I have chronic pain issues, and the past couple days have been worse than usual, so at some point, I said #$&^ it and added some Tylenol (2 pills or 1000mg, every 6 hours, as recommended) to my cocktail of naproxen and my usual scripts. I kept an eye on my CGM, expecting ???s to kick in eventually, but it’s been normal and reliable except for a brief cut out for maybe 20 min which backfilled (so I think that wasn’t the acetaminophen). So I am now no longer considering acetaminophen off limits, which is great, especially since one of my specialists recently told me he recommends it over it over ibuprofen/naproxen for some of the types of pain I have.
Of course, this is just my personal experiment—YDMV, but I’d be curious if other people can replicate this.
I would definitely not use Tylenol with the Dexcom G4/G5 sensors. Dexcom has said over and over again this will cause inaccurate readings. It is not necessarily the ??? which you would expect but rather the cgm reading to have higher innacuracies as compared to a meter reading.
The Dexcom G6 sensor (not yet approved or released) has specifically been modified so as to avoid this issue.
We use either ibuprofen (Motrin / Advil) or naproxen (Aleve) as required.
The biggest issue with using acetaminophen (Tylenol) while on the Dexcom is the cgm readings may be erroenously reported as higher then they are. If dosing a bolus from the cgm number this may result in excessive insulin being used. As well, this may mask a low BG situation.
The degree to which the cgm reports higher readings can be different from person to person as well as in impacted by the amount of acetaminophen (Tylenol) consumed.
I was also concerned about inaccuracy, so I was testing a lot more often during that time point, and haven’t noticed anything irregular on that front either (and I’ve been high and low during the last 24 hours and checked to confirm each). So for me, it so far doesn’t seem to be effecting accuracy either, but again, this is n=1 and I definitely would not assume that would be true for anyone else or even for myself in the future, and would still check more carefully if/when I use tylenol again.
I’m already maxed out on naproxen (500mg/2x a day; or if I do ibuprofen, 800mg every 4 hours) and I already take several prescription non-opiates to manage pain (and am intolerant of opiates, so those aren’t an option for me), so if I’m at the point where I need to add to that, I honestly don’t care if it makes my CGM less reliable because I need to not be in overwhelming pain. I was just pleasantly surprised that it didn’t have a noticeable impact on my CGM.
Also, my experience makes me wonder whether it’s a situation where it’s possible that it may affect CGM accuracy, so they cover their asses and urge you not to do it, or whether it’s actually likely to have a major effect. I think Dexcom’s guidelines and public statements would be the same either way, so people would probably have to experiment to know.
Ok, well I edited the title since I don’t want to be misleading, but figured I’d share my experience in case it’s interesting/useful for anyone else. For me it was good confirmation of YDMV and you don’t really know how something will work exactly until you experiment with it yourself. Multiple published studies matter more if I’m trying to make general guidelines for use; my own experiences matter more when making personal treatment decisions.
Also a quick perusal of the published studies suggests that 1.) on average there is a substantial effect, although it’s about 30mg/dL for the modern Dexcom receivers; it’s the older ones where it was really extreme (Basu et al, 2016; Maahs et al, 2015), and 2.) there are significant individual differences in the effect, and for some people (possibly up to half), the effect fell within 20%, so within the level expected as normal CGM noise (Maahs et al, 2015). The recommendations from that would indeed be to avoid it, but it does suggest there are likely some people from whom the effect is not that substantial.
@cardamom Make it (n=1 x 2). My doctor recommended I use Tylenol for a few days earlier this year. I was expecting to see the G5 readings go crazy high and become useless, but nothing really happened. I tested frequently during this period and did not really see any difference between the CGM and the finger sticks.
With that said, I usually avoid Tylenol because of the warnings. Also, I would probably do finger sticks more often when using tylenol and not dose off the CGM.
Please also consider your experiment to be ok for the site where you have the sensor implanted, and not over your entire body. If the interstitial fluid where the sensor is located contains tylenol, you will see a signal increase.
Makes sense—I will definitely keep testing more than usual if/when I use it, so I’ll report back if I get more data on that front. I only ever use a very limited amount of real estate on my lower abdomen for sites though, so might be more variable for folks who use a wide range of sites.
Cardamom, thank you for posting your experience here. I will start CGMing soon and was concerned about having to abandon a migraine rescue drug containing Tylenol that is v helpful to me. I will not worry as much when using it and will monitor v closely with finger sticks. Thanks again! Jessica
@JessicaD, really good to see you here, Hope you are doing well!
It is great news about the CGM: getting a CGM has made an extraordinary change to our we deal with diabetes in our household. Much of how improvement over the years is due to the CGM as a root of all work.
I also sleep a lot better knowing that I have alarms to wake me up in case my kid goes low.
So Mazel Tov to you: I hope a CGM brings you as much as it has brought us!
Michel - thank you! It’s been a busy fall/winter with too many BG lows and it will be great to get started with CGM. (Although I admit I’m a little nervous) It’s so good to hear of experiences like yours! I’m reading up on all of the tagged CGM threads right now to figure out what I need to be thinking about - can’t wait to get going! Happy new year to you and I hope that you’re staying warm! (we are in the middle of a bombocyclone (hmm - blizzard) and having fun with the snow!). Jessica
But all is relative of course We spent about 10 days in Canada over the vacation, where it was very cold, then came home to subzero temperatures. Yesterday, for the first time, we had a temperature in the teens. So here I am shoveling my huge driveway, and I am thinking at the same time: gosh, it is so warm today!
@JessicaD, starting the CGM is a big step, but please don’t let the sensor change the way you medically treat yourself, just understand what can happen when you provide that treatment.
Also, the biggest value of the CGM in our house was gaining a greater understanding of what happens when I do something specific, i.e. different foods, exercise, stress level, etc. This allowed us to quickly modify our behavior to try and stay in range more often. Yes, my wife and I love the low alarms which gives us good peace of mind, but really the first few months when we had all these key learning’s was the biggest positive.
There was so much learning in fact, that even if people don’t want to commit to a CGM forever, I think every diabetic should wear one for three months just to jump start their learning. (super skinny people excepted, since it seems to cause so much frustration when it isn’t accurate)
Couldn’t agree more with @Chris on this point, @JessicaD Knowing how your child’s (or your) BG trend is critical in being able to know and identify. We LOVE the alarms because this helped me finally be able to sleep, but understanding cause and effect of different actions and foods with your own specific body is critical.
Our single biggest saving grace through all this has been the CGM. If I had to give up one device, CGM or Pump, it would be the pump hands-down. CGM is such a critical device (even if it isn’t accurate a lot of the times for us, it’s still worth it’s weight in gold to us.)
There is SO much knowledge within the FUD walls that I’m fairly certain any and all questions you have pertaining to a CGM can be answered in short order. We have DMS here as well (Diabetes Mad Scientists) who are willing to test things for those of us who are less brave with diabetes decisions.
You’re welcome! I think it’s easy for folks to say just don’t use Tylenol, but if you’ve got chronic pain, it’s really not that simple. Much as I love my CGM and it has revolutionized my diabetes control, when I’m in severe pain, I’ll take effective pain relief over perfectly reliably CGM readings every time. I’ll be interested in hearing your experiences! Mine so far make me think it does perhaps shift the Dex readings a bit up, but not that dramatically, and trends were still useful. Also if you use the Tylenol for a while, it seems like you could calibrate the Dex to account for that kind of discrepancy, but I’m sure it works differently for everyone, so you’ll have to see how it plays out for you.
We spent about 10 days in Canada over the vacation, where it was very cold, then came home to subzero temperatures. Yesterday, for the first time, we had a temperature in the teens. So here I am shoveling my huge driveway, and I am thinking at the same time: gosh, it is so warm today!