Taking a CGM vacation

I’ve often been asked why I don’t wear a pump. I do MDI (multiple daily injections), always have. I’m usually asked the pump question by a pump user, who of course extols the benefits of using a pump. And I am sure there are many and it is a wonderful device for many.

Sometimes my pump wearer then tells me they also take pump vacations. It is what it sounds like it is. They take a break from wearing their pump and do injections instead for a while. Wearing a pump, as most (all) devices, has its drawbacks as well as its virtues. In the case of a pump, although if you wear one you’ll know better than me, drawbacks include changing sites, occluded tubing or any other pump failure, carrying tons of supplies, where to wear it for the beach.

Yet, in all the years I’ve heard people talk about taking a pump vacation, I’d never heard, or thought about myself, taking a CGM vacation. Yes, I wear a CGM. Currently Libre 3 Plus. I’d never thought of taking a break until I had reason to do so a week ago.

How’s it going? Remarkably, actually. I’m back to checking my glucose on a meter about 7 days a day. Do I like the finger sticks? Nope, no more than before. But, I’m surprised (amazed) that when I do a check, my numbers are great (I avoid saying ‘good’ as numbers aren’t “good” or “bad”). They are nearly always in range and numbers I like: 83, 101, 98. Huh? How could it be?

I have to guess it’s because of two values I hold. The first is routine. I eat and exercise pretty similarly day to day so I’ve learned my patterns, how my blood sugar reacts. It’s pretty similar day to day. That was the second value by the way, learning my patterns. Which of course came from years of wearing a CGM.

I don’t know how long I’m going to wait before I start up my next sensor. I’m enjoying this vacation. If you’ve never done it, you might like to try. My mind no longer obsesses about my numbers (although it surely did the first day I was CGM-free). That means there’s more space up there and a certain carefreeness. I feel a little more ‘normal,’ and a little less like a person with diabetes. Trust me, I didn’t expect this. But, hey, interesting. (Caveat: I’m no doctor, you need to be comfortable with this decision).

I gave up my CGM last week because I’m experimenting with photobiomodulation (red light therapy). I was going to do a red light therapy treatment on a bed of lights called the Novothor and I didn’t want to risk that the sensor would be affected or shut off. Simple as that.

I’ll write more about photobiomodulation soon. It’s a healing modality that uses certain wavelengths of light with really no side effects. In the short run, it can help heal injuries, lower inflammation, aid blood flow and charge up mitochondria for more energy. In the long run, it may even help people with diabetes avoid what’s come to be called Type 3, brain conditions like dementia and Alzheimers. People with diabetes are at higher risk of such conditions due to the damaging effect of high and low blood sugars on the brain. More to come.

So just a suggestion – next time you feel overwhelmed by your diabetes you might want to take a CGM vacation. See how you feel and what happens.

That said, I know I’ll be putting my sensor on again fairly soon. It’s still an amazing tool and likely, in the long run, I trust it will keep me healthier than without it.

CGMs’ strength is marking the relative field rather than being 100% accurate

I remember having this conversation years ago with a friend, fellow type 1 and doctor. He said to me, and I didn’t want to hear it, “Your CGM isn’t going to be accurate or precise in the way that you want it to, rather it’s going to tell you about where you are.” Why, I thought, can’t it tell me I’m 106 or 202 or 57 with pinpoint accuracy? Well, I get it now.

Wearing the Freestyle Libre 3, that delivers blood sugar (although it ‘s really interstitial fluid) results every single minute, I can see how it isn’t precise. Not in that machine-like way we think of precision. One minute I’m 104, next minute I’m 108, next minute I might be 105 or 119. And I have learned to take a pause before I determine if I need to do something about where my blood sugar is.

It’s mind-boggling to think what in the world is happening in my body for these moment to moment readings to be ever fluctuating like this. I don’t know. What I do know is you can’t think any one number is perfectly it. So I am learning to slow down a bit, watch the numbers and look at the trend. That’s really what CGMs are all about. Showing you trends. Indicating about where you are and if you’re climbing or bottoming out.

As I was keeping an eye on my CGM today, I just thought this was worth mentioning.

Kickbacks and formulary exclusions for CGMs

My friend Scott Strumello, probably the smartest diabetes advocate regarding tech, costs and insurance policies, sent me the heads up below regarding costs and coupons for Dexcom and Freestyle Libre CGMs. I’m passing it on to you with his permission.

From Scott: I have been (putting it nicely) perturbed by the fact that my own insurance company (Aetna’s PBM Caremark) is receiving legally-exempted rebate kickbacks contingent upon “formulary exclusion” for any CGM that is not DEXCOM brand, which basically means Abbott Freestyle Libre.

Dexcom, for its part, offers a manufacturer coupon save “enabling patients to ‘Save $200 per 30-day supply of sensors and an additional $200 on each 3-month transmitter’ to buy Dexcom sensors (and transmitters for the G6) which it distributes via GoodRx and on its website at https://www.dexcom.com/en-us/savings-center-cgm-without-insurance/ which is a valuable work-around for anyone with high-deductible insurance plans, are uninsured (or on  Medicare, for that matter, you just cannot submit it as a Medicare claim to use the manufacturer coupon or reveal that you’re covered by Medicare, but technically, they are not legally entitled to know that anyway). But for anyone with commercial healthcare insurance, I was unaware of any such manufacturer coupon offered by Abbott for Libre. 

Then, I discovered they do offer one (see https://www.freestyle.abbott/us-en/private-insurance.html for more) “If you are commercially insured and asked to pay over $75 for two sensors”. Patients must call Abbott’s Customer Care Team by telephone at 1-844-330-5535 (Available Monday to Friday from 8AM – 8PM ET) and ask for its eSavings voucher. Within 24 hours, Abbott will email the patient a voucher.

That seemed to be comparable to Dexcom’s coupon offer. For example, the retail price for a box of 2 Libre 3 sensors was $118.51 at Costco Pharmacy. On a per-sensor basis, that reduces the cost from $59.26 per sensor to just $37.50 each. But it also offers patients a choice which they might not have had available before.

I blogged about it at https://blog.sstrumello.com/2023/12/abbott-gets-real-about-formulary.html.

Thank you Scott for always looking out for us.