CGMs and Why They Suck

CGM’s all around are a pain in my ass. #

So its pretty well known that a lot of things annoy the fuck out of me in pharmacy. From the patients to new drugs that aren’t covered, to pretty much anything.

However CGMs (Continuous Glucose Monitors) hold a special place in my black, bitter, hate-filled heart. These abominations that they advertise on TV have given me more fucking heartburn, patient calls, and just general misery that I’m about to stop carrying them in the store. You know the patients who are on just Metformin 500 daily and want to test their sugar 10000 times a day? As if testing a ton is going to magically make their shit eating habits not matter? These are the people who you would think a CGM would work well with right?

Fucking wrong. Dead fucking wrong. Let me pharmsplain to you why these suck.

Coverage requirements for Medicare-B and MediCalRx are stupid. #

• Medicare-B and MediCalRx (California’s Medicaid System) have stupid requirements for coverage

Medicare-B #

• You must be on a self adjusting (ie: sliding scale) short acting insulin at 3 or more injections a day OR an insulin pump
• You must be evaluated by a specialist at least once in the last 6 months
• Your doctor must sign a form (which is the same for strips) that they never fucking sign, and if they do, its signed by some fucking resident who isn’t registered with PECOS therefore you cant bill it to Medicare-B.
  • Even if they do sign it, 6 months later when you re-send the form for renewal (gotta be seen once every 6 months remember?) they write a nasty note almost instantly saying “Gave 12 refills”. No you fucking idiot, did you not read the fucking form that you signed saying you saw the patient in the last 6 months? Jesus fucking Christ doctors can be fucking stupid sometimes.
  • Plus if they outright lie on the form, you think Medicare is going to go after the MD? Fuck no, they are going to come after us for magically knowing their doctor is a fucking liar and cant read the fucking requirements.
• They will pay for (For the Libre) 2 sensors every 30 days.
  • Those astute pharmacists will say “Wait, each sensor is only good for 14 days, what about the remaining 2 days?” Well, the patient can get fucked and deal I guess. Typical government stupidity right there.

MediCalRx (California’s Medicaid) #

• Must be a Type 1 diabetic
• Must be motivated to improve their diabetes
  • How the fuck do you prove this? Make the patient do a little fucking dance? Write a song about how they like to eat sugary bullshit and ignored their health for 40 years but now “I can change I can change?”
• There’s other shit too but who cares, the first requirement eliminates about 90% of the people who want this. Not a documented Type-1? Nope, requires a prior auth. Seriously, this is one of the requirements, a fucking documented type-1 diabetic.

Sensor falls off? Oh well, lol! #

If you fuck up a test strip, you’re just out a test strip. Test one time less today and move on with your life. If you fuck up a Libre Sensor, you are rightfully fucked for 2 whole weeks. No, it doesn’t matter if you come in holding the fucked up sensor like your dead hamster and want me to replace it. I cant. 2 sensors every 30 days remember?

They take a little more brainpower than strips #

This sounds fucked up, but its true. These devices take some actual brainpower to not only apply the sensor, but common things like:

• Apply the sensor.
  • Why Libre stopped supplying little alcohol pads with each sensor is beyond me, because 99.9% of the cases where sensors fell off is because the patient had about 10 layers of lotion (at least I hope it was lotion, ew) and the sensor glue decided to just suicide itself onto the ground.
  • No matter how many times we tell them to clean the sensor area with alcohol they never do it. However they will blow through a box of 100 wipes to clean their fucking fingers before a finger stick, then wonder why their numbers are all fucked up.
  • Its gotten so bad, that a few patients I actually have to put the sensor on for them. I’m fucking nice aren’t I?
• Pairing the sensor to your phone (lol) or to the reader.
  • Yes, you actually have to look at the fucking picture that your reader is showing you and do what it says. Oh, you cant reach the sensor because your arms look like overfilled sleeping bags full of fat and your idiot kid put the sensor on where you cant reach? Yeah. That’s happened.
  • I’ll help you download the app, and pair your first sensor, but you gotta actually learn how to do it yourself.
• “I was taking a shower and I was scrubbing my arm and the sensor fell off!”
  • Well no fucking shit. Its just glued onto your arm, not surgically attached. Wash gently around it. I don’t know why I would have to tell someone this, but a TON of people just decide to scrub where the sensor is like a fucking angle grinder.

Its shit like this that makes me wonder how in the fuck have they not killed themselves dosing their own insulin via sliding scale. Like how have you not OD’d yourself on Humalog yet?

They feed into a bad habit of testing 1000 times a day #

There are people who are addicted to testing, especially when they are on oral meds that they cannot change/adjust like you would a sliding scale for insulin. This is the equivalent of stopping every 10 miles to check the gas in your car. Why? You cant do shit about it on the side of the road!

However we all have “that” patient who their insurance only pays for once daily testing (Why test more? They cant do anything about it. Change diet? LOL!) but takes it upon themselves to test 6 times a day for no fucking reason what so ever. Now I’m not talking about if a diabetic feels sick, or doesn’t eat due to the flu or COVID or whatever; I’m talking about 6 times a day, every fucking day.

No matter how many times you tell them “Listen its only once a day. That’s all your insurance will pay for” and they go “Okay”; 13 days later they walk in with an empty box of test strips wanting more. Then they act fucking shocked when they have to pay.

This habit isn’t healthy. CGM’s just feed into that habit. Its like giving someone with a gambling habit unlimited money. They just test and test and test and test. Then they start obsessing over the numbers, and call you every single time a number is just a bit off like if went hog wild at the ice cream machine at Golden Corral. Their life is consumed by the number on the fucking CGM reader. I mean fuck their A1c, that number doesn’t mean shit to them.

They are expensive #

Lose a sensor? Congrats you’re either out $50 for a new sensor or waiting a week for the company to send you a replacement.