What is a time of joy for many women was my darkest hour.
I just injected a sensor into my belly. It will transmit glucose readings around the clock to a receiver, to my cell phone, and to anyone who chooses to monitor me (with my invitation). No longer will I use a handful of isolated readings throughout the day to gauge the effectiveness of my diabetes management plan. Now I will have a graph of all the ups and downs, 24/7.
I can't eat a cinnamon roll and ignore the consequences because the sensor knows something caused that blip. I also won't wonder why I'm shaking and sweating in the middle of the afternoon because the sensor will beep and tell me my glucose is too low.
I am the bionic diabetic, merged corporeally with technology that can make me better, stronger, faster.
This kind of technology wasn’t much more than theoretical when I was diagnosed with Type 2 diabetes 10 years ago, but my endocrinologist has been suggesting I try a continuous glucose monitor for a few years now. At my last appointment, he said more data is the key to better control. More data=better? He might as well be a charismatic cult leader the way those words flipped my switch.
Yes, doctor, more data.
Now Big Brother is watching my blood sugar at all hours, steering me back on course when my readings stray outside the range I’ve defined.
For me, diabetes management has been sort of low tech up until now. Stick finger, record glucose level, take pill, inject medication, see the endocrinologist every three months so he could interpret the data and make adjustments. Just six years ago, I was mystified that he would suggest I incorporate a smartphone into my monitoring regimen.
Now there are five continuous glucose monitors by three manufacturers on the market. They are very expensive, and not commonly used. I’ll be frank: I have good insurance so I have access to medical treatments that many people do not. I know I’m fortunate, and I take advantage of that good fortune to get the best healthcare I can. For 10 years I have been all over diabetes, using my medical team, drugs, diet, research, and exercise to keep it in line and delay complications.
When I was first diagnosed at 29, I was embarrassed. Before obesity hysteria, Type 2 diabetes was commonly considered a disease of the elderly. The concept of having this disease at 30 was so novel, I started writing a book about dealing with Type 2 as a youngish person.
Now Type 2 diabetes is the punchline to fat jokes. The most hurtful public misconception is that it’s a lazy person’s disease. Without getting too defensive, I’ll just say managing diabetes is a lot of freaking work. Lowering my blood sugar from “Excellent” (by diabetic standards) to “Normal” (by non-diabetic standards) has been a months-long mission of exercise, diet changes, monthly doctor visits, med adjustments — and now, technology.
Why this recent push to be not just a good diabetic but a Super Bionic Diabetic? My fertility doctors essentially want me to cure diabetes before I get pregnant again. I don’t blame them, I want the healthiest possible pregnancy too!
The first time I was pregnant, this wasn’t an issue because my glucose levels were already in the non-diabetic range. I was even cavalier about how easy it was to be diabetic and pregnant. Now 40 is coming at me like a freight train, pregnancy and stress have taken a toll, and I’m finding it harder to push those numbers down.
With this continuous monitoring system, I insert a glucose sensor into my belly once a week. A transmitter snaps onto the sensor and beams readings to a pager-like monitor clipped to my waistband, or in my pocket or purse. The receiver and transmitter can be up to 20 feet apart. I set upper and lower limits, and the receiver alerts me if my glucose is outside those limits.
With constant feedback about my levels, I can take steps to control highs, treat lows, avoid foods that trigger spikes. Too low? Eat a snack. Too high? Take a walk and consider avoiding the food that caused that spike. Consistently too high or too low? Adjust insulin.
In real life, this is what that looks like:
Beep beep beep buzz buzz beep beep beep buzz buzz!
It’s the first night with my sensor and at 4 a.m. it wakes me up. My glucose is below the threshold and falling fast. I am unprepared and have to scramble for a suitable snack. At 6 a.m. It goes off again — too low and I need another snack. For months doctors have been treating my morning highs by ratcheting up the bedtime insulin. Now I know why it didn’t work — I was crashing in the middle of the night, and my liver pumped out glucose to compensate. That also explains why I woke up at times dripping with sweat and my heart racing.
A few nights later, my husband wakes me because the thing has been beeping for 20 minutes, and he just figured out it was the monitor. This time, my glucose is above the acceptable range. That midnight snack of crackers and jam caught up to me. Before continuous monitoring, I slept through these events, and there was no fine-tuning of my behavior and medication for tighter control.
The device doesn’t only alert me when my readings are already too high or low. It tells me if my glucose is rising or falling rapidly so I can take action before it is out of my preferred zone. Like last week when I made the regrettable decision to eat an inexplicably sticky croissant from Starbucks. (I’m sorry, France.) My glucose zoomed to 200, and the beeping commenced. I load the baby in the stroller and set my glucose eradicators (muscles) to turbo. After a 30 minute walk, my blood sugar is falling back to the comfy range.
Thank you, legs. Thank you, sidewalk. Thank you, monitor co-pilot. We have done our jobs.
Alas, I have an adaptive mind, already plotting how I can cheat the machine. What if I want to eat a gross fake croissant without getting hassled by Big Brother? What if I want to crash in a pizza coma? I can turn the sensor off, give myself a break before inserting a new one. I thought of these “cheats” before I started using the continuous monitor, afraid I would eventually get annoyed by the tattle tale.
Now that I’m a few weeks into the new regimen, I don’t feel that need anymore. I don’t want a gross croissant or pizza coma. I want my data. And if I do eat a treat, I want to “cheat” the monitor by burning the sugar out of my system before the beeping starts. I want this monitor to be the answer.
The efficacy of continuous glucose monitoring has a lot of room to improve. I still have to do a finger stick and use my traditional blood glucose monitor at least twice a day to calibrate the continuous monitor. There’s the aforementioned issue of cost, a big inhibitor to widespread use. Also, sensors are only meant to last 7 days, and the transmission range between sensor and receiver is fairly limited.
I am still a bit sheepish about revealing my diabetic status, not wanting to be judged by people who don’t know my whole story. I used to sneak off to the restroom to inject insulin or stick my finger, worried I would offend the squeamish. I started to let go of those worries because 1) I want to be more okay with myself, a.k.a teflon to the judgment of strangers, and 2) it’s just not practical to sneak off to a dark corner, hauling a toddler, for a little injection I can do in 10 seconds, one-handed.
And now, my diabetes is even more visible — a transmitter lump under my shirt, a monitor I snap open a few times an hour to see how I’m doing. The curious can ask questions, the assuming can have their assumptions, and I’ll just be over here taking care of myself.