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My Diabetes Mastery in 2022

I use technology to master diabetes, but that's just the tech.

The mastery really emerges from contemplation.

I began evolving the protocols I use currently in late 2019, when I got the Tandem t:slim X2 and Dexcom G6 devices. I added the Abbott Freestyle Libre 2 in early 2022, after struggling with hypoglycemia around exercise and sleep in 2 years between 2019 and 2021.

My wearables include:

You may ask, why two CMGs?

The answer is simple: neither has perfect data reliability, particularly around fasting states such as sleep and exercise.

The only solution is to wear two devices and interpolate. This is not perfect either, but it does give a consensu opinion. That is, if both devices report within a similar range, they're likely correct, at least in the direction the data is moving, or ballpark accuracy, like you can expect from a blood glucose fingerstick.

I'm the lucky diabetic. Most of my habits around diet, exercise, and insulin have been discovered, learned, and reinforced by my career trajectory in medical devices and healthcare - using lean to master diabetes.

But it's really the contemplative practice that has informed the insights that I've had around this tech stack:

The X2 is as good as we have in the commercial world today, but it is not perfect. CGMs have a fatal flaw in that subcutaneous interstitial fluid as a proxy for plasma blood glucose produces unreliable data around two states:

  1. exercise
  2. sleep

In turn, either of these can produce high risk hypoglycemia.

First, exercise is difficult since it exerts a strong downward force on blood glucose that must be dealt with acutely or may be deadly without glucagon or similar emergency treatment.

Second, sleep is made even more difficult by the fact that the patient is unconscious, and while the devices have alarms designed to eliminate unconscioussness, the patient may sleep right through the alarms.

Third, the Somogyi Phenomenon may exert downward force on blood glucose that is similar to exercise.

Fourth, alarm fatigue accruing from sensors that are produce unreliable data during exercise and sleep is inescapable and common at 3 AM, destroying any chance that the patient has for sound sleep.

These warning aside, the truth of the matter is that my HbA1C declined over 2 points between between fall 2019 and spring 2021 and has continued declining from 6.3 in 2020 to 6.2 in 2021 to ???

The bottom line is that an HbA1c is just data, but the feeling that comes along with it is priceless.