Sugar Surfing Lesson #16: The Power of Glancing
Glancing at a CGM screen is an empowering act. With a quick look, dozens of individual blood sugar readings are immediately converted into a family of recognizable shapes and patterns. The power to visualize these glycemic patterns as they are forming makes Dynamic Diabetes Management possible.
Sugar Surfing™ is the method of seeing, interpreting and acting upon visual glucose patterns and shapes with the intent of controlling the flow, shape and range of the trend line itself.
Sugar Surfing requires the focused awareness and interest of the individual in order to work properly. The engine of blood sugar control is driven forward by the information collected in a simple glance. Glancing can be likened to the wind that drives a sailboat. Without the breezes of glancing, the ship of blood sugar control often remains trapped in the doldrums; adrift and chaotic, lacking any meaningful direction.
In my practice I see some patients who glance at their sensors as little as once a day to never. They may have embraced this technology with enthusiasm and fascination in the beginning. However, over time their interest waned. There are several possible explanations for this. One reason may be a lack of clear understanding or training about how best to leverage this visual information in such a way as to improve blood sugar control as it is happening. This is the reason Sugar Surfing was originally written and why this blog exists.
Another reason may be a fear of failing or disappointment when seeing disconcerting blood sugar values. The reaction of the person or those who care for them can also turn into a disincentive to glance. If an out of range BG value is followed by judgmental comments or thoughts like “what did you do?” or "I failed", it should not come as a surprise that avoidance of glancing might be the behavior that follows.
Blood sugar values in any form (meter or sensor collected) are best discussed in neutral terms, without any “good” or “bad” comments inserted.
Like any skill, Sugar Surfing improves with time, attention and practice. Failure is the Surfer’s greatest teacher. If this is not appreciated at the beginning, unrealistic expectations quickly extinguish personal motivation. As an experienced Sugar Surfer, I own my fails and do all in my power to learn from them. It only makes me a stronger Surfer. No one has perfectly managed diabetes. It is always a work in progress.
For years I’ve referred to an insulin pump as being no better or worse than its user. This same fundamental truth applies to glucose sensing technologies. Without proper training and support, a CGM is little more than a glorified blood sugar meter. I don’t dismiss the value a CGM provides for alerting others to the BG results of its user though its remote sharing features, adjust insulin pump basal rate delivery in newer devices, or how they just make blood sugar data collecting quick and easy. These are all valuable indeed, but BG data has a very short 'shelf life' and is best put to work immediately in order to get maximum benefits.
Compared to when I first started using a CGM, I glance less often. I now glance more smartly. Every time I glance, I project what ‘might’ happen over the next few minutes to an hour. I ‘own the moment’ of a glance.
At work I glance as I leave and before I enter an exam room. I mentally ask myself if I see a trend pattern which might put me out of range while I’m busy seeing patients. I effectively ‘look ahead’ into the immediate future. That’s what drives my choices in the present. I also recall my most recent actions (e.g., food, activity, stress, insulin) and how they are affecting the CGM trend pattern I've just glanced at. What happened beyond the recent past (days or weeks) is not very helpful in the moment.
In the scenario above, perhaps I need a micro bolus of rapid-acting insulin to mini-pivot a slowly trending high blood sugar. Maybe I need a micro carb (4-6 gm fast carbs) to deflect a slowly trending low in 20-30 minutes. None of these actions would be possible without smart, strategic glancing.
Around meals I glance more often to check for unexpected rises and falls. It allows me the opportunity to consider taking further action to blunt a worrisome trend line moving in either direction. After-meal glancing permits me to discover over- or under-dosed meals. I know ‘when’ to expect rapid-insulin onset inflections (20-45 minutes after dosing for me) and when peak onset of meal time insulin works (60-75 minutes for me). This information allows me to apply carbohydrate brakes for a drop or choose to I-chain for a delta wave. But none of this would happen effectively if I didn’t glance.
I often challenge my young patients who are new to glucose sensing. I ask them to aim to glance at their CGM readout at least 10 times a day. I don’t tell them what to do, since that decision must be made in the moment. My aim is to get them accustomed to just looking, not immediatly turn them into "Lady or Sir Glance-a-lot". I want them to make glancing a habit. To be "aware". Only then can true Sugar Surfing be taught and learned. Awareness is the first step.
As a sailboat captain, even with a robust wind filling your sails, it takes experience and commitment to steer and tack the boat to its ultimate destination. That wisdom comes with desire, practice and time. But the first step on the path to successful Sugar Surfing begins with a glance.