Juicebox Podcast: Type 1 Diabetes

Episode #1442 Small Sips: Using a CGM Well
Host: Scott Benner | Guest: Jenny Smith
Release Date: February 23, 2025

Episode Overview

This "Small Sips" episode distills listener-nominated diabetes management insights into a concise, actionable discussion focusing on continuous glucose monitoring (CGM) graphs. Host Scott Benner and diabetes educator Jenny Smith delve into how to extract value from CGM data—beyond the raw number—to improve daily diabetes care. The conversation is practical and supportive, seeking to replace fear with informed, bold action.

Key Discussion Points & Actionable Insights

Understanding CGM Graphs: Beyond the Number

• Interpreting Graphs Across CGM Systems

  • The fundamental strategies for interpreting CGM data are applicable across brands and models, though minor differences in interface or readings can exist (02:25–02:40).
  • All CGMs display directional trends (arrows) and glucose values; these are universally useful (02:40).

• Identifying Compression Lows

  • A sudden drop in glucose values—"a cliff dive"—on the CGM graph may be a compression low (when lying on the sensor), not a real drop (03:58–04:29).
  • Recognizing this pattern can help prevent unnecessary treatment and the accompanying panic.
    • Quote:

      “It's almost, I kind of describe it akin to a cliff dive.”
      —Jenny Smith (04:00)

• Responding to Sudden Lows

  • If a sudden, dramatic drop appears, use a fingerstick meter to confirm before treating, instead of reacting immediately (05:02–05:15).
    • Quote:

      “Instead of the panic putting a juice box into your hand, let the panic put a meter into your hand...”
      —Scott Benner (05:02)

Using Graphs for Insulin Timing & Dosage Adjustments

• Analyzing Post-Meal Glucose Trends

  • The angle and trajectory after eating indicate whether the pre-bolus was sufficient.
    • A sharp, upward line suggests the bolus was too late or too little (06:00–07:00).
    • A gentle rise with a quick plateau and return signals “almost right.”
    • Subtle differences between timing and amount can be seen in the line’s shape.

• Reflective Approach vs. Self-Blame

  • Avoid judging past decisions—use the information to adjust, not to criticize (07:00–07:50).

    • Quote:

      “Trying to take the emotional piece out of it. Don't judge your decision. Instead… take a look at your data, look historically back and see, okay, I can see where I might need to make an adjustment.”
      —Jenny Smith (07:10)

  • Regularly scheduled reviews (e.g., once a week) foster proactive management.

• Patterns Reveal Insights for Next Steps

  • Slower, steady rises indicate too little insulin; sharp jumps after an otherwise good pre-bolus suggest not enough pre-bolus time (08:00–08:30).

Avoiding the Roller Coaster Effect

• Don’t Set and Forget CGM High Alarms

  • Setting high alarms too high (e.g., 400 mg/dL) leaves you reacting too late, making recovery more difficult and increasing variability (09:50–11:28).

    • Quote:

      “Please don't just treat it as a low alarm, right? And then push your high alarm up to 400 and ignore it.”
      —Scott Benner (10:00)

  • Addressing rising glucose earlier can prevent prolonged highs and subsequent lows caused by overtreatment.

• The Importance of Avoiding Lows

  • Preventing lows can reduce subsequent highs because over-treating lows leads to “roller coaster” blood sugars (11:30–13:04).
    • Quote:

      “If you can filter out a good majority of the lows, you’re often going to decrease the height of the highs.”
      —Jenny Smith (12:28)

• Typical “Roller Coaster” Scenario

  • Many people experience stability overnight, then trip up on breakfast dosing, resulting in “whoop up, crush it down, panic about the low, eat too much, back up” cycles (13:04–13:30).

Memorable Quotes

• "I don't feel like you should look at it and say, oh, this is what happened. Here's what I did. I know what I should do next time to stop this from happening. Like, those lines tell you a lot."
  —Scott Benner (06:30)

• “The whole game is timing and amount. It's using the right amount of insulin at the right time. And that graph can teach you a lot about it.”
  —Scott Benner (08:30)

Timestamps for Key Segments

• [01:38] – Introduction to using CGM graphs for more than just numbers
• [03:23] – Compression lows: identifying and responding
• [05:02] – Confirming sudden lows with a fingerstick before treating
• [06:00] – Using post-meal trends to assess bolus timing and amount
• [07:00] – Avoiding self-blame; using data as a learning tool
• [09:50] – Setting and using high alarms proactively
• [11:30] – Focusing on preventing lows to stabilize overall patterns
• [13:04] – The roller-coaster pattern and how to break the cycle

Final Takeaways

• Use the full power of your CGM: The graph is more than a number—it's a story of your diabetes management. Learn its patterns, and adjust routine decisions confidently.
• Regular review, not panic: Analyze CGM data weekly to spot and solve recurring issues, rather than reacting emotionally in the moment.
• Adjust alarms thoughtfully: Setting appropriate high/low alerts enables timely, gentle corrections, avoiding dramatic glucose swings.
• Empowerment through data: Ditch judgment, embrace lessons. Each line, jump, or dive in the graph is feedback to help you become “Bold With Insulin.”

For further learning, the hosts recommend checking out the Pro Tip series (starts at Episode 1000) and the Bold Beginnings series.