Here is a simple one:
I am not so sure now.
(I am sticking with my story that CGM is significantly better and more useful than A1c).
But to the issue/question as to what actually causes damage,
I think this article:
is pretty spot on to the question of:
But itās also accurate to say that itās not the glucose that directly damages the blood vessels, per se.
Basically, thereās a complicated, multi-step chemical reaction (or several of them) in which free-floating glucose is bound and then chemically transformed into multiple byproducts which we lump together as advanced glycation end products. Some of these AGEs likely directly contribute to damage, some may be correlated with underlying damage processes but not directly respnsible, and some may even be a sign that the body is adaptively responding to high sugar levels in a way that is protective (some Joslin medalists have a few AGEs that seem to be protective), and some may have no significance at all. i found this study, which is talking about skin aging, to still have a good and informative discussion about AGEs in the beginning, although perhaps others might find this too technical.
I donāt disagree with why you have said in any way. You usually have a better technical answer than I, since my cro-magnon research was on transition metals, and in no way studied how they affected the numerous body processes.
Every damage pathway will include some combination of genetic predisposition, acute and chronic changes to normal physiology, multiple chemical reactions resulting in a simple or complex pathway change. I find it interesting that some have been found to be helpful.
I kinda have to side with @Thomas on this one. A1c can be pretty variable in a narrow rangeāis 5.5 really that much better than 6.3?
CGM gives you information to figure your average bG AND the Standard Deviation. An average of 108 will give you an A1c of about 5.5. But what you donāt know if if that was achieved with an S.D. of 15 or 40.
That makes a big difference.
I think science hasnāt quite yet determined if it really makes any difference at all in terms of complication riskā¦ it seems to be a widespread assumption amongst users that it does, but not one yet established by science, and maybe not one that ever will be, perhaps even one that will be disprovenā¦
But we do know that A1C and complication risk go hand in hand.
I think itās a reasonable goal for everyone to minimize variability to as closely as possible mimic normal glucose profiles, and I think the cgm is a very good tool to use in pursuit of that goal, but I donāt think that goal does anything to reduce the value of a healthy A1C-- which we positively know for certain is hugely significant in the the complication risk
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Some of the things CGM doesnāt capture well:
- Gaps when sensor is down, new insertion time, or time when the sensor and receiver are not communicating.
- Lags in low time, how the CGM thinks you are low for 30 minutes but youāve actually corrected it much faster.
- Never reaching the top height of your BG spike, you reach 200 and have corrected and your on your way down, but your CGM is still at 150.
I think these are problems with the CGM as a marker.
I donāt think A1C is useful for comparing Eric to Doc, but I do think it is useful for comparing the Doc from āJanuary thru Marchā to the Doc from āApril to Juneā. (As long as you havenāt killed a lot of your RBCs 
)
A lot of the problem we have is comparing our own A1C with that of another. That is not a valid comparison.
G5 v1.2 transmitter - No longer an issue. Fixed. 3 hr data backfill from transmitter to the Apple/Android apps.
[if you have more than a 3 hr gap - you probably have bigger issues - lol]
As FYI, we absolutely do not see a 30 minute lag time. Not even close. 10 minutes maybe?
Must be nice, the lag time doesnāt work that way for me.
Also when I turn on my phone app, I get zero backfill. Is that an app version problem maybe?
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I donāt know that it would be expected to backfill starting the moment you turn the phone onā¦ but if the app is tracking the data and is interrupted for a period of time, it should backfill for up to 3 hoursā¦
Iād say I also see close to a 30m lag on the cgmā¦ at least 20 anyway, and when my blood sugar is actually acting funky itās unacceptably inaccurateā¦ it basically is only really good and accurate for tracking my bg while itās perfectly stable and not moving, and even then it frequently registers false lowsā¦
Iāll mess with the phone backfill some more. I mostly use the receiver. I like it better becauseā¦you can buy them on eBay!
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I tested the backfilll from Apple iPhone on app version 1.7.1. (I think - version not in front of me as I type.)
Based on the Dexcom receiver NOT working with the backfill, I would assume that older apps also did NOT support the backfill. I can only say the one (ie Apple v 1.7.1) that I saw which DOES support it.
You can also buy tweezers on eBay. I did so today.
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My daughter just had a low in the 55 range of so. Donāt recall exactly. We verified with a meter partly because the Dexcom had been complaining for lack of a calibration all day. I forget the difference but it was less than 10 points between the CGM and meter.
At least for us the Dexcom is really great and quite accurate.
It will register lows (some of them correctly even) so for people who really struggle with lows I can see the appeal, and I suspect when youāre managing for a child theyāre probably the best thing in the worldā¦ at this stage of the game for me though I just already know when my blood sugar might be low, what conditions might lead to that being the case, and can avoid those situations long before a cgm could notify me of themā¦
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We find Dexcom is really great and accurate ā¦ except when the numbers are weird. It often (very often) overestimates the depth of lows and how long they last.
If ever get the mental bandwidth I plan to do a systematic experiment: Finger test before each of our Dexcom treatment thresholds, then record the same reading on Dexcom at the same time. Finger test 15 minutes after treating the low, and record Dexās reading at that time. Thensee if Dex has any skew. My guess is that it may be lagging by about 10 minutes on the steep drops but that it dramatically overestimates the time it takes for BG to rise.
Anecdotally, I would say about 75% of the time when it says our son is low during the night and I actually test, heās not low. I canāt say at school because they usually donāt test, but a lof the really persistent lows (say heās hanging out in the 50s or 60s for nearly an hour on Dex) and I ask them to test, heās usually 89 or 95 or something.
The main times when heās low by finger stick and Dexcom is oblivious to the low, we have usually missed a calibration earlier in the day.
But it would be nice to actually have some numbers on this,
@Eric I have a 98% capture rate consistently in xDrip+. The A1c estimate it gives me is exactly what the A1c blood test shows. I also get readings during sensor warm-up, with only 3 or 4 being erroneous.
I am sure that within a short time the FDA will give Dexcom the OK to start doing the things that xDrip+ does now
I am not sure that is the direction Dexcom is going. What functionality are you thinking of? (I am not familiar with xDrip+ other than the general concept.)
Yeah, I guess xDrip gives you better coverage times compared to what the regular receivers give you.
My last sensor coverage was basically useless.
Switch to one of the [updated] smartphone apps for a receiver.