28 Days and Counting -- An Emerging CGM Success Story

Diabetes Technology Glucose Monitoring
#1

I have been an insulin dependent diabetic for over 25 years. During that time only a handful of diabetic treatment technology gains have made a real difference to my health and quality of life. These advances include the home blood glucose testing, the insulin pump, and the production of quick-acting insulin analogs.

Now the continuous blood glucose monitor stands with these invaluable treatment tools for insulin dependent diabetics. Four weeks ago I started on a Dexcom Seven Plus CGM. The results already produced have delivered BG improvements better than I hoped for and the promise of impressive future gains seem clearly within my grasp.

Up until a few years ago my A1c numbers hovered around 6.5%. But then my A1c started to rise and got as high as 8.3%. While I had gained some weight and my exercise regimine faltered I still watched my blood glucose closely, sometimes testing as much as 20 times per day. I knew that my weight gain (about 15 pounds) and less than daily exercise contributed to my diminished control, I still felt that something else was going on.

I went through several periods that I meticulously counted carbs and kept a daily chart of carbs, insulin, exercise and BGs. That added attention did help. Over the last year I have been able to drop my A1c from 8.3% to 7.2%. While I appreciated the improvement in my A1c, I wouldn’t be happy until my numbers returned to under 7%.

From my perspective as an insulin dependent diabetic the stories about continuous blood glucose monitor development seemed tantalizingly just out of reach. I think I started reading about the CGM in the mid 1990s. A consumer-ready product always appeared to be two years away - just over the horizon.

When the first generation of CGMs arrived however, the insurance industry was slow to give it a green light. It was just this spring that I learned that a few other diabetics at my work had applied for CGM coverage successfully. I started the process last July and finally received the 7+ on September 4.

The Dexcom 7+ has exceeded all of my expectations. My last A1c of 7.2% translates to about an average BG of 177. In the last 28 days my average BG as measured by the Dex is 135 - that is equivalent to an A1c of 6.0%!

I’m having my blood drawn tomorrow for an A1c as I prepare for my visit with my endocrinologist next week. It seems promising that my A1c will drop below 7% but I’m truly excited about the next A1c, three months from now, measuring in the low 6% range.

As a single person that lives alone, I must face all that diabetes hands out by myself - especially the night-time lows. The Dex has successfully woken me up several times during the last four weeks to warn me of both lows and highs.

It seems to have virtually eliminated waking up in the morning only to discover a BG in the 50s and realize that it has probably been there for several hours. As you all know, an undiscovered overnight low usually rebounds with four to eight hours in the 200-300 range. I often delayed eating in those situations until the middle of the afternoon so I could keep my BGs below 200.

During the day I am able to head off any impending lows by popping a couple of glucose tabs. I can also respond more quickly with corrective doses of insulin to reel in a developing high. By the way, the ability of todays insulin pumps to calculate a corrective dose while considering the “insulin on board” is also an amazing tool. (I can remember countless times in past years attempting to calculate the right corrective dose while I’m busy with life’s other demands and my brain sluggish with elevated BGs.)

Last, but not least, CGM appears to be able to head off the major disaster of slipping below BGs of 55 and then becoming unaware of your condition. Anyone who has had insulin dependent diabetes for any length of time has their “story” to tell. Its a hellish nightmare that no one wants to repeat. You feel lucky to survive and not to injure anyone else

CGM technology is a major breakthrough in diabetes treatment technology. I look forward to an endless string of good A1cs. More importantly, I’m starting to feel the return of an energy that high and variable BGs robbed me.

For anyone who is considering this technology, I encourage them to give it a try. Like the finger-stick meters, insulin pumps, and fast-acting insulin analogs that preceeded it, CGMs are a keeper. Going forward, I will not face life without one!

#2

I too started my Dex 7 on 9/4/09 and can’t believe I didn’t try it sooner. It has headed off two lows that would have been BIG ones, I am also having A1C problems so that was my main reason , I think I’m ready for a pump because now the Dex shows me the daily spikes. I told my Dex rep they could paint up my car with advertising, he said I don’t think we have done that yet maybe I could be the first. Hee Hee

#3

I’m now 26, I practically gave up on my diabetes in college because I was using so much Lantus to get me through the day that I couldn’t go to bed with a blood sugar under 200 without getting massively low at night. My A1C were in the high 6/low 7 range which my doctor thought was great for college but during the day, every day, my sugars were going from the 40s to the 250s. I got my pump back in February and thanks to variable basal rates was finally able to start going to be with more reasonable sugars (I thought). When I got my Dex in early September (just after my 11 yr. diabetes anniversary) I realized I was still slipping into the 50s most nights which accounted for mid-morning highs. I’m still in the process of reducing insulin to correct for that but thank God for the Dex and the Omnipod (my pump) as I’m finally feeling like I’m back in control of my diabetes and not the other way around. :slight_smile:

#4

I got my 7+ in June and can no longer imagine to live without it. I started encouraging people on the forum to give it a try. The resistance disillusions me. I don’t want to be a nag. As the saying goes “You can lead a horse to water but you cannot make it drink.”. Now I rather enjoy the company of same-minded people.

#5

I really, really want one. I contacted the Dexcom people two and a half months ago, and my insurance approved it, but I’m still waiting to get it. Soon, hopefully. I hope it works as well for me as it seems to have done for you guys.

#6

I think CGMs and pumps work well together. I’m now trying to make adjustments to my basal rates using the info gleaned from the Dex.

Dexcom and the other CGM companies must be selling more an more systems. As the systems become more commercially viable today, that can only mean better technology tomorrow.

#7

I just started following this site a few months back. Have you encountered a lot of skepticism about CGMs? I would think that people following a “Dexcom CGM users forum” would largely be enthusiasts!

Has your A1c responded well to your Dexcom use? Can you report a pre and post-CGM A1c?

#8

I would like to add we are thrilled with how easy it is to insert, how painfree. And when you remove the sensor, there is barely a mark left on DN’s body.

#9

I’m on day 12 of sensor 3 of my Dexcom Seven. I am amazed at the highs and lows i was having and still didn’t know, even with testing 10-15/day. I’m fortunate enough I can work from home 2 day/week and test my basal rates frequently during those periods. Dex was still able to show me periods where i could do better. It has saved me from some of those nightmare unexpected lows on several occassions. My insurance only covers the sensors at 50% so Dex is not cheap, but worth every penny. I could be buying a new car with the money my diabetes costs me each month, but then how would i drive it with no feet or eyes to see? I love technology, but without Tudiabetes, I’d be lost. You all have helped me get through this with relative ease. I am not alone!

#10

What method are you using to test your basal rates? I’ve been using the one described by diabetes educator Gary Scheiner in Diatribe. See this article for details. I still need to do more work on my basal rates; you’re right it does help to have time at home to do this.

I’m on sensor three, day four. With having to pay out of pocket a portion of the sensor cost, you have good motivation to make the sensors last. I think Dex was a good choice considering that. I feel very lucky to a good health plan and as I’m enjoying the benefits of CGM, I wish that all diabetics had access to this technology.

Thanks for your update.

#11

Both Pumping Insulin by John Walsh and Diabetes Solution by Bernstein give good methods for checking basals. It’s basically fasting and checking BG every hour. Dex help me look at the trends. For example, I was going high about an hour after going to bed (no food involved) and wouldn’t have known it without looking at the curve Dex provides. I slowly increased my basals (ruling out all other factors) till I stayed smooth. I wake at around 90, and if I don’t eat, I’ll stay around 90 till lunch.

#12

The worst skeptic is one of my wife’s coworkers. He is unresponsive on a regular basis and has a seizure in the office at least once a month. My wife trained other coworkers on how to recognize the symptoms and then they feed him glucose tablets. When I got my dex my wife told him exactly what to do to get one. The company owner offered to pay if insurance wouldn’t. An HR person filled out the paperwork. But nobody can make him go to the doctor and get the prescription. He has forwarded me papers from medical journals trying to prove that CGMs don’t work and are not worth getting. He has definitely exhausted my patience.

Next topic:

My A1C did not change much post-CGM. I get my A1C tested only once per year and it was always between 5.7% and 5.9%. My one and only post-CGM A1C was 5.5%. Don’t be discouraged by the small change. The pre and post-CGM A1Cs don’t tell the whole story. Pre-CGM my bg frequently spiked above 200. I always brought it down fast as soon as I noticed. Post-CGM I don’t see 200+ anymore. 160+ is rare. I spend 85% of the time below 130. SD dropped from 60 to 30. For the first time I feel optimistic about avoiding complications.

#13

I was all set to buy a Dex till I heard about the short range it has.
Is that really a factor I should be concerned about. I heard after
you lose range you have to reprogram the receiver. Where do you
put the reciever when going to bed or taking a shower ?

#14

wow! your control amazes me! how do you keep from spiking into the 200’s after you eat? i don’t eat any junk food and i cook balanced meals, but i still find my blood sugar spiking to the high 200’s after a meal, even if i take insulin before i start eating. what’s your secret?

#15

The short range annoys me.

Q: Do I need to reprogram the receiver after being out of range?
A: Absolutely not.

Q: What do I do with the receiver at night?
A: The receiver sits on my night stand. I get at least 90% of all possible readings.

Q: What do I do with the receiver when taking a shower?
A: I keep the receiver nearby. Sometimes I lose a reading, sometimes not. How many people prick their fingers every 5 minutes while taking a shower?

Q: What if I could get unlimited range for a monthly fee?
A: I would pay no more than $20/per month for unlimited range. If insurance would not cover the Dex I would not hesitate to pay $500/per month OOP. I hope this illustrates the importance of having a CGM versus a CGM with unlimited range.

#16

Lindsay, I am on 2 shots a day. One shot in the morning when I get out of bed and one shot at night before I go to sleep. I don’t inject before meals. The best label for what I do is ‘portion control’. I don’t explicitly count carbs. Let’s say I ate a meal and my bg shot up to 200. I register that I ate too much and the next time I eat half. There is always a portion size that keeps me within my bg target range. Does this mean that I eat half a cookie for lunch? Not really. I learned what I can eat a lot of. When I eat salmon and veggies I need to add a cookie to keep me afloat. Steak with mashed potatoes seem to be enough by themselves: no cookie. Of course I tried to use fast-acting insulin to avoid portion control. I just cannot get it right. My bg either goes high anyway or so low that I have to eat after I am done eating. I also noticed that my weight is strongly correlated to my insulin intake. In other words: extra injections push up my weight. You could also say that I gave up. I acknowledge that I am a diabetic and I eat frequent small meals instead of a few big ones. BTW, I really like that my next meal is always around the corner. 15 minutes after I ate I never know whether I ate a lot or a little. But it is nice to know that the next meal is only 1 hour away instead of 4 hours.

#17

I love reading about your success, Terry. I agree CGMs are a keeper! I’ve been a fan of CGM ever since I tried Dex for 3 days per my doc. I had recent troubles with my Lantus and realized how great it would have been to have CGM “video” to identify the problem quickly and easily. I’m considering purchasing out of pocket and using it very rarely. I figure even 10 days every 6 months would be very useful. I’d have to be careful about the 4 month shelf life of each 4 pak of sensors, though. I’m also not sure how well the rechargeable transmitters will last if I only use it very rarely. Anybody have comments on using CGM only rarely?

I’m curious how you tweak basals based on CGM data? I picture looking at the pattern via download to PC, mentally adjusting the time frame back 15 minutes to account for the interstitial lag, and adjusting basals up or down 1-2 hours prior to any out of range bg?

#18

I’ve had my Dex since early September and was also worried about this problem. Turns out that it’s really not a problem at all. At night my receiver sits either on my nightstand, on the bed with me, or on the floor nearby the bed (usually in the pocket of my pants). I rarely lose readings in any of those locations. When I shower I usually leave the receiver in my room on my bed. My room and the bathroom share a common wall and my shower is in the same general area as my bed. I’ve found that I almost never lose a reading in the shower either. The first couple days I used to take it into the bathroom and leave it near the shower, since forgetting it and having it read fine from my room I don’t bother. I’d say I’m usually 8-10 ft. from it when I’m in the shower with no problems. The only range issue I have is during charging and even then it’s usually find within 2-3 feet as long at there aren’t any solid objects between the receiver and Dex. I usually charge while I’m sleeping but sometimes leave it charging on my computer desk while at the office. Again, haven’t had any real problems and my A1C went from 7.2 (pre-CGM) to 6.4 (after just a month with the CGM!). It’s changed my life.

#19

I’ve significantly tweaked my basals since getting my CGM. It became quickly obvious to my Endo and myself that my morning highs were rebounds from overnight lows. We looked at the graph, saw where my sugars started to fall, then lowered my basal rates an hour before the fall. We’re still fine tuning but now I’m only low every 2 or 3 nights (instead of all night every night) and I’m using about 3 less units of basal a day! We’ve also raised the basal or Insulin to Carb to adjust for the fact that my sugars rise 3 hours after my meal. We’re starting that today, it’ll probably end up being an insulin to carb adjustment with extended boluses but may also need some basal adjustment. So yea, your idea is pretty much right on, download the data, look at it, and adjust for any abnormalities! It works great.

#20

Thanx!