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Continuous Glucose Monitors - any info?

 
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Stumpymum



Joined: 27 Jan 2010
Posts: 22
Location: Perth WA

PostPosted: Sat Apr 24, 2010 10:07 pm    Post subject: Continuous Glucose Monitors - any info? Reply with quote

HI - My 8 yr old son was diagnosed T1 in 5 months ago, and although he is now handeling everything really well, the finger pricks still get him down everynow and again.
I read an article about CGM's but they only seemed to relate to pumpers - and I can't seem to find any more info about what it is, how long it stays in, how big, or uncomfortable, or dangerous (?) etc. Does anyone have any experience of them. Its a couple of months until we see the endo again - but a keen to find out more before we go. We are not too keen on pumping yet (don't even know if its an option) as he is a very boisterous boy - constantly play fighting, of playing footy, or rolling around etc.
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amk



Joined: 10 Mar 2007
Posts: 102
Location: Perth, WA

PostPosted: Sat Apr 24, 2010 11:08 pm    Post subject: Reply with quote

Hi Stumpymum. CGM is generally used in conjunction with a pump as it measures glucose levels every 5 minutes (in the case of the MEdtronic Minilink) and uploads the data to the pump. It is of greatest value when used with a pump because you have the flexibility to act quickly on the readings (after confirmation by finger prick).

The Medtronic Minilink comprises two components - a probe which is inserted under the skin and a transmitter about the size of a 20c piece that transmits the data to the Minimed Paradigm pump. My daughter (we trialled it when she was 8 years old) wore it on her tummy. Though she did not complain about it I could tell she wasn't fussed with the extra attachment on her body. The introducer needle and probe is fairly large - probably equivalent to a 21G needle. The probe is now approved to stay in place for up to seven days.

The information the two week trial gave us was immense. What I thought was good control actually wasn't that crash hot as I was puzzled why we had good levels but an HBA1c around 7. The CGM showed us significant peaks after breakfast which fell by morning tea and significant peaks after dinner which fell by bedtime. So essentially, finger pricks did not pick up these peaks but they were significant enough to cause an HBA1c near 7. By altering carb ratios and basal rates we flattened out those peaks and her first HBA1c after that was 6.2 - we have hovered around 6.5 since then.

CGMS is a great tool if used properly but it is expensive. Each sensor costs around $70 and the transmitter around $1,000.

We were recently asked if we wanted to be part of a trial of the new Paradigm Veo pump in conjunction with CGMS. The Veo effectively shuts down or goes into suspend mode in response to low glucose levels. My daughter's eyes went as big as saucers when I mentioned it so we have declined to be part of the trial!

I hope this info helps.
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S



Joined: 04 May 2007
Posts: 390
Location: Perth

PostPosted: Sun Apr 25, 2010 12:28 pm    Post subject: Reply with quote

We're part of that trial that amk mentioned. Ally wears the sensor in her bottom and she hates having it inserted - she's pretty good with her pump cannula insertions, but the sensor insertions really hurt her. She doesn't really like wearing the sensor - she's a small 6 yr old and it's fairly big on her. The transmitter, as amk said, is about the size of a 20c coin, but it's a bit thick too.

If you're thinking of CGMS because you want to stop having so many finger pricks, then don't bother. They like you to claibrate the sensor with a finger prick about 4 times a day, and then you still have to double check all BGLs before correcting a high or treating a hypo. You can't rely on the sensor's BGL - ours is regularly out by as much as 4mmol/L. So we find we are still checking BGLs as usual, regardless of what the sensor says. Say, for example, that the sensor says she's 9, so then we want to correct her, but we have to confirm with a finger prick because if she turned out to be 5 then we wouldn't consider correcting her. The only time it's helped avoid a finger prick is when Ally comes out of bed in the evening saying she feels low and we know it's just an excuse to get up - we can take a look at the sensor and tell her she's fine and to go back to bed. There are a few times before snacks when the sensor says she's a good level so we've not done a BG, but not a lot of times, because if it did turn out that she was slightly high then we would want to correct it straight away. It would probably help us avoid, at most, one finger prick a day (we do 7-10 tests a day). I must admit that occasionally Ally says she feels low and the sensor shows that her level is good but she's dropping rapidly. Then I have treated her for a hypo without confirming with a finger prick. But you're not supposed to do that.

The sensor is really good for detecting trends. So you can see when the BGs are shooting up, and when they are pretty stable etc, and what they do during the night. So if you find you are doing a lot of extra finger pricking because your son is telling you he feels low or high, then I guess the sensor could help because you could get better control and avoid those extra finger pricks.

I don't know if they have any device you can use to read the sensor straight away without a pump. You can still use the sensor without a pump, but you don't have the info until the end of the 6 days when you take the transmitter off and upload the info.

Hope this makes sense (I'm pretty sleep deprived now and not always making sense).
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fismum



Joined: 26 Oct 2009
Posts: 19

PostPosted: Sun Apr 25, 2010 2:01 pm    Post subject: Reply with quote

Fi had CGM set up last year for 3 days. She doesn't have a pump yet. We couldn't see what her blood sugar was but had to take it back to be uploaded and printed out at the end of the 3 days.

For some reason Fi had fairly severe pain every time the reading was taken. The doctors couldn't tell us why she could feel it, but I watched her when she didn't know I was and could see her flinch every 3 minutes and could set it by the clock. I took her back after the 2nd day to have it removed.

The insertion was very painful, but not sure how it compares to pump insertion pain. I don't feel it was worth it for the info we got. For Fi there were no surprises, her blood sugar went up from after school, above the level it can measure and didn't go down until her morning insulin dose. Her insulin dose was increased at night, but I already knew it needed increasing.

HTH
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MelnG



Joined: 24 Jul 2007
Posts: 296
Location: Perth

PostPosted: Tue Apr 27, 2010 11:38 am    Post subject: Reply with quote

Interesting topic!

We too are in the Veo trial and it is hard work!

The CGM requies constant calibration and beeps quite a lot for 'meter bgs'. The first few nights it kept telling us G was low when in fact we tested and she wasnt, but heading that way, so as far as a trial goes, it is great in picking up the trends in BGLs.

The first 6 days we wore the CGM without the Veo so had to wait for the upload...thank goodness we had the CGM on at that time...her levels were ridiculous and thanks to the trial Endo we made a lot of adjustments and she is basically flatlining on the Veo most of the time at 7.

CGMs have their pros and cons...the first insertion I did for the sensor had both of us in tears because not only did I hurt G I managed to nick myself when I withdrew the needle and we had blood everywhere.

The second insertion we used ice and I basically closed my eyes and pressed the lever - it worked a treat! I didnt hurt her or myself!!

The readings we have obtained have been invaluable in G's management and I think worthwhile if you have difficulty locating where problems lie. You can use the CGM without the Veo but like said earlier you have to wait until the end of the 6 days to get your readings.

Overall I am glad we are using the CGM as the unpredictability of BGLs can be monitored and you get lots of nice graphs and charts and stuff so you know exactly where things are going wrong or right.

Good luck

Mel
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Stumpymum



Joined: 27 Jan 2010
Posts: 22
Location: Perth WA

PostPosted: Wed Apr 28, 2010 2:16 am    Post subject: Reply with quote

Thanks for the replies guys - When I first read about CGM's - I though "Wow - Fabulous!!" then as I looked into it and couldn't really find any info I figured there must be a catch. I thought it was a monitor that could tell you "constantly" what the BGL was at any given time. Oh well. a 20c piece seems very large - he's not a big 8 yr old. Not worth it yet - hopefully there might be something in the future. Thanks again for all your info - this really is a great Support site. xx
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millyyates



Joined: 17 Nov 2008
Posts: 14

PostPosted: Mon May 10, 2010 7:45 am    Post subject: CGMS Reply with quote

We have been using cgms for about 18 months. Medtronic with 722 pump.
It is hard work doubling the amount of work that a pump is if not more. It gets easier when you get in the grove. We now only use it on and off. We have used it for 2 long stints of 6 weeks and 2 months. We reduced A1c by about 0.5 to 1. Lowest was 6.3.

Milly likes reduced finger sticks. Issues for us include skin real estate usage ( enough space to use it, pain putting it on, keeping it on ( we put cover adhesive over it all- this causes skin reaction so therefore have to use Skin Prep ). Then the issue becomes what do you do with all this info.

We use this site to help use the info

https://studies.jaeb.org/ndocs/extapps/CGMTeaching/Public/Default.aspx
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Peter

Milly's Dad
Dx Feb 08
MM722 May 08
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swansman



Joined: 30 Nov 2009
Posts: 15
Location: Sydney

PostPosted: Mon May 10, 2010 1:42 pm    Post subject: Re: CGMS Reply with quote

millyyates wrote:
We have been using cgms for about 18 months. Medtronic with 722 pump.
It is hard work doubling the amount of work that a pump is if not more. It gets easier when you get in the grove. We now only use it on and off. We have used it for 2 long stints of 6 weeks and 2 months. We reduced A1c by about 0.5 to 1. Lowest was 6.3.

Milly likes reduced finger sticks. Issues for us include skin real estate usage ( enough space to use it, pain putting it on, keeping it on ( we put cover adhesive over it all- this causes skin reaction so therefore have to use Skin Prep ). Then the issue becomes what do you do with all this info.

We use this site to help use the info

https://studies.jaeb.org/ndocs/extapps/CGMTeaching/Public/Default.aspx


Peter - I'm interested in the quote in bold - could you elaborate where the extra work comes from in CGMS?

Thx

J
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MelnG



Joined: 24 Jul 2007
Posts: 296
Location: Perth

PostPosted: Mon May 10, 2010 6:33 pm    Post subject: Reply with quote

J...

The extra work with the CGMS is two canula sites instead of one..and a bloody long canula on the CGMS...so in our case using the bottom we need both sides so neither gets a rest...

The CGMs requires calibration, or entering of BGs to ensure the pump and CGMs are on the same wavelength and in our case, it beeps when we are over 18 and under 3.8..this morning it told us G was low and when we tested she was 16.9...so I guess we are testing more often because the pump is sending off warnings because of CGMs readings that are not quite right..this technology has a long way to go...but at least its there...

G went on school camp last week and even tho she doesnt wake for the alarm, one of her friends did...good thing too, she was 2.3 in the middle of the night...hate to think what would have happened without the CGMs...

And the CGMs is not just changed, there is quite a procedure to it as the sensor itself must be refrigerated, cooled before use, the transmitter placed on charge while its cooling, sensor inserted then left for another period of time while it starts reading, the transmitter is then attached and requires calibration readings when it is first changed at 2 hours and 6 hours as well as your normal BGLs..yes hard work and yes we want to give up, but if someone doesnt do the research ...how do we get anywhere....

Hope that answers some of your queries...
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meegsd



Joined: 17 Oct 2009
Posts: 266
Location: Tasmania

PostPosted: Tue May 11, 2010 8:37 am    Post subject: Reply with quote

Zac is due to get his pump next week & one of the things he had to do was 'pump school online' which was a series of questions he had to answer. Quite a few related to CGM's & the one thing that it kept telling him was that you ALWAYS confirm the CGM reading with a finger prick.
So, Millyyates I was really interested to read that your daughter liked the reduced fingerpricks with the CGM. Was that something you were told was OK, not to double check? I find there are so many inconsistencies in the medical professions' opinions on diabetes management & care, that I am sometimes unsure that any of them have any idea whatsover.
I read the other day that a young adult was told by her endo that she didn't qualify for a pump because she had a good Ac1!
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S



Joined: 04 May 2007
Posts: 390
Location: Perth

PostPosted: Wed May 12, 2010 2:49 pm    Post subject: Reply with quote

J, I agree with what Mel said with regards to the extra work of calibrating and testing every time that the sensor alerts to a high or low. And the sensor changes, as she said, aren't as simple as a pump site change - you need to plan to be around for awhile, then you need to make sure that 2 hours after the sensor the BGLs are going to be stable so you can do the first calibration. We are finding it hard to fit that in around school - can't change the sensor in the morning because then school will have to do the first calibration. Can't do the sensor change after school, because by the time the first calibration needs doing it's just after we've eaten dinner. We have to do it after dinner so that the first calibration gets done while Ally is asleep. Or else have a late dinner. And then the second calibration, 6 hours later, is always needed in the middle of the night. So that part is not much fun.

I wanted to add that we find it a lot of work when Ally hypos. It's great that it alarms, but often we find that it takes the sensor awhile to realise that we've treated the hypo. So she goes low, we stop what we're doing to test and treat the hypo. Then a minute after she's had her glucose the pump alarms, so we need to dig it out again to turn the alarm off, then just after you get back to whatever you were doing it alarms again - and you need to turn the alarm off or else it will suspend the pump. It's not a huge issue, just a bit of a hassle, and probably wouldn't be so annoying if your child was older and the pump was more accessable.

We've also been woken a few times in the middle of the night with the sensor alarming that she's low, when she turns out to be around 8 or 9. I do think that since we started the trial both Ally and I (and hubby) are more tired than usual as we are up more during the night. We actually seem to have good stable levels at night, so occasionally when they are actually sitting at 6 for the whole night, the sensor can start thinking that she's sitting around 3.5-4, so it spends half the night alarming whenever the BGL dips a little, until the calibration kicks in and it realises she's fine.
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Jacky Grayson



Joined: 12 Oct 2009
Posts: 40
Location: Samson, Western Australia

PostPosted: Mon May 31, 2010 11:08 pm    Post subject: Reply with quote

from my perspective, I love the CGMS. We were able to trial one for 6 days and combined with the VEO, it felt like a security net. Having the insulin delivery cut out if BGL fall below what ever you set it to is great. My daughter (9yrs) always forgets to suspend her pump if BGL's fall below 2 at school, and forgets to test 1/2 hr later too. It also gave us confidence to let her sleep over at a friend's house.

We found the sensor to be accurate and the number of finger prick tests was reduced throughout the day. Kate plays alot of sport and to be able to look down at the monitor and see which way she is trending was fantastic.

The downside - the sensor is bulky for a little bottom and she doesn't like having the set change, but liked the benefits. We are in the VEO low suspend trial, but are waiting to see if we are in the contol or sensor group. Part of me is hoping for the sensor group, but not for the set changes. We entered the study because there is no way we could afford to use CGMS otherwise.
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jnz71



Joined: 03 Aug 2015
Posts: 1

PostPosted: Mon Jul 03, 2017 5:50 pm    Post subject: Reply with quote

Just in case someone finds this useful:


What Is Glucose Monitoring?

Without diabetes, your body tracks glucose levels all day and night to ensure the right amount of insulin is released at the right time. To successfully manage diabetes, a monitoring system is needed to consistently check your glucose levels. Check your blood sugar levels using an up to date blood sugar levels chart.

The most common glucose monitoring solutions are blood glucose meters and continuous glucose monitoring (CGM) systems.


Sensor overtape not shown in depiction
What is Glucose Monitoring?
How Does CGM Work?

CGM is a way to measure glucose levels in real-time throughout the day and night. A tiny electrode called a glucose sensor is inserted under the skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. The device can detect and notify you if your glucose is reaching a high or low limit. The latest Medtronic CGM systems can actually alert you before you reach your glucose limits.
Does CGM Replace Fingersticks?

It is recommended that you calibrate CGM systems with fingersticks 3–4 times per day for optimal glucose sensor accuracy. CGM does require at least 1 fingerstick blood glucose reading every 12 hours to calibrate the CGM sensor1.
CGM Components

CGM systems usually consist of a glucose sensor, a transmitter, and a small external monitor to view your glucose levels. MiniMed insulin pumps have built-in CGM so the information can be conveniently seen on your pump screen.


The CGM monitor or insulin pump is small, discreet, and easy-to-wear. It can be attached to your belt, hidden in your pocket, or placed under your clothing. This component will show your current glucose levels and your historical glucose trends. It also notifies you before you reach your low or high glucose limits and if your glucose level rises or falls too quickly.
The CGM transmitter is a small, lightweight device that attaches to the glucose sensor, gathers your glucose data, and sends it wirelessly to the glucose monitor unit. The Medtronic transmitter is waterproof and can be worn while swimming, bathing, or showering without worries.

Components of continuous glucose monitoring

The glucose sensor is inserted under the skin to check glucose levels in tissue fluid. The glucose sensor has a small adhesive (sticky) patch to hold it in place for a few days and then it must be replaced with a new sensor. The glucose sensor is inserted with a needle, which is removed after the glucose sensor is in place. The most common place to wear a glucose sensor is in the abdomen.
The glucose sensor is easily inserted under the skin using an insertion device. A sensor is placed into the insertion device, and with a push of a button the glucose sensor is inserted quickly and easily.

Discover the Benefits of CGM

A blood glucose meter only provides a brief “snapshot” of your glucose level at a single moment in time. A CGM device, though, gives you a greater view of your glucose trends. CGM provides you with:

The direction your glucose levels are going
Early notification of oncoming lows and highs
Alerts for lows or highs while you are sleeping or anytime
Insights into how food, physical activity, medication, and illness impact your diabetes

CGM can provide valuable information at crucial points during the day, including before and during exercise, prior to driving, before test/exam-taking, and in the middle of the night. It is still required to check blood glucose levels with a fingerstick before therapy adjustment.
the Benefits of CGM the Benefits of CGM
Is Continuous Glucose Monitoring For Me?

CGM can be used by type 1 and type 2 diabetes patients who would like better glucose control to improve the health and quality of their lives.

CGM is especially beneficial for people who:

Want to reduce their A1C targets without increasing hypoglycemic events (low blood glucose)
Have frequent low glucose levels or are unaware of their low blood sugars2
Are pregnant or thinking about becoming pregnant2,3
Are children and adolescents at or above their target A1C if they are willing to use the device every day
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