Trust & Type 1

Trust is essential in any relationship. It allows us to feel safe. It gives us permission not to worry; not to have doubt. When we have trust, we can rely on our significant other. As someone with type 1, I rely heavily on my medical supplies. But what supplies earn that trust? And how long does it take to earn it?

The glucometer.

This is the OG diabetes tech. It's what I've been using since infancy. When I was a baby, my parents used to prick my toes to test me (I was diagnosed at 13 months old). Because of this, my glucometer often feels like my lifeline. It's been there literally my entire life, giving me the data I need to treat myself. Granted, there are days that my numbers are so wacky that I stare at my meter in frustration and wonder, are you lying to me?

The meter has evolved over the years - becoming slimmer, quicker, and requiring less blood from my callused fingers. But the idea is still essentially the same. Prick the finger, get the number, react accordingly. I would say that I rely heavily on my glucometer - because I trust it.

The pump.

Coming along in my grade school years, the pump took some time to earn my trust. When it first came out, I remember writing in my diary in wonderment, marveling at the fact that I didn't have to use MDI (multiple daily injections) anymore. I remember putting my "very last syringe" in my memory box the night before my pump training. It was a huge deal for me.

Maybe because of this, I was crushed when I had a rough go of it the first time around. I struggled with highs; had one particularly traumatizing, painful, kinked catheter; and site changes for some reason terrified me. I eventually went off the pump for a year or two until my parents & I felt I was ready to try it again. I've remained a pumper since then.

But still, there are days where I feel that doubt niggling at the back of my mind. What if my pump malfunctions? What if I can't get my insulin? What if I get too much? Can I really trust this device functioning as my pancreas? Clearly, this doubt isn't significant enough to cause me to switch back to MDI, but still, it is there.

The CGM.

Thus far in my diabetic life I've had two CGM experiences - Medtronic Enlite and Freestyle Libre, the system that I currently use. I was weary of this tech at the beginning, and was adamant that I didn't want something else attached to me. I was also a high schooler, and annoyingly stubborn. As I got older, I began to grow curious. But alas, it wasn't meant to be - my insurance did not think that this (statistically proven life-improving) technology was "medically necessary." So, I went without until I enrolled in my own insurance this year.

If you follow me on Instagram or read my blog, you know that I'm in love with my little Libre. But it's a new love. It's still deepening. The trust still needs to grow. I get asked all the time, "So you don't have to prick your finger anymore?" And I wince, because I know I really don't have to as often as I do. But kicking an almost-26-year habit is hard.

To be fair to myself, there are discrepancies between the readings, and for the Libre it is recommended to check via finger stick before making treatment decisions. Still, there is room for improvement on my end. I feel the doubt trying to drown me, telling me "just make sure" or "just prick your finger, it's no big deal." I am hoping that with time, I'll develop a functional doubt:trust ratio.

Bottom line.

As human beings, we're comfortable with what we know. We are, in fact, creatures of habit. It's been my experience that people who were diagnosed at a younger age, or many years ago, are more familiar with the older tech and are more weary of relying so heavily on the new stuff. But those diagnosed during this stage of the game, where CGMs are the norm, feel much more comfortable trusting in their gadgets. A big part of this is about feeling safe. I feel safest testing my sugar the old-fashioned way, because it's what I knew for so long. 

My hope is that with time and practice, my trust will continue to deepen. My other hope is for you to know that if this is something you struggle with as well - you're not alone!

Data Overload

Technology's advances in today's world have become a hot-button issue. Is it as helpful as it is hurtful? Is the constant connection to the blue screen just too much? Rudimentary statistics have come out regarding the pros and cons of tech, but it may be too soon to tell what the long-standing impacts are on our overall well-being. When it comes to diabetes tech, the concerns are no less significant.

Continuous glucose monitors

Probably the biggest advance in diabetes technology since the insulin pump, Continuous Glucose Monitors (CGMs) have become widely used tools by both type 1s and type 2s. Whether you're a Guardian, Libre, or Dexcom user, you no doubt know how much this technology has impacted your diabetes care. These little guys check our blood sugars without us having to finger stick, tell us if we are trending up or down, and even tell us the speed at which we're trending. They alert us, our phones, and even our loved ones if we so choose. It sounds amazing to most people, but there's a downside here.

Too much of a good thing?

What's helpful about a CGM can also be harmful - we are inundated with data. This constant stimulation can be super overwhelming, especially for someone who's had diabetes since long before this tech was available. Before CGMs, you would test, bolus, eat and then not think about your BGs so much until you were going to eat again or if you were symptomatic. We didn't know what was going on in between our finger sticks. Now, we know immediately when our sugars begin to rise or drop. The issue is, once we see those dreaded arrows, it's difficult for some of us to just observe. We feel the need to correct, even though our sugars are supposed to rise after meals. That's just what happens. Just like sugars start to drop when we exercise. There is a constant pressure to have the straightest line possible, but is this really realistic? Trending down doesn't mean we are bound for a hypo, and trending up doesn't mean our IOB won't bring us down like it's supposed to.

A common vibe

If you don't believe me that this awesome technology has a downside, I'm not the only one feeling it. I recently read a post from Libby Russel for Beyond Type 1, reflecting on her experience using a Dexcom. This spot-on hits all the frustration that comes with wearing a sensor. Reading about Libby's struggles and her relating her Dexcom to an overly attentive boyfriend was super relatable (and hysterical). Data overload is also touched on a lot in Out of Range, Beta Cell's podcast with Craig & Laura. And an overwhelming seventy percent of Instagram followers who participated in my poll agreed they over-correct based on sensor data. These little arrows can wreak havoc on our peace of mind.

Now, don't get me wrong. CGM is an amazing tool to better know your patterns, and is essential for people who don't feel their lows. But it can be a tough road, learning how to calmly observe our numbers without overreacting and panicking. It's a skill that takes practice and fine-tuning. But we're used to that, huh?

My Libre Experience

By now I'm sure many of you have heard about or seen pictures of the Freestyle Libre system. For those of you who haven't, here's how it works:

The system has two parts: the sensor and the reader. The sensor is itty bitty and gets inserted into the back of your arm. It stays in for up to ten days. When you want to get data, you click on the reader and simply wave it over the sensor. It gives you your current BG, along with a graph of your previous readings for as long as you've been wearing it. The reader also tells you if you're trending rapidly up or down, slowly up or down, or running steady.

Unlike the Dex or Medtronic system, the sensor doesn't automatically give you your numbers - you have to wave it to get the data. This means there's no alert system if you're about to go low or if you're creeping up. The reader works through clothing, and it has a built in Freestyle meter as well.

Journey to Libre

I started my journey, of course, with insurance issues. When I first attempted to pick up the system at the pharmacy, they told me that insurance covered none of it. This was when it first came out in the US, in the beginning of 2018. It was also VERY difficult to locate a participating pharmacy that had it in stock. After a frustrating failed attempt, I spent a couple of months on the Enlite system, as it was covered by my new insurance. I did get some good data with this, but I went through too many inaccurate readings and failed insertions. My mind drifted back to the Libre. I decided to go through the company, and let them battle it out. They reached out to my endo to get a prescription, and went back and forth between her office, the pharmacy, and insurance. The system ended up being partially covered, and the out of pocket is less than the Enlite system for me.

Bringing the Libre home was super exciting - at this point I'd heard more and more about how convenient and accurate it was, and was itching to try it out. I was especially excited to use it while running. I've been on it now for about a month, and am thrilled so far. The readings are accurate, I'm pricking my finger less, and I feel like a spy from the future every time I wave the reader and get hours of data. Not to mention I have the system decked out in gear from Pimp My Diabetes and T1D Chick. There are certain aspects of the system that I can see some people being hesitant towards, depending on their situation. Below I've detailed my pros and cons.

PROS

Accuracy: My libre is almost always spot on. I trust it, which is a big deal for me. Small discrepancies tend to happen when I'm rising or dropping quickly, like with most CGMs. 

Size: You cannot beat it in the size department. The sensor itself is roughly the size of a quarter and flat. The reader is tiny as well, even in a case. Because it's so flat to your body, it's harder to rip out on accident. 

Duration: Sensor change is every 10 days. Enough said. 

Dual meter: The reader can also be used as a meter with Freestyle Precision Neo strips. These strips are super convenient too- they're wrapped individually in foil so you can fold them up flat. I use them for when I'm running, at work, or need to carry less bulk. Then I don't have to carry my usual meter as well. 

Cost: Even with the lower rate of insurance coverage, the out of pocket still ends up lower than the Enlite for me. The original market price of the system is lower than other sensors. 

Minimizes alert anxiety: If you feel your lows and highs and aren't reliant on the alerts on the Dex/Medtronic, this can be a good option for you. I tend to have alert anxiety, in which I get alerted that I'm dropping or rising and tend to over-correct.  The Libre eliminates this for me.

CONS

No alerts: If you don't feel your lows and highs, this system may not be ideal for you. While it's easy to scan and check your BG, you don't have the peace of mind that may come with the alert system.

Not technically "continuous": Because you have to scan the reader over the sensor, the system isn't technically considered a CGM. It isn't automatic - you have to put the little bit of effort into it.

Insurance: Because the system is so new, it's less likely to be covered by insurance. Or if it is, it may not be completely covered. I anticipate that as time goes by and more people use it, more insurance companies will offer more coverage.

Bottom Line

Bottom line is, if your insurance will cover it, I highly recommend trying it out. It's small, accurate and fun to use. My coworkers in the medical field are in awe of it. Plus, it's always fun to hear people guess what the heck is on your arm. So far I've gotten:

• A penny (this guess was from a 3-year-old)
• A radiation sensor
• Miscellaneous crap stuck to my arm ("Hey, you've got something stuck there")

We'll see what guess comes next...