CGM Burnout

Hi all,

So I’ve been on CGM for about 2 or so months now (Medtronic 670G) and on a pump for about 10+ years with no CGM. Previously my A1C was 7.6 and now it’s 6.2 which is great but at what cost?

In the 23 years that I’ve had type 1, I used to spend no more than 2 minutes in total per day treating my diabetes and now it feels like it’s become all consuming - the constant need to check my pump to see if I’m in range or tending up or down is taking it’s toll on me.

Some EG’s that come to mind: when my BG is 5.8 mmol/l / 104 mg/dl and I’ve got 3 downward arrows, it evokes a massive amount of anxiety whereas I would previously get symptoms, test my BG, eat something and so life would continue.

The same occurs when I see that my BG is trending upwards, I enter SG (sensor glucose) values in the bolus wizard every 5 minutes until my BG’s start coming down - this does not feel normal in any way!

On the flip side, I wake up every morning with perfect BG’s which has been amazing but at what cost…

I’ve been advised to take a break from my CGM for a month or so and then re-asses? What do you guys suggest?

Thanks for reading :grinning:

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@Muttley hi Martin,

when I was younger, they said to eat the same thing at the same time every single day. They said to write down everything… a colossal diary of food, times sleep, test results, etc.

So that turned out to be too “costly” and so I didn’t do any of it, which for me wasn’t the right answer either. I try to focus not on perfection… but on what is tolerable. The truth is that diabetes hasn’t gotten any different or any harder than it was… it’s the way you feel about it that’s changed and it seems that it’s specifically the anxiety around the CGM arrow trends that’s got you spun around.

if A is how the world is… and B is how I feel about it… well then the only control I have at all… is modifying B.

Anyway… whatever works is fine. if you can’t modify your concerns watching a CGM plot versus time… maybe a break is in order. Maybe 6.2% is causing you too much anxiety and so maybe your number would be better at 6.5%… see that 6.2% if it leads you to burnout and you end up neglecting your diabetes… then that’s what’s not worth it (IMO). but if you could sustain a 6.8%… forever… that’s a better number.

anyway, I also get consumed by OMG I can’t do this FOREVER… the FOREVER time frame can exhaust me. I stick to TODAY. IF I have a off day of 180-250 (10-13 mmol/l) who cares… IF I can say that I was exhausted today and I couldn’t chase that high or low, then who cares… I do my best today, I can reset every day or even every half day if I want to. again… the magic… whatever you need to do… is fine… just for today.

balance beats perfection in this thing of ours. good luck.

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Thanks for the feedback - I really do appreciate it!

Perhaps I should’ve mentioned in my original post that it’s not really the lower A1C that I’m chasing, it’s more about trying to keep my numbers in check as a result of having all this data. The knock on effect is a better A1C.

It’s all the information at my fingertips or should from my arm :upside_down_face: that’s driving me mad…

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@Muttley, I can really relate to what you are saying, except that it’s not me who is feeling compelled to keep checking, but, my pump system, (I have Medtronic 670G) that demands it. And that is what I find so exhausting. It’s rare that I can get a night’s rest without interruption of some sort of notification. I had a lot of disruption with my form Dexcom CGM too. But, I do think that I’m the type of person who does need some prompting to stay on top of things.

When I get busy, I tend to not bother with finger sticks and may end up high for hours, unless a CGM will bug me to address it. So, for that reason, I think I need a CGM. I do wonder if that the info about my body, that I’m gaining with the pump and CGM, will equip me to one day manage my BG with MDI again. It’s a hard call. I did recently lower my A1C substantially. But, man…it’s take a toll. I can barely enjoy it, because, I feel like I’m really exhausted. It’s like I took on another full time job, where I work around the clock.

I discussed with a doctor recently (my Endo and a Intergrative physician) and he suggested meditation. I’m going to check it out.

Also, you said that you go to Bolus Wizard. Does that mean that you are not in Auto Mode on your pump? Would Auto mode help you or not?

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Are you trying to diet, workout or trying something your body isn’t used to. I’m 13 and have had diabetes for 2 1/2 years, but all of our body’s are different and we dont always experience the same things,

Have you talked to your endocrinologist about your concerns?

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Hi Dee,

Thanks for the feedback… As mentioned before, I really appreciate it.

I’ve found that if I calibrate in the morning at say 8AM, 8PM and then around 10:30PM/11:00PM before bed, I can generally make it through the night with no interruptions. I find that if my BG before bed is quite good and I’ve had enough fluids, then it also means less chance of it waking me up.

In terms of what I mean’t about the Bolus Wizard, what I’ve been doing is the following:
Pump shows SG: is 12mmol/l / 236mg/dl, I go into the Bolus menu, enter the BG from what the SG value is, leave carbs at 0 and then click next. Based on my settings (insulin duration time etc), the pump will then allow or disallow me from doing a bolus. If it allows me to, then I’ll do a “correction bolus”. The correction bolus will vary depending on active insulin and or what the SG reading is. I keep doing this (sometimes every 5 minutes once the SG has updated) till my BG’s are in target.

I’ve been doing the above as I realised that:
1: Insulin works way too slowly for the pump to correct by just doing micro boluses or Auto Mode
2: Auto Mode is not aggressive enough in dealing with high BG’s.

If my BG’s are way too high, I’ll exit Auto Mode and do a correction like I’ve mentioned above as the pump will then give more insulin as this is based on insulin sensitivity. This is of course if I’m certain that it’s not a site issue and I’ve checked that SG & BG values are close to one another. Once all is normal, I’ll go back into Auto Mode.

Not sure if any of the above is best practice or advised…

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So diet is not really a concern as I usually eat similarly every day and it’s mostly healthy stuff… pretty sure my carb counting is also good enought. In terms of working out - I feel too darn exhausted to even consider it whereas I used to cycle 3/4 times a week before CGM… :pensive:

I did speak to my endo and nurse educator, they both suggested a CGM holiday so I’ll see how that goes.

Thanks for the input :grinning:

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@Muttley, okay. I got it. And, I agree about Auto mode not being aggressive enough in treating highs. When it takes hours to get it down, to me, that’s BS. I have heard from others who have difficult with Auto mode for that an other reasons. Yesterday, when I was not in auto mode for a warmup, my BG stayed at a nice 84. So nice. I would never be there if in Auto mode.

I’ll be interested to know if you take the CGM vacation. That really is not something I feel comfortable with, because I like having Suspend Below Low.

I find it strange how Auto Mode works so well for some yet terribly for others. I guess that what makes type 1 such a complex condition.

I’m fortunate in that I’ve always been able to detect my lows and usually still detect my lows before the pump alerts me. I think with my control being a lot tighter, I’m now detecting lows when my BG’s haven’t quite hit the “low mark” which means that something is not right for me…

Off on vacation I go, I’ll be sure to keep you updated.

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Yeah, well, I think that some would think that Auto mode does work for me. My Endo is ecstatic about it. She is very pleased with my A1C which was 8.0 in March was 6.8 last week, since start of pump. But, I know that I can do better, if not in Auto mode AND, she doesn’t fully appreciate how disruptive it is to your life. Plus stressful…

I’ll keep my eyes open for your post after your vacation period…that is, if you return. lol

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@Muttley
i guess it is a trade off, it is hard to not want do better when you have so much info without having to do much, you have to do more then i do, you have to finger stick at least twice a day right? with a g6 there is zero finger sticks, and i use loop with my omnipod… i to micro manage my t1d way to much and it is a hassle… i question sometimes to what expense? to try to have the best control i can = what? a extra year of life? 10 extra? who knows i could get killed in a car accident on the way home from work… point being it is tough to keep on track and even tougher to manage almost normal bg levels… at the end of the day its up to you to decide which is the best option

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On a good, NON first day of sensor day, I can get by with THREE finger sticks with my Medtronic. lol But, it’s not even that. It’s the entire thing that is so convoluted. I hesitate to say that, but ,then at times, it sure seems that way. I have to make a list of what exhaust and annoys me the most. Better yet, I can just copy what so many other users have said. I think it’s pretty common. I guess, I figure, if I’m going to go to this much work and trouble, why not have a 5.9 as opposed to a 6.8. I’m not sure how much difference that makes in the scheme of life.

Thanks for putting your side across…

It’s funny because, I really don’t mind the finger stick tests - it actually helps me to trust the data coming from the sensor. Besides, I’ve been destroying my finger tips for the past 23 years so I’m pretty used to it.

I also find the once off normal injection of insulin quite nostalgic - kind of going back to my roots :grin:

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No, I’m not that bothered by finger sticks either. (Within reason.) Reliability is much more important to me. As is functionality.

Do you suffer from unawareness of low BG’s? If so, a break from your CGM would be dangerous. My CGM has woken me up in the middle of the night by beeping loudly before I completely pass out and become unable to treat the low BG. I have been using a CGM (not integrated with my pump) for over 5 years and have gotten my pump settings to a better level as a result. It meant a lot of interruptions to sleep at first. But now I am rarely woken up by my CGM.

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You have expressed exactly what I’m feeling! Burn out. This constant flow of information that now I must deal with when before my 670G/sensor and auto mode, I dealt with in minimal time & effort. My pump has now surpassed my iPhone for constant checking & attention.
I’m waiting on my 1st A1C since starting my 670G / CGM. I’ll have to see if there’s been any improvement.

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As for diet and meal choices…
Everyday and every meal is different, the thought of eating the exact same thing day after day just to avoid Bg fluctuations sounds awful and down right depressing. Life for me is cooking, enjoying good food, wine & CAKE.

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Fortunately I’ve also be hypo aware but I have noticed that I’ve definitely become more reliant on the CGM and less trusting of what my own body is telling me - this is not great :pensive:

Perhaps the pump integration is the problem- this is where the constant flow of info comes to. As @Jodijay mentions, it seems like we’re both suffering from the same need to constantly check :upside_down_face:

I’ve pumped for 30 years and cgm dexcom for 6. After 8 months of intense stress and futile work the 670 and guardian cgm sent me into the most severe burnout depression I’ve had in 49 years of T1. Please please please if there’s any way you can get off of 670/guardians do it. I moved to Tandem X2 integrated with Dexcom G6 and got my life back. It is not you or cgms it is that system. I feel for you and wish you the best.

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Martin, I am so with you. I’ve been a T1 for 44 years–now on an Omnipod and Dexcom-- and frankly some days, I’m just tired of the whole thing. You’re right, constantly chasing and trying to fix BG numbers often only makes them rollercoaster up and down. Not to mention the anxiety and gadget overload. Yes, technology has made many improvements, but I often wonder if the researchers who come up with them have ever tried living the life. Every day, for years and years, with no break or real explanation for episodes that simply don’t make any sense. Of course, the options are limited. Just know that you’re not the only one who feels this way.

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