemia unawareness. The week before I started my Dexcom, one day I was feeling a little spacy, and when I checked my blood sugar was 28. Huh??? Plus, I almost never wake up low at night, so I can only assume I sleep through the hypoglycemia and that some of my morning high readings are rebounds. I do have my husband sleeping next to me, and I love him dearly, but he is not one of those magical people who can wake up out of a deep sleep because my breathing changes and he senses trouble. I know someone whose husband can do that, the lucky duck, but the love of my life sleeps through just about everything. I needed some mechanical backup.

3. To avoid unexpected nighttime highs I had to wake up at least once each night to test my sugar. I started doing this when I got pregnant in January 2005, which means I have not slept straight through a night for 2 1/2 years.

4. My husband and I are considering another pregnancy, and 15 finger sticks each day, including 2-4 times each night, just isn't feasible now that I have my son running around, sleeping with us at night, and just making it generally impossible to have my second pregnancy be all about me.

5. Now that I have a kid, the potential consequences of severe hypoglycemia unawareness are much more frightening. They were easy to dismiss when it was just me and random hapless pedestrians at risk, but if I don't feel a bad low coming on, and I'm alone with my son...I can't even bear to think about it.

6. Now that I have a kid, the cumulative effects of sustained high blood sugars scare the pants off me.

Let me say more about those last two. Before my son was born, I was vaguely afraid of diabetes complications and I was vaguely afraid of death. I felt that a long life was preferable to a short life, all things considered. Post son-birth, this preference for long life and good health became a crushing need. I must see this little person turn into a big person. I must be there to help launch him into adulthood. I want to be around to help him in the way my parents are still around to help me. I want to drink sangria on the porch with my 50 year-old baby boy. Of course, he might decide as an adult that he wants nothing to do with me, but heck I'd at least like to be around to give him that choice.

I'd liked the idea of a CGMS, but I knew insurance wasn't covering them yet, and I thought I'd give it a few years and see if I could get it paid for. I think it was one morning in May, when I skipped my middle of the night sugar check (still didn't sleep all the way through since my little leech sleeps in bed with us and still nurses), I woke up and my sugar was over 300, and it hit me, really hit me, that these highs and lows are very dangerous. I turned to my husband and said I needed one of those continuous glucose monitor thingies, no matter how much it cost. Other than being an excessively sound sleeper he's a really good guy, and he agreed with me. So I started to research the various options.

Comrade Dex and me

A couple people have asked if I am blogging about my new Dexcom 7 continuous glucose monitor system (CGMS). I have never blogged in my life, but since I am apparently the first person to receive this device commercially (or so the sales rep kept telling me), maybe I’ll give it a shot. I haven’t read other Dexcom blogs, so I’ll probably be redundant to other people with the 3 day system, but I will do my best to be original.

First off, I never used the 3 day system, so I can’t compare the 7 to the 3. I just purchased it a couple weeks ago, and they gave me the 7 right off the bat. I am on my first sensor, and it’s only day 6. At $60 a pop, I will use each sensor for as long as possible.

Starting off the experience was the sales rep meeting. Tim is a very nice guy and gave a good demonstration. He was able to answer my basic questions, but was fuzzy on some of the details. For instance, when giving the spiel about how the higher price of the 7 day sensor ($60 vs. $35 for the 3 day) actually translates into lower per-day costs, I pointed out that since most people get far more than 3 days out of each sensor, that is only true if the 7 day sensor lasts proportionally longer than the 3 day sensor. He seemed thrown by that one. I also asked if the sensor was actually different, or if they just asked the FDA to let them market the original sensor for 7 days. He didn’t know. Some things in the 7 system are different – for instance, the transmitter is redesigned to fit more tightly to the pod, allowing 7 users to shower and swim without using a patch. That doesn’t seem to have anything to do with 7 days, though. He did say it’s more accurate than the 3 day, but I don’t know if that’s a difference in the sensor, or improvements in the transmitter and receiver. Since I am only on day 6 of my first sensor, I don’t know how long the 7’s will last, but my guess is that the per-day cost will be higher than the 3. Since I am a nerd, here is a chart to show what I mean:

For anyone who has been using the 3 day sensor, a rough guide is to take the number of days you usually get per sensor, double it, subtract a few, and that is about how many 7-sensor days you need to get the same per-day cost. If your 3-day sensors usually last 10 days, you have to use the 7 sensors for almost 18 days to break even. If you get 21 days out of the 3, you have to use the 7 for a whopping 36 days before the 7 starts to get cheaper. So yes, the 7 is cheaper than the 3 if you only use it for the specified number of days, but we all know most people use them as long as they last, so it is disingenuous to claim the cheaper costs as a selling point for the 7. Maybe the improvements in the new system will help people not resent paying more for the 7, but heck, let’s be honest about the expense, since most of us are paying for all or part of these systems ourselves.

All this said, I don’t want to come down too hard on these companies. I know a lot of money went into development of Comrade Dex, and I am very grateful to have it. It feels like a miracle to spend time with my toddler and not worry (quite so much) about crashing while I’m taking care of him. Now if only I can figure out how to get it to sense my high blood sugars at night, but that’s another story.