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Sugar Surfing Lesson: Awareness drives action

“There isn’t any good or bad, everything is either a product of pure awareness or sheer ignorance” Ramana Pemmaraju

The first step of our daily journey with diabetes begins with awareness. Prior to the development of CGM, it took a minute or more to stop what I was doing and check my blood sugar. In the earliest days of glucose meters this action took several minutes. In the CGM era it takes a mere second or two to create awareness of one’s blood sugar levels and how they are trending in time.

The ability to be instantly “glucose aware” has been truly transformational. Large scale studies prove a definite connection between CGM viewing frequency and positive patient outcomes. Awareness matters.

It is implied that the information rapidly obtained from a CGM readout is more likely to lead to a self-care decision about acting on that information or not. As the number of checks (scans) increases, the more opportunities to act. There really is power in numbers.

A major theme I raise at follow up visits with my CGM using patients is encouraging greater “glancing” at the CGM readout during the day. Some CGM’s track the daily usage of the sensor. I am surprised with how infrequently some patients use their devices. In some cases, it is 3 to 4 times a day, occasionally less. I teach them about the positive association between scanning frequency and improved metabolic control.

New CGM users typically glance more often, at least for a while. The newness and novelty of a CGM is intriguing. But this eventually wears off and some may check no more often than they would if using a standard blood sugar meter. It may speak to how the person perceives the value of the CGM. If the device is expected to be worn for another person to oversee their care, it is not hard to imagine this being viewed more as a chore or duty, and not as an empowering tool. If the information obtained by a scan is not used except to identify highs and lows, then its use as a self-management tool will be rather limited.

Today, many insulin pump systems are integrated with a CGM. The CGM data are immediately used by the system software to adjust insulin delivery without requiring much, if any, immediate patient involvement. This illustrates how a steady stream of glucose data, properly analyzed in the moment, can be a tremendous tool for achieving tight metabolic control.

But in the absence of such a system, the information from a CGM must be made aware to someone. This is the only way CGM information can be used as a proactive tool for control, as opposed to becoming a detailed record of what already happened in the past. It is certainly useful in hindsight. But a CGM is so much more valuable when used proactively for Dynamic Diabetes Management decisions (Sugar Surfing™).

Triggers to glance at a CGM screen are as unique as those who wear them. As I said, raw curiosity is the first prompt for many. Next, a more focused or thoughtful form of situational curiosity sets in. The CGM can become a tool of glycemic self-exploration. “What happens to my sugar when I eat this?”, “How fast does my sugar change when I eat this or do that?”. “Does my sugar change when I get stressed?” As I said, there may be an endless number of these questions. After an extended period of this kind of personal discovery, effective CGM users develop their own approaches or protocols for how they use their devices to best manage different life situations (meals, exercise, stress, recurrent life events, etc.…).

Glancing creates the awareness that drives effective Sugar Surfing. Most experienced Surfers report looking 15-25 times a day. The research data suggests around 20 scans a day (not equally distributed of course) seems to provide sufficient awareness for good outcomes. Some may do well with less, others may crave more. Each Surfer is unique.

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