Preventing CGM Induced Anxiety

Freestyle Libre 14 Day Reader Graph Shows I was High a lot
Disclaimer:

This website and blog does not provide medical advice, diagnosis or treatment. Read full disclaimer.

Anxiety is a common experience for many of us with diabetes.  The feeling of anxiety can be a symptom of low blood sugar (hypoglycemia).   But we can also get anxiety because we are anxious about things in our lives — for example, being anxious about diabetes!

This article is about anxiety that may be related to a specific type of diabetes technology.  CGM stands for “Continuous Glucose Meter”.  I specifically have experience with the Freestyle Libre 14 Day System and I will discuss potential anxiety based on my experience.

One way to reduce anxiety is through Behavior Modification.  Changing your behavior will change your thoughts and in turn may reduce anxiety.

Reduce checking frequency.

It’s super easy to get in the habit of checking ALL OF THE TIME!   The Libre reading does update every 1 minute, BUT it takes longer than a minute for your body to absorb the sugar you just ate!

When experiencing low blood glucose, I’d encourage you to follow a protocol.  The treatment for low blood glucose is to eat something with SUGAR in it.  Juice, soda, or candy are a few things that usually work fast.  The typical recommended amount to eat is 15 grams of sugar.  However, if the Libre says that you are low and going STRAIGHT DOWN, then double that amount (at least).   Then WAIT 15 minutes before checking your blood glucose again.  It takes TIME for your glucose to rise.  Checking too frequently may just make you anxious that the sweet stuff you ate isn’t working.  It probably is working but just needs TIME before it will cause the interstitial fluid’s glucose to rise.

The Freestyle Libre sensor estimates the blood glucose level from sensing the interstitial fluid.  After eating, it takes some time for the interstitial fluid glucose level to change.

I also would recommend in general not looking at it immediately after eating a meal, because after eating, your glucose is changing too fast for the Libre’s reading to be accurate.

Think about WHEN you can benefit the most from checking your glucose reading, and do it then.  For example, I usually check about 1.5 hours after I eat a meal.  By then, most of the quick acting insulin has had its effect and most of my meal has been digested… If I ate a high fat meal, that may not be the case, though.  But, usually at the 1.5 to 2 hour mark, is a good time for me to check.  If it’s high at that point, I can give myself more insulin.  And if it’s low, I can eat something to correct that.

YOU ARE SMARTER THAN YOUR SENSOR!

Yes, the Freestyle Libre 14 Day System and other CGMs are LIFE CHANGING technology for people with diabetes!  I 10000% agree with that statement.  But, if you just ate food, trust that your glucose level is going to increase.  Understand that there is a delay before you will see the number change on the Libre.

Also, if the sensor is telling you something that seems unlikely, it may be wrong!  Sometimes sensors go bad.  I’ve twice had one go bad on the last day.  Poke a hole in your finger and do an old fashioned blood test.  If the sensor reading is WAY OFF repeatedly, call Freestyle Libre Customer Support and they may send you a replacement.

Strive for better, not perfect.

Now that you have a Freestyle Libre or other CGM, you have a lot more information.  You can see how often you are TOO HIGH or TOO LOW.   This may be causing your anxiety 🙁

Maybe you don’t have all of the tools you need right now to get to your goal.  Maybe you are going to be too high a lot of the time because it’s safer than being too low.  Maybe you need to get a different kind of insulin.  Maybe switching to an insulin pump will be the answer.   Regardless, there are likely limits on how much you will be able to improve your numbers in one day.

Strive for better, not perfect.  If you have a TIME IN TARGET of 50% for the last 7 days, strive for 55%.  And then when you get there, try for 60%.  Keep increasing the goal by 5% and then when you reach stagnation, reach out to your doctor and healthcare team.   Ask them how you can do better.

Perfect doesn’t exist with diabetes treatment.   Perfect would be a cure for diabetes.  We don’t have a cure, so all we can do is our best.  If you would like to read more encouragement about DOING BETTER with diabetes, read Chuck Eichten’s excellent book “The Book of Better: Life with Diabetes Can’t be Perfect. Make It better.”

Poke a hole in your finger, when…

This Freestyle Libre reader is indicating that I should check my blood glucose before making a treatment decision.

See that magnifying glass and blood drop symbol on the Freestyle Libre reader in the above photo?  This means that the Libre reading may not be accurate and you should check your blood glucose by poking a hole in your finger.

Also, do an old fashioned blood glucose check whenever you are in doubt about the reading and need more information about what’s really going on.  The Libre is great for figuring out trends, but sometimes it’s wrong.

Add alarms, or change alarm settings.

Are you having anxiety because you are checking too much because you are afraid of getting high or low blood glucose?  Wouldn’t it be nice if you could count on the device to sound an alarm?

If not knowing is causing you anxiety… Then I would look into adding alarms to your Freestyle Libre or switching to a CGM that has alarms.

I have not tried the product myself, but I am aware that the company MiaoMiao has a product that sends alerts to your phone from the Freestyle Libre.  Read about the MiaoMiao Smart Reader.

Another option is to switch to the Dexcom sensor or another company that has alarms.  If you switch to an insulin pump, you will want to get the CGM that can communicate with the pump so that you can receive alarms.

If you already have alarms going off, are they set at the right level?  Everyone is different and personalizing the alarm settings may reduce anxiety.

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