Next Time You Look for Patterns, Do This
Go deeper into your CGM data with this one trick
Looking at CGM data can be really overwhelming. I would know. Not only do I look at my own CGM data, but I have helped 50+ clients over the last 3 years analyze their own data plus I taught 3 rounds of Essentials of Pattern Management (much of this content is being turned into a self-paced course: get on the waiting list!).
Analyzing CGM data is a process that involves identifying, explaining, prioritizing, hypothesizing, planning, executing, and evaluating. And there is one part in the Explanation Phase — yes, one of the first things we do — that in my experience is often overlooked and it can have a pretty profound impact on the rest of the process.
When I work with clients, everyone is experienced enough to know when the graphs are showing where they are high and where they are low. They might even go so far as to interpret correctly where they need to make to make changes, but the why in the interpretation step is often complete overlooked.
Why something happens is absolutely essential for interpreting correctly. There are a lot of reasons why something can happen (42 in fact!) but there are a few other Whys that I want to make sure get included.
We need to remember to consider the impact of our own habits and choices and why they happened. There are reasons behind our behaviors and decisions, and examining them helps us to create other options that can serve us better.
CGM Analysis Exercise:
Open up your CGM analytics program and pick a random day in the last week (further back and your memory won’t be as good). From that day, pick a high or a low blood sugar. Trace back to the origin of that high or low and think about what was going on that day. Identify the behavior and then provide a nonjudgmental explanation for why or how it happened. If you normally bolus on time, but this one day you didn’t and spiked, don’t just stop at “I didn’t prebolus.” Examine nonjudgmentally why you didn’t. Which means you don’t say “I didn’t prebolus because I was lazy,” you would say “I didn’t prebolus because I was struggling with keeping up with my to do list and I didn’t have as much time to wait.”
Example:
Let’s say I go high every night after dinner. My doctor hypothesizes I need a stronger insulin to carb ratio because his explanation is I’m not taking enough insulin. Which could be true… This might be partly right but on reviewing things further, I see that I’m actually reducing the amount of insulin I take for my evening snack because I don’t want to go to bed with “too much insulin” in my system. My “why?” - my actual why - isn’t just that I’m not taking enough insulin (which is true), it’s that my thoughts and emotions around my blood sugar and insulin at bedtime are leading me to a behavior (reducing my insulin on purpose), which is having clearly unhelpful effect.
What’s even worse is when healthcare professionals judgmentally accuse individuals of not bolusing. Why is it a problem if it’s true? Because it puts people on the defensive, which is a problem for a few reasons:
If we think we are going to get in trouble, we will go into fight or flight mode.
If we go into fight or flight mode, we can’t get any support.
If we can’t get support, we will stay stuck in the behavior that we now recognize is happening but feel powerless to stop, which sets in shame and guilt.
And plot twist: we do this is to ourselves too!
This is one of the reasons why self-compassion is such an important concept and part of diabetes management. We can be the source of our own judgement around what we see happening in our blood sugars. I am going to be talking more about Self-Compassion in a two-part newsletter next week. The first part, on Monday, will talk about what self-compassion is, and on Thursday (the paid newsletter), I will talk about ways to develop self-compassion.
See you then!