The psychology of CGM

By | 25 July, 2011
A psychologist pictured with an ultra-modern CGM

A psychologist pictured with an ultra-modern CGM

As much as I love, cherish and adore my continuous glucose monitor, I have to say there has never been a piece of diabetes kit so expertly designed to mess with your head. My pen, pump and meter combined have never provoked such a wide range of emotions as my CGM. In one day I can go from ecstasy to blind rage, all provoked by one tiny little machine. Here are just a few of the emotional responses it provokes:

Celebration. You wake up in the morning and the graph looks like you’re dead. You’ve been a 5 all night, one single flat line right across the screen. You celebrate sheer basal brilliance.

Comfort. You’re a 3. You’ve finally admitted that it might be a good idea to acknowledge the low and actually eat something. There’s something very comforting about seeing the numbers start to climb again on the screen. It happens very slowly, 3.0, 3.2, 3.3, 3.6 but they give you hope that things are moving in the right direction and that a second bottle of juice would be overkill.

Convenience. You’re just getting on with your day. A quick glance at the CGM shows that all is well with the world.

Reassurance. You’re going to sleep, on your own. You can see you’re a 6, you have no insulin on board and you’re holding flat. You know the CGM will alarm if you drop below a 4. You’re reassured and sleep well.

Irritation. There is little more irritating than having a smug little machine remind you that you’re high, when you know you’re high, you’ve been high for several hours and no amount of insulin is bringing it down. There’s no need to go on about it. That’s why I like the “alert silence” setting so much, it’s the CGM equivalent of “yes, I know, now shut up”.

Fury. The machine alarms to tell you you’re 17, when you really weren’t expecting that at all. You’re torn as to where to direct your fury. First you shout at the CGM because there’s no way in this world you can be a 17 and it is obviously making stuff up. Useless piece of junk. Then you check on your meter and that says you’re actually 16.5, so to be fair to the useless piece of junk it was pretty spot on. So now you have to admit you were wrong and split your raging fury equally between your useless pancreas, your brain which seems to have lost its ability to play at being a pancreas, and the rest of your body because no doubt there’s something going on in there that caused the 17 in the first place. Aaargh!

Never has one machine provoked so many emotional responses in so little time. It’s only because it’s delivering great results that the thing hasn’t been pitched out of the window before now.

14 thoughts on “The psychology of CGM

  1. Megs

    @Alison, I thoroughly agree, my cgm has quickly exerted a powerful hold over me. I rejoice in seeing a flat line when I display the sensor graph first thing in the morning and delight in my super fantastic textbook control through the night. If only I could achieve the same when awake.

    My overall emotion 3 months in is reassurance and a feeling of pride in it, working away 24/7 putting all its effort into looking out for my safety. I really miss its comforting display when changing sensors and resent having to go it alone for 3 hours while the sensor warms up.

    I do suffer from misplaced grumpiness when it has the cheek to predict a low. I sometimes refuse to accept its oracle like predictions but it gets the upper hand when it alarms frantically and suspends insulin delivery in a ‘that’ll teach you to ignore me’ hissy fit. I like its no nonsense attitude when it orders you to test blood sugar NOW, there’s no ‘please do it when you can be bothered’ . Its a quirky bit of kit but so far its welcome to stay around and mess with my mind.

  2. Dave

    Excellent timing on this one for me. Tomorrow is the start of a 72hr CGM ‘trial’. Trial is the wrong word as there is very little chance of me being able to get one permanently but something is better than nothing.

  3. Alison Post author

    @megs It sounds like we’re in violent agreement!

    @seasiderdave Good luck with the trial, I hope it goes well. If you want to keep it on more than 72 hours, you could restart the sensor yourself. I’m assuming you’re using a Medtronic CGM? If so, the sensor will automatically turn off after 3 days. If you go to “Sensor” then “Sensor start”, “New sensor” it’ll reactivate it for another 3 days (within a few minutes it’ll ask you for a calibration, then you’ll need to calibrate again within 6 hours, exactly the same as starting a new sensor).

    You can do the same again on day 6, however at day 7 it’ll stop working. At that point if you want to keep using the same sensor you need to disconnect the transmitter, put it on the charger for about 20 mins, reconnect and do the usual sensor start up process. I’m guessing you won’t be able to do this bit as you won’t have a charger?

  4. Dave

    Thanks Alison. Unfortunately I think the one I’m sat waiting to get must be platinum plated as I’ve been given very strict instructions to return in 3 days for it’s removal before it’s passed to the next user/victim/lottery winner.

    I like tech so am a bit excited about getting it though 🙂

  5. Dave

    🙁 I now feel like the man who went to the phone shop after seeing the advert for an iPhone and walked out with a £9.99 payg and didn’t realise it had less features.

    After a bit of Googling I realise I’ve been given Minimed CGMS Gold which whilst it does what the name suggests – conitnually monitors glocuse, it doesn’t show that on the screen and it’s only after download on Friday that I see what’s been happening.

    Bloody NHS budgets!

  6. Tim

    @seasiderdave – ah, as I understand it these CGMs are like this by design. If you let a patient loose with a real-time CGM they tend to fiddle and overcorrect up or down, so you don’t get any idea of trends and what-not because the patient keeps fiddling about. A non-reporting CGM let’s the DSNs look at your normal trends over a three – or so – day period without introducing any other variables.

    That’s the theory anyway. I’ve also heard that non-reporting CGMs are more accurate than real-time CGMs because they can take longer to do their calculations (or some such like that).

    1. Dave

      Ah yes @tim, is that because patients are stupid and shouldn’t be trusted to try and manage their own condition?

      I’d believe it’s more accurate than a real-time one as it resembles a brick so it must have enough processing power to analyse data from a Large Hadron Collider.

  7. Alison Post author

    Ah, well it should still give you some useful data about what your blood sugars are up to when you’re not looking.

  8. lady up north

    I am trying desperately to get a CGM from my DSN – apparently my diabetic clinic possesses only one, and it is always “out with someone else” when I ask. I’ve been told it does 6 days, but don’t know if its a realtime thingy or not. On a more positive note at my appointment yesterday my DSN suggested that maybe I would like to go away and research pumps online as she thinks I may be a suitable candidate for one. My clinic uses Meditronic ones so I would be grateful for input from people here who have one. She also said that I would need to get it covered by my house insurance for a value of £3,000 – is this usual ? And does this come with an inbuilt CGM ?

  9. Alison Post author

    @ladyupnorth I’d ask your clinic what date the CGM would be available and ask them to reserve it for you then. Surely they can’t possibly run a system where you get it if you’re lucky enough to be there on the day its free??

    If you haven’t already, take a look at our pump basics section http://www.shootuporputup.co.uk/tag/pump-basics/ for some useful stuff on the basics of pumping. If you’re starting from scratch, the last two posts are a probably a good place to start as they give you an overview of pumping.

    You can see an overview of which pumps do what here http://www.shootuporputup.co.uk/2011/01/picking-a-pump-in-2011/ . The Medtronic Paradigm Veo is CGM capable. To make it work you need to buy a transmitter (approx £200 I think, and lasts about 18months) and sensors (approx £50 each, last 6 days). You’d need to have the funding argument with the PCT, but it is generally pretty exception to get the sensors NHS funded.

    Some hosptials do ask you to insure your pump and most insurance companies will stick it on your existing house contents policy quite cheaply. INPUT have a useful explanation of this http://www.input.me.uk/insuring-your-device/

  10. Dave

    My trial went OK. Showed generally level figures just about 4 points too high. Met with DSN today and we’ve got a few things to try.

    We also discussed getting a pump and the subject of insurance was mentioned by her. The only problem she has had getting funding recently is where the patient is refusing to insure. This is still ongoing but if I was convinced a pump was for me (still not sure) I’m not sure having to pay £40 or similar to insure it would be a problem considering the value of the items I’m getting to improve my care.

    My hospital supplies the Medtronic Paradigm and whilst they don’t give a CGM tramsitter with it they have a couple they quite happily loan out for 6 days and often to the same people as they have plenty of availability.

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