Caleb started using the DexCom Seven Plus continuous glucose system in September. This week was his first endo appointment since starting, a tidy three months later. I had no apprehensions about this appointment. In fact, I expected us to be in and out quickly. We just needed an update to Caleb’s prescriptions in addition to the normal routine.
This quarter’s results were no different. His A1C was unchanged. I wasn’t necessarily expecting a change, but I am a numbers and measurements kind of person. Even if it went up, I could say we were dealing with lows better. We had introduced a significant enhancement to his diabetes care. It seemed odd not to have it reflected in “the number”. If there had been any measurable difference, then I could attribute it to CGM and thus justify its use. His A1C was not giving me that justification.
So why are we doing this?
My biggest reluctance to starting CGM was asking Caleb to endure more discomfort without realizing a tangible benefit. He would have to be poked. He would have to wear the transmitter and carry the receiver. He would be the one who would be interrupted by all the beeps and alarms. Of course this is all to improve his glucose control, but that’s not measurable to him. I would be able to rest a little easier at night. I would be less stressed when separated from him. I would be less anxious between finger sticks wondering what was going on inside him. It seemed he was making all the sacrifices and I was getting all the benefit. So it would be nice to have something to point to to say yes indeedy, this is worth it – look, your A1C shows it. There’s no doubt about it. This was the right thing to do. It’s all here in black and white.
That is not the case.
Caleb’s doctor explained that when you already have tight glucose control, CGM typically will not change your A1C result. However, the quality of that result is often improved. In other words, the average of your blood glucose is still the same, but you are avoiding the high highs and the low lows that cancel each other out. The peaks and valleys are more subtle. The A1C remains unchanged, but it’s still a “better” A1c.
Hm. Okay. So do I believe that is the case with Caleb? It may be. I feel like we have caught things quicker and there are less surprises. We still have highs and lows, but they seem less severe. I don’t tend to go on feelings though. I like hard facts. Embracing this concept, although perfectly logical, isn’t all that easy for me.
After tweeting my concern (and doing a poor job of it because I led people to believe that I was a bit of a lunatic and wanted Caleb’s A1C lower and truly that was not my objective at all) I believe I got the justification that I was looking for. My wise friend, Melinda, helped me get there. She has a teenage son who has lived with diabetes since he was just younger than Caleb is now. Talking to her is like taking a magical trip into the future and getting a flavor of what it might hold for us.
I realized, with Melinda’s help, that an A1C isn’t the only way to measure the success of CGM. From the beginning I have stated that DexCom provided me some relief. I could see things before my eyes instead of worrying and wondering. I think I got so used to that so quickly, that I didn’t realize how much of an impact it has. I know that I am generally less anxious about Caleb’s BGs. I am wound pretty tightly to begin with, so it doesn’t take much to get me excited. There is a true, tangible value in decreasing the stress factor. It’s one that is very important to me. I know that Caleb has a lifetime of this management in front of him and how I handle it today will impact how he handles it tomorrow.
These are Melinda’s words that eased my worries:
“But HE benefits from having a less stressed-out parent. They certainly pick up on our cues. There’s a lot of value in that too.”
I know I do a good job of keeping Caleb’s blood sugars in tight control. I also know I do a poor job of hiding the impact the out of range numbers have on my psyche. That is where I need help and DexCom has provided it.
The answer is no, A1C impact is not all there is to CGM. There is much more. Thank you Melinda and all my Twitter friends for helping me understand that.