A case of TMI from CGM?

Looking at your CGM (Continuous Glucose Monitoring) can be daunting. If you feel or think that you are getting TMI (too much information), you are not alone.

But it does not need to be like that.

Technology, or tech for short, can be a double-edged sword. Let it cut through the issues rather than judge you as a person.

It is not a report card and not a pass or fail. Instead, let it inform and guide you.

Using tech for good, but for whose good?

I remember attending a session at a diabetes conference last year on tech entitled ‘how to read a download in 60 seconds?’

As a dietitian, the idea of cutting through the sea of numbers or information in a CGM download in quick time appealed to me. My time spent in clinic with people living with diabetes is premium, so I would rather spend that time working with the person.

While the focus was for healthcare professionals to get the most information quickly, it was also about getting to the heart of the matter.

Heart and mind

There were two angles that the speaker focused on.

The first is structure. Items like adjusting target settings, alarm settings, insulin-to-carb ratios or correction factors are important to consider. Structure reminds me of the mind, the framework.

While tweaking structures may help, it can be equally (if not more) useful to look at a second angle - the behaviour behind some of the CGM data. Unfortunately, this is something we explore less often when reviewing the data. Behaviour is important and reminds me of the heart, the motivation.

In my practice, I have seen quite a few people who live with diabetes come out of an appointment where they were asked to change their insulin dose by 2 or 4 units. And they already know that the suggestion will not work. Why? Because they had already tried it before the appointment. If it did not work then, why would it work now?

Getting to the heart of the matter

Instead, I suspect the health professional did not ask them much about some common behaviours or actions taken.

For example, “do you sometimes…”:

miss or delay insulin boluses?
overtreat highs and lows?
avoid correcting highs?
enter “false carbs”?

And also, “do you sometimes…”:

take food without insulin or take insulin late?
have higher fat meals?
stack insulin or give insulin too soon since the last dose?
over-correct with insulin?

Let’s go with the heart…your heart

It takes a lot of heart and bravery to own up to these actions. Without you feeling judged, let’s explore your health beliefs. So, what made you choose any of these and what are your triggers? Are you worried or fearful about what higher or lower glucose levels may do to you?

If you arrive at a health belief that explains your action, then let’s trust your team and trust the tech to make some changes.

It is OK if changing your actions and health beliefs take time. Confidence is not built in a day. But your team and the tech will walk by your side to get you there together, a day at a time. Let them both show you their worth.

Read our article on Managing your diabetes effectively when CGM allocation is exhausted here.