I have recently been diagnosed with T1D and I am giving myself injections at mealtime and long lasting every 24 hrs to stabilize my BG levels. I do not plan on switching to a pump in the near future, but I am considering a CGM. I discussed this with my endo and she did not recommend using a CGM unless I was using a pump and she didn't really explain the drawbacks of a CGM + injections. Will the CGM still be worth it if I am using injections or will it be a waste of money? The thing that is so attractive to me about the CGM is that it can tell me if I'm trending low before I start to feel too bad. I play division 1 college soccer and a CGM would really be a life saver to me.... but would it be as affective in tandem with injections?
Due to insurance issues I wound up starting on dexcom g4 cgm for about a month or two before getting my tslim pump. I will say that the info I was able to acquire from using the cgm and MDI was invaluable in my level of control. If I had to choose between a pump and cgm I would pick the CGM hands down. While a pump lets me fine tune my basal rates and IC ratios through the day, I could not get there without the info I get from my G4.
I have been able to match my dosing to the foods I like to eat in a way that does not drive me high. Have used the g4 info to modify what I eat/when I eat/ when/how I dose. I had no idea how many of the foods I ate effected my numbers in real time vs the occasional snapshot I got when testing at defined times pre and post meals.
As an athlete being able to see where my numbers were heading and how that effects my performance would be vital to how I adjusted meals vs dose vs activity.
I don't use a CGM, but it's my understanding that the results are delayed by about 20 minutes from the actual blood sugar level. It was my understanding that, because of this, a CGM was more useful for spotting trends and adjusting doses than it was for detecting lows. Maybe this is outdated now since the new CGMs have low alert predictions and such, but I always believed that it was better to test a lot and retain low symptoms to detect lows rather than relying on a CGM that may not alert to a low until you have already been low for ten or twenty minutes.
Yes there is a lag but if you set your exercise alarm targets up to allow for the lag you can get a warning of your trend in time to adjust.
I found that it helped me to try out basal and bolus modifications and find out what really works for me, depending on my level of activity and food on board.
I'm a hiker/backpacker and struggled to find a way to do extended trips with out crashing low or rebounding high after.
I'm on MDI and I've been using the Dexcom for about three months. I think it provides incredibly valuable information to me on a constant basis. I think you're right that it would probably be very helpful for you as an athlete. I've never understood endos who think it's only beneficial with a pump.
I would give up my Omnipod pump before my Dexcom CGM. The CGM is as big a benefit in controlling T1D as are low carbs, self-monitoring, and multiple injections.
Sometimes I go off the pump but still use the CGM.
Thank you that is extremely helpful!
is there any reason you are on MDI as opposed to a pump?
This is so helpful thank you for your opinion!
Hi Bailey: I use the Dexcom G4 and an Animas Ping. Not sure where your endo is coming from, but IMO she is simply wrong. I think the Dexcom with MDI would be excellent. My biggest problem with hypos has always been with exercise. The Dexcom helps so much--when I am exercising all out and I am alerted by the Dexcom (two arrows going down!), I drink a juice box or some other form of fast-acting carb and keep on going. It's great. Be sure to get the Dexcom--it is far superior to Medtronic. Hope you can get one! I think it would really help with soccer.
Doc's wrong. The CGM Is invaluable to fine tune insulin program, whether MDI or pump, it doesn't matter. I would think that an active athlete like yourself would find the data stream particularly useful.
If you'd don't like watching your numbers then it's not for you. I find it an indispensable safety tool. I've been on a pump for 27 years and I would give up my pump first if I was forced to choose.
Ask the doc for the script. Tell him it's for your safety. Find another doc if necessary.
Maybe your Endocrynologist was concerned about the frequent BG readings and the infrequent shots and how you would handle the extra information with only injections. My pump broke so I used injections and the cgm with shots was a great combo. If you can only get Medtronic it will still help you avoid low BG but it won’t help as much. And the Medtronic is a nuisance. It beeps it turns off it rejects input etc.
How did you handle the frequent BG readings/infrequent shots and extra information with only injections? Is it difficult or just something to get the hang of?
With MDI, it still works - the pieces you can change are timing of bolus, types of foods you eat and when and how much you exercise in relation to where you are at and in what direction your trend are going.
Have you read The diabetic athlete yet? Good reference to review.
No i have not read i still have a lot of learning to do
A few reasons, I guess. I was diagnosed a few years ago and my total daily dose is still fairly low (I'm a very slow onset T1 or LADA) and I think I'd waste a lot of insulin on the pump unless I used a diluted solution. Generally, I've been doing okay on MDI, so I haven't really been too excited about getting attached to another device 24/7. I also worry about scar tissue from pump sites, but I know a lot of people don't seem to have a problem with that. Also, the expense is a bit of a deterrent right now. I figure I'll have T1 for the rest of my life, so there will be time to try the pump at some point. When I was first diagnosed, I really thought I wanted to get on the pump right away, but I'm glad I've done MDI. I think it's helped me understand insulin a bit more than I might have had I jumped to the pump right away. Sorry you had to join the T1 club, but it sounds like you're already on top of things!
Yes I am trying to be on top of things as best as I can, I do go back to college in a month so that is my driving factor to get this under control before I am living on my own without the help and support of my family (close by). I agree with you about the pump, I'm sure there will be a time where it will make more sense to use a pump but at this point in time I like MDI better because it does help me understand the way my body reacts to the insulin. I do want a CGM for those times where I don't recognize a low right away wether it be in class or on the soccer field I want to be alerted before it gets dangerous. That's obviously where the CGM comes into play; however, I still want to stick to injections. My main concern is is this possible.
There might be a lag, however, the CGM has helped me before to catch hypos way earlier than without it. If you trend down and go under 80, you can test and are usually low. like 70. I usually dont feel lows until i am under 60, and then have to treat it aggressively, which causes a whole rollercoaster. with the CGM i was able to avoid rollercoasters after lows.
Think the basic reason of using a CGM with injections is simply the lack of control as such. While it would allow you to see a hypo and so forth and react to that, unlike a high where it's a case of pressing a button to fix, it's a case of stacking in injections. And that also brings in the fun of dealing with is it actually a high, or just lunch taking a long time to work with the insulin and ending up over correcting.
For sport yeah, would be handy again. But for micro managing things as pump users do is what it sounds as though your endo is bothered about.
I don't see why more data with MDI wouldn't be useful however I have always preferred pumping to MDI but I also had a weird approach to it, coming to pumping from R/NPH which don't work quite as well as the newer insulins. I suspect the fine tuning that you can do with a pump would be harder to do with shots and I think that doctors kind of like being able to rip your data to have something to look at and talk about but none of them have ever said "we like you having a pump because we can spy on you better."