How CGM and a diabetes clinic called Steady Health changed his care
Since his diagnosis in 1980, Steve’s diabetes care had remained relatively the same. He used finger sticks to check his blood glucose and a sliding scale to calculate how much insulin to use for each meal based on his current blood glucose level. For this treatment to be successful, he chose many of the same, specific foods and mealtimes. Steve wasn’t encouraged to dose insulin depending on the content of his meals, and this made it impossible for him to avoid high blood sugars. It cemented a feeling that it was impossible to achieve good blood sugar control. Steve says that he was often puzzled by this “fixed” approach to care, and describes it as “almost blind management”. Even though he felt he was doing what he could, Steve could not get his blood glucose under the level of control that he wanted.
“I was puzzled by how ‘fixed’ the sliding scale was, it felt like a lot of guesswork — almost blind management.”
In addition to feeling frustrated from high blood sugar and the fear of dramatic lows, another aspect stressed Steve even more; He knew that prolonged high blood sugars put him at increased risk for long-term complications like kidney failure, heart disease, and even blindness.
These prolonged high blood sugars can be measured by a blood analysis called Hemoglobin A1C, and Steve’s personal goal was to get his below 7%. He went to see his endocrinologist regularly, made all the adjustments they suggested, but never got his A1c lower than 8%. With a stagnant approach to his care, Steve’s personal health goal was hindered.
Steady Health’s first step was to get Steve started on a continuous glucose monitor (CGM). A CGM shows a blood glucose reading every 5 minutes and gives a trending arrow of where it is heading to help make informed decisions. No more finger sticks. No more guessing. Even with these benefits, Steve was pretty reluctant to the idea of having a device fixed to his body. Since being diagnosed with diabetes, he has always just wanted to be like everyone else, and having a device attached to him only exaggerated his differences. At the same time, he was curious about what he could learn about his blood glucose while using a CGM. After talking to us and reading our founder’s medium post, Steve jumped at the opportunity.
Getting a CGM
39 years to date, the biggest and most impactful change in Steve’s diabetes care was starting on the Dexcom G6 CGM. “If you’re only doing finger sticks, you’re only getting snapshots and not filling in the blanks. I was testing before meals and that’s about it. If I was feeling low, I would test. If I was feeling high, I would test. I have a pretty good internal meter so I knew when I was going low, but not when I was going high. Now, I’m much more in tune with how my meals are not only affecting my glucose levels, but also my dosing.”
CGM data enables instant feedback and fills in the blanks for people with diabetes. But, to do a proper analysis of why someone is going high or low, we need to compare different instances and have information on how food, exercise, stress, etc. is affecting them. We have our members track these meaningful events in their day to day in the Steady app and then we’re able to see it alongside their CGM data:
The Steady care process
After a 2 week tracking period, Steve came in for an In-Depth Analysis appointment (which was much longer than his typical 15 minutes Endo visit!). During this session, he met with our clinical team of Endocrinologists and Certified Diabetes Educators to talk through his data and collaboratively develop insights on how he can improve his daily decisions for better long term health. Our model of care is set up to help every member reach their goals and live healthier lives.
After working with Steady, Steve says he gained a completely new perspective on his blood sugar management, “I was seeing little things that I never really knew, my eyes had been opened.” Through Steady’s analysis of his CGM data, Steve found out that his blood glucose naturally rises between 6–8 am. Before having a CGM, he never knew that. How could he? Now, he wakes up, gives himself a bolus, and starts every day in better range.
Another thing Steve learned from his own data was that short-acting insulin sometimes lost its effect before his dinner had been completely absorbed, which led him to have high blood sugars overnight. With Steady, he figured out a way to manage those meals, “The coaching sessions with Steady helped me learn new things about how to manage blood sugars and try things I wouldn’t have tried on my own. I bolus in a completely different way than a year ago. I still take the same amount of Humalog, but I take it differently.”
One day of Steve’s tracking period: the green dots are his blood glucose values, he logged pictures of food and drinks shown at the bottom, and the blue circles display the units of insulin he administered.
Steady app messaging
A new feature Steady provides is quick, direct messaging with our care team. Messaging allows members to contact Calvin, our endocrinologist, or Aimee, our nurse, and diabetes specialist, with any questions about prescriptions, insulin doses, or symptoms and get a response directly from them.
This showed to be extremely beneficial when it came to adjusting Steve’s basal dose. For the last 20 years, Steve’s doctor had been moving his Lantus dose up and down trying to find the right amount. At Steady, Calvin gave Steve instructions to complete an overnight basal test and to send an in-app message after doing it. When he messaged Calvin the next morning, right then and there, they adjusted his basal dose.
Steve was taking 24–26 units of Lantus before Steady, and now he’s taking… wait for it… 16 units! That’s a lot less insulin! When he was on 26 units of Lantus, Steve was having frequent lows, rebounding with too much glucose and ending up high, swinging back and forth. By sending his doctor only a handful of finger stick values, and making the next adjustment, Steve continued to struggle to get where he needed to be. With Steady, he was able to message his endocrinologist, get a response and change the dose in less than 24 hours.
“I feel like I was getting very traditional care from my previous endocrinologist, where now I’m getting a very modern, upgraded version of care from Steady.”
Technology has come a long way in diabetes care. Steady Health, fortunately, has been designed with this new technology in mind.
Results with Steady and CGM
Before joining Steady, Steve explains diabetes as a nagging voice in the back of his head, “You’ve managed diabetes for nearly 40 years, why don’t you have this under control?” After being with Steady for 6 months, Steve’s A1c dropped from 7.8% to 6.8%. A whole point lower and finally at his goal.
“I had such a clear goal of getting my A1c below 7% and I’ve hit that goal. I’ve won. Steady helped me win. Now I’m setting new goals, ones that will help further improve my management.”
Along with dropping his A1c a whole point, Steve also increased his time in range by almost 20%. Time in range is the percentage of time that someone with diabetes spends in the standard glycemic range of 70 to 180 mg/dL. In November, Steve started with a time in range of about 70%, and by April he had increased his time in range to almost 90%.
He dramatically decreased his time spent in a high blood glucose range (over 180) and in a low blood glucose range (under 70), which were two of the goals he set in his appointments.
Steve was able to decrease both his time in high and time in low drastically from first joining Steady in November 2018 to April 2019.
“Because of Steady, I’ve seen the most radical improvement in my management in the last 6 months and I’ve completely changed my diabetes care… Steady overall has made me healthier and I have much better control in managing the disease.”
Thanks to Henrik Berggren, Emma Lane, and Björn Hansell, MD.