How I Would Improve The Dexcom Continuous Glucose Monitoring System

Sorry for the long title. I went for the straight-forward approach on this one.

Across the Internet you will find countless success stories about the Dexcom CGM. Scary lows avoided, A1c’s lowered, pregnancies a little bit easier to manage (because giving birth is easy, right ladies?), and ultimately quality of life has been raised. For those of us with insurance living in the now, this thing is great. I know Dexcom is working on, among other improvements, a 10-day sensor but that isn’t what I want out of the next-gen Dexcom. Although, the thought of getting a single sensor to last a full month does sound like a nice achievement.

Since Dayle and I started hanging out way back when, diabetes has always been something of a shared experience with us. We’ve dealt with failing OmniPods, forgotten test strips, I’m-out-of-lantus-pen situations, and plenty of low blood glucose readings. We both work pretty damn hard to get things right diabetically speaking. It’s her “fault” I’m eating healthier and ultimately using the Dexcom CGM. I’d like to think I’m part of the reason she switched to insulin pens after a number of consecutive bad experiences with her OmniPod. If one of us forgets our CGM charger on our way to work, there’s a good chance the other has one in their bag (She saved me on that one today). Included with this shared experience are the Dexcom alarms.

Despite what the pictures I post on Twitter may suggest about my diabetes management, I’m not perfect. Highs and lows are a frustratingly persistent recurring theme of my life with diabetes. I do what I can to minimize the bumps in the road, but it’s never a smooth or easy process. Most of the time it’s “Oh, you’re low, would you like some juice?”, “Can I have a (pepper)mint (patty)?” or the dreaded “that’s your high alarm. Again.” That last one is the kicker.

During the day I can do a pretty solid job of staying on top of my blood glucose. I think being at work helps focus on the important things of the moment, namely 1. whatever report I have to complete at the moment and b. what my blood glucose reading is. By the time I get home, make and eat dinner and watch last night’s Jimmy Fallon my brain is fried and I need sleep. It’s those hours between 11pm and 5am that lack my full attention diabetically speaking – naturally, I’M TRYING TO SLEEP. The last thing I want to do is (half) wake up, find an insulin pen needle and deal with another injection at 2:30 in the morning. Sometimes I treat high or rising blood glucose levels immediately and with swift justice. Other times I just acknowledge the alarm and try to make the most of sleepy time before the morning routine begins.

If I don’t treat the high or at the very least acknowledge the alarm then the Dexcom receiver gets angry and starts yelling. BEEEEP BEEEEP. Sometimes I hear it. Sometimes I don’t. Sometimes Dayle hears it. Sometimes she doesn’t. No matter what happens, there’s a chance I may wake Dayle up and that’s not fair. We may share some of our diabetes experiences, but this is one I wish I could bear on my own. Yes, my blood glucose is high. I’ll deal with it at some point but please leave her out of this.

What I want, back to the point of this post, is a way to set alarm thresholds and alerts throughout the day based on the time – much like basal rates for an insulin pump.

During the day I could probably do well to lower my high threshold from 180 mg/dL to 160 mg/dL, assuming I have the motivation to stay on top of things. But at night I want a little more flexibility. Not that high blood glucose readings should ever be tolerated but let me move the threshold up to 200. Or, let me keep the high threshold at 180 and have a secondary “okay, you really need to do something about this” threshold set above that – like the 55 mg/dL on the low side. Give me an initial high threshold of 180 with a 2 hour snooze and a Super High threshold of 200 from the hours of 11 to 5, or something like that and we’ll be set.

Yes, I can manually change these settings each time I wake up and before I go to sleep but you pump users aren’t manually changing your basal rates every hour, are you? It’s not unreasonable to think the same is possible with a CGM, is it?

If I can manage the different thresholds depending on the time then maybe nights would be a little more restful and more importantly I can respect the fact that I’m not the only one having my sheep counting disturbed at night.

So what do you think? Time-based Dexcom alerts that you set and manage similar to a pump’s basal settings?

[Girlfriend’s Note]

Hi. Dayle here. Three things I’d like to add:

1. Let’s not forget that my CGM goes off in the middle of the night, too, and no doubt wakes you up from time to time, so it goes both ways. Although I don’t think that diabetes is what keeps us going (despite my grandma’s comment last month as we pulled out our insulin pens at the dinner table that “those who stick together, stick together”), I do think it’s nice that if my CGM is going to wake up someone else in the middle of the night, at least it’s someone who understands a gazillion %. I know that you won’t judge me for rolling over and snoozing another five minutes. Not sure if that’s because you wear a CGM, too, or if that’s because you’re you – and the best man I know.

2. While I like the idea of time-sensitive threshold shifts, I also like the idea of controllable volume settings. Combine the two, and you could have the volume change for the hours at work, at home, in class, and while you’re asleep. Maybe rather than worrying about waking up our significant others, the “while you’re sleeping” alarm could be more assertive and really say, “Wake up Chris, you need to do something.”

3. To take the idea a little further… if Dexcom doesn’t want to take their technology in that direction, maybe they could create a buddy system with mobile health tools. They are probably looking into bringing readings up on a cell phone already (as the FDA continues to define what a mobile medical app is), but what about alarms? Maybe I like my job too much, but there really could be an mHealth opportunity here: program the CGM to trigger the phone, with its advanced ability to buzz and make all sorts of sounds with volume control, so it’s your mobile phone that wakes you up. Might not be as direct as we’d like, but it’s a thought. You could even combine it with our boy Jimmy Fallon’s mobile app so that when you’re blood glucose gets too high, it’s Jimmy Fallon calling you and telling you that it’s time to get up[and take a correction bolus].

And, for the record, both you and keeping your blood glucose in range are worth waking up for – any time of day or night.

6 thoughts on “How I Would Improve The Dexcom Continuous Glucose Monitoring System

  1. oh my. the only comparable experience i have is rooming with martin and jacquie at FFL last year. all three of us use medtronic pumps and cgms. holy insane amount of exactly identical alarm tones, batman!

    the medtronic cgm does have adjustable high and low thresholds, which i love. during the day, my high is set to 180. at night, it’s set to 200. now if they could just make the alarm a decent bit louder…

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  2. Love the idea of different alarms based on time. One other thought I’ve had (and did share with Dexcom) was separating the alarm ranges from the displayed ranges. If it could alarm at 80/160 but show lines at 70/180. (Or 60/200. Whatever you want.) Get the opportunity for tighter control without the psychological failing from being out of range.

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  3. I need volume control – why does it seem so stinking loud at work but I can’t hear it at night?

    I also would like to have different nighttime and daytime ranges and alarm delays.

    Maybe the next generation? 😉

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  4. This may sound trivial but I wish Dexcom would make their buttons quiet-er! I always feel bad having to press the buttons during the night because the “clicking” of it is so loud & feel bad waking the hubby (as always). When you press the buttons on my Ping pump for instance you don’t hear a thing. That would make me very happy 😉

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  5. First, this post is cuteness overload. Second, I agree with Dayle on the alarms. Mine don’t ever wake me up in the middle of the night. And I really like what Chris said about different thresholds. I’d never thought of that before, but it makes sense. I don’t have a significant other, but I do worry it bothers my dogs. OK, I don’t actually worry about that. But I do worry when I do have someone else to think about. It may not wake me up, but I wouldn’t want it to bother someone else. And third (actually, I lost count), I’m stealing this idea, too. Great post! Thanks!!

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