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“We know that not all people with diabetes are looking for a wearable continuous glucose monitoring device to manage their diabetes." Okay that's pretty bogus.

“We know that not all people with diabetes are looking for a wearable continuous glucose monitoring device to manage their diabetes." Okay that's pretty bogus. Some people can't afford it, but everyone with diabetes would benefit from a CGM. There's much more to be gained from trends in CGM data than singular data points. (I was diagnosed with Type 1 at 16, been on a CGM for most of that time).

tempdiabetic 5y ago
The Dexcom G6 is the best CGM on the market, but its sensor filtering (Kalman or particle?) has smoothness and/or continuity priors that cause persistent inaccuracies. I observe these persistent inaccurate states on the fifth or sixth day using a sensor. Calibration doesn't help. The reading goes wrong and stays wrong. It probably happens to you, too, but anyone who doesn't test with a glucometer will likely not notice the failure. You will be harmed by these inaccuracies. Persistent inaccuracy is different than the Gaussian (normal) error of a glucometer, which is far more benign. Also, CGMs are slow. The reading is based on interstitial fluid and lags direct blood glucose test by 15 minutes or more. I have completely abandoned the Dexcom G6 and have gone back to 16x daily finger stick blood testing. I am also on a low-carb/high-fat diet, which makes it easy to maintain normal human blood glucose. My HbA1c has been 4.9 for a decade. I was overjoyed to use the CGM at first, but it turned out to be a net loss. If you want to control your diabetes, use a glucometer and adhere to a strict low-carb/high-fat (ketogenic) diet.
- jcims 5y ago
  Is there a good source for info on ketogenic diets for type 1 diabetics? My youngest has been on pump therapy for the past 5 years and is completely burnt out from all of the alerts and scares (some of it is self inflicted). She was on a medtronic closed loop system for 4 years and that was the source of most of her frustration. She's on g6+tslim now which has been much better, but she still falls off the wagon regularly. I just think a keto diet would make it easier for her, but I'm seeing all sorts of conflicting info on it and her doctors don't support it. I've done it a few times in the past and getting started is the hardest part. I'd like for her to try but I'm getting no support on the idea. ?
  - rpmisms 5y ago
    Keto is generally best once you've finished developing. If she's under 18, I wouldn't do Keto.
    - jcims 5y ago
      She's right on the bubble, but something tells me I've got some time.
  - tempdiabetic 5y ago
    Dr. Phinney's lectures (Virta Health) are a good resource. Here's the first one, it's easy to find the rest: https://youtu.be/1IEuhp8RFMU https://youtu.be/1IEuhp8RFMU Your fat sources should be nuts and olive oil and chia seed, with some cheese and egg. Healthy food with lots of healthy fat. The brain uses ketones as fuel, so you will find that hypoglycemia is easily handled. In ketosis, your brain will have plenty of fuel, even if your blood glucose drops too low.
  - gukov 5y ago
    Look into the Type1Grit community: https://youtu.be/FXRNYWPooqc https://youtu.be/FXRNYWPooqc
  - DougWebb 5y ago
    I'd recommend watching Dr Sten Eckberg's videos, like this one: https://youtu.be/XTmUnIrmAe8 https://youtu.be/XTmUnIrmAe8 I'm on a keto diet for chronic insulin resistance and obesity, caused by 50 years of high carb eating. (Every meal a sandwich, or including potatoes or rice, and lots of sugar.) I got a CGM a few months ago to help me directly see the impact of the foods I'm eating. It has allowed me to fine tune my diet and get rid of everything that causes a noticable rise in my glucose. My daily graph now shows little more than than the natural daily cycle of glucose produced by my liver: starts rising before dawn, peaks around 10am, drops to my average by 6pm, and drops to daily low around 3am. If I were a type 2 diabetic (I was headed there), I wouldn't need supplemental insulin because I'm not eating anything that increases my glucose. The only glucose in my blood is the small amount my liver puts there because I need it. If I were type 1, I'd need to take insulin because my body wouldn't be making any at all. With my natural, consistent, and small-range daily pattern, it would be easy to predict my needs and take the right amount at the right time. CGMs are life changing.
- willcipriano 5y ago
  > 16x daily finger stick blood testing Is that typical for people with your condition? Once an hour while you are awake? I never knew people had to do it that often.
  - tempdiabetic 5y ago
    I do what works best. Typical is not my concern. A glucometer test takes 20 seconds, total.
  - guywhocodes 5y ago
    I would say it is quite high, I've never been recommended to measure that much even
  - sgmoore 5y ago
    I think the usual recommendation is before meals, two hours after meals and before going to bed. So that was 7 times a day for me. The big problem with testing more times is that you are literally damaging your fingers and hoping that they heal before you need to use that area on your finger again. For me this didn't always happen and is one of the reasons I love my FreeStyle Libre.
- RHSeeger 5y ago
  I can't say enough good things about my G6. It literally changed my life as far as how I interact with my diabetes. - I feel safer when I go to bed, because it's there to wake me up if my blood gets low (or too high). - I feel safer in general because I don't need to worry that my blood is low but I haven't noticed it; and that I'm going to just fall down face first while walking across the room. - Testing my blood is just a matter of looking, vs going over to (or downstairs to) where the tester is. - (Because of the above) I have a better "feel" for how my blood sugar reacts to various foods and activities. - When I'm having trouble with my sugars (morning highs, for example), I can see what my history has been via nice graphs on their web site. Honestly, it's amazing. While I respect your choices, I can only assume you weren't taking full advantage of just how wonderful having the G6 is.
  - tempdiabetic 5y ago
    If I may ask, what's your HbA1c, and please be honest?
    - RHSeeger 5y ago
      Summer 2021 - 6.7 Winter 2020 - 6.2 Summer 2020 - 5.7 Winter 2020 - 6.6 Fall 2019 - 6.0 My numbers tend to range in the high 5s to low 6s. That being said, the past two years have been rough because of a thyroid issue, plus 2 different drugs that impact blood sugar a lot (my blood sugar was hovering around 180 all day today, having not eaten since last night, and taking 80 units of short acting insulin over 4 shots... its been pretty crazy)
- idealmedtech 5y ago
  I've done accuracy studies of the G6 for a submission to the FDA, and while it's true they do filter out spikes, they're never more than 5mg/dL off from the measured value (which itself is usually within 10% of the real value). Interstitial lags are closer to 5 minutes when you're not experiencing severe perfusion issues, which is more than close enough for making dosing decision, especially considering subcutaneous insulin has similar or longer lag times (depending on lots of things of course, and subject to an individual's own body).
  - deleted 5y ago
    [deleted]
  - tempdiabetic 5y ago
    Any diabetic can confirm for themselves my claim about the Dexcom G6's unacceptable persistent error states. Simply compare the CGM with your glucometer (testing 8x per day, for example), and watch the CGM go wrong (and stay wrong) on day 5 or 6 of using the sensor. I wish what you said was true. I would love to have a CGM that works better than a glucometer, but they don't exist yet. In particular, the Dexcom G6 is inaccurate in a harmful way.
    - btowngar 5y ago
      I’m T1 and I use the G6. I used to regularly check against a glucometer multiple times a day (without calibrating) to check accuracy, and found no issues. A blanket statement such as “the Dexcom G6 is inaccurate in a harmful way” is certainly not true in general, even if true for you.
Talanes 5y ago
Are you looking to transition from your current CGM to a wearable one at the first opportunity?

tempdiabetic 5y ago

The Dexcom G6 is the best CGM on the market, but its sensor filtering (Kalman or particle?) has smoothness and/or continuity priors that cause persistent inaccuracies. I observe these persistent inaccurate states on the fifth or sixth day using a sensor. Calibration doesn't help. The reading goes wrong and stays wrong. It probably happens to you, too, but anyone who doesn't test with a glucometer will likely not notice the failure. You will be harmed by these inaccuracies. Persistent inaccuracy is different than the Gaussian (normal) error of a glucometer, which is far more benign. Also, CGMs are slow. The reading is based on interstitial fluid and lags direct blood glucose test by 15 minutes or more. I have completely abandoned the Dexcom G6 and have gone back to 16x daily finger stick blood testing. I am also on a low-carb/high-fat diet, which makes it easy to maintain normal human blood glucose. My HbA1c has been 4.9 for a decade. I was overjoyed to use the CGM at first, but it turned out to be a net loss. If you want to control your diabetes, use a glucometer and adhere to a strict low-carb/high-fat (ketogenic) diet.

jcims 5y ago
Is there a good source for info on ketogenic diets for type 1 diabetics? My youngest has been on pump therapy for the past 5 years and is completely burnt out from all of the alerts and scares (some of it is self inflicted). She was on a medtronic closed loop system for 4 years and that was the source of most of her frustration. She's on g6+tslim now which has been much better, but she still falls off the wagon regularly. I just think a keto diet would make it easier for her, but I'm seeing all sorts of conflicting info on it and her doctors don't support it. I've done it a few times in the past and getting started is the hardest part. I'd like for her to try but I'm getting no support on the idea. ?
- rpmisms 5y ago
  Keto is generally best once you've finished developing. If she's under 18, I wouldn't do Keto.
  - jcims 5y ago
    She's right on the bubble, but something tells me I've got some time.
- tempdiabetic 5y ago
  Dr. Phinney's lectures (Virta Health) are a good resource. Here's the first one, it's easy to find the rest: https://youtu.be/1IEuhp8RFMU https://youtu.be/1IEuhp8RFMU Your fat sources should be nuts and olive oil and chia seed, with some cheese and egg. Healthy food with lots of healthy fat. The brain uses ketones as fuel, so you will find that hypoglycemia is easily handled. In ketosis, your brain will have plenty of fuel, even if your blood glucose drops too low.
- gukov 5y ago
  Look into the Type1Grit community: https://youtu.be/FXRNYWPooqc https://youtu.be/FXRNYWPooqc
- DougWebb 5y ago
  I'd recommend watching Dr Sten Eckberg's videos, like this one: https://youtu.be/XTmUnIrmAe8 https://youtu.be/XTmUnIrmAe8 I'm on a keto diet for chronic insulin resistance and obesity, caused by 50 years of high carb eating. (Every meal a sandwich, or including potatoes or rice, and lots of sugar.) I got a CGM a few months ago to help me directly see the impact of the foods I'm eating. It has allowed me to fine tune my diet and get rid of everything that causes a noticable rise in my glucose. My daily graph now shows little more than than the natural daily cycle of glucose produced by my liver: starts rising before dawn, peaks around 10am, drops to my average by 6pm, and drops to daily low around 3am. If I were a type 2 diabetic (I was headed there), I wouldn't need supplemental insulin because I'm not eating anything that increases my glucose. The only glucose in my blood is the small amount my liver puts there because I need it. If I were type 1, I'd need to take insulin because my body wouldn't be making any at all. With my natural, consistent, and small-range daily pattern, it would be easy to predict my needs and take the right amount at the right time. CGMs are life changing.
willcipriano 5y ago
> 16x daily finger stick blood testing Is that typical for people with your condition? Once an hour while you are awake? I never knew people had to do it that often.
- tempdiabetic 5y ago
  I do what works best. Typical is not my concern. A glucometer test takes 20 seconds, total.
- guywhocodes 5y ago
  I would say it is quite high, I've never been recommended to measure that much even
- sgmoore 5y ago
  I think the usual recommendation is before meals, two hours after meals and before going to bed. So that was 7 times a day for me. The big problem with testing more times is that you are literally damaging your fingers and hoping that they heal before you need to use that area on your finger again. For me this didn't always happen and is one of the reasons I love my FreeStyle Libre.
RHSeeger 5y ago
I can't say enough good things about my G6. It literally changed my life as far as how I interact with my diabetes. - I feel safer when I go to bed, because it's there to wake me up if my blood gets low (or too high). - I feel safer in general because I don't need to worry that my blood is low but I haven't noticed it; and that I'm going to just fall down face first while walking across the room. - Testing my blood is just a matter of looking, vs going over to (or downstairs to) where the tester is. - (Because of the above) I have a better "feel" for how my blood sugar reacts to various foods and activities. - When I'm having trouble with my sugars (morning highs, for example), I can see what my history has been via nice graphs on their web site. Honestly, it's amazing. While I respect your choices, I can only assume you weren't taking full advantage of just how wonderful having the G6 is.
- tempdiabetic 5y ago
  If I may ask, what's your HbA1c, and please be honest?
  - RHSeeger 5y ago
    Summer 2021 - 6.7 Winter 2020 - 6.2 Summer 2020 - 5.7 Winter 2020 - 6.6 Fall 2019 - 6.0 My numbers tend to range in the high 5s to low 6s. That being said, the past two years have been rough because of a thyroid issue, plus 2 different drugs that impact blood sugar a lot (my blood sugar was hovering around 180 all day today, having not eaten since last night, and taking 80 units of short acting insulin over 4 shots... its been pretty crazy)
idealmedtech 5y ago
I've done accuracy studies of the G6 for a submission to the FDA, and while it's true they do filter out spikes, they're never more than 5mg/dL off from the measured value (which itself is usually within 10% of the real value). Interstitial lags are closer to 5 minutes when you're not experiencing severe perfusion issues, which is more than close enough for making dosing decision, especially considering subcutaneous insulin has similar or longer lag times (depending on lots of things of course, and subject to an individual's own body).
- deleted 5y ago
  [deleted]
- tempdiabetic 5y ago
  Any diabetic can confirm for themselves my claim about the Dexcom G6's unacceptable persistent error states. Simply compare the CGM with your glucometer (testing 8x per day, for example), and watch the CGM go wrong (and stay wrong) on day 5 or 6 of using the sensor. I wish what you said was true. I would love to have a CGM that works better than a glucometer, but they don't exist yet. In particular, the Dexcom G6 is inaccurate in a harmful way.
  - btowngar 5y ago
    I’m T1 and I use the G6. I used to regularly check against a glucometer multiple times a day (without calibrating) to check accuracy, and found no issues. A blanket statement such as “the Dexcom G6 is inaccurate in a harmful way” is certainly not true in general, even if true for you.

Talanes 5y ago

Are you looking to transition from your current CGM to a wearable one at the first opportunity?