Continuous Glucose Monitoring


#1

Has anyone used the Medtronic’s paradigm pump with continuous glucose monitor? I’m considering starting my soon-to-be 4 year old on a pump, and this one was just approved for kids. I’m thinking that the CGM would be very handy and so much less invasive than the 10 times/day that we test her. Heard any buzz about it?


#2

I have a pumper friend who is on it and his last A1C was 5.6, but besides that you can see if you are on an upward trend or a downward spiral, which in my opinion would be very helpful.

There is a CDE whose husband and child are both on pumps and the CGMS and they all love it and of course this CDE is now working for Medtronics so I am sure she gets all free of charge.

I am in the process of seeing if my insurance will pay for it, but I know in the letter of medical necessity you do not want to state that the reason you want it is to eliminate finger pokes.

For me it is for hypoglycemic unawareness. Being able to exercise and drive my car without fear of the unknown of a low. I think if I do obtain one I will only use on weekends when my exercise and eating is so unpredictable.

I think for a child and the constant growth spurts and hormonal changes it could be wonderful and such a relief for a parent to possibly sleep through the night without testing.


#3

Hi I think CGM is really neat we also thought about it for our daughter Shelby Who is going onto a pump next Tuesday and it was a hard choice for me and my husband. What we came to was that the CGM is not quite there yet because you still have to do finger stick!!! That is the onlt way the FDA approved it. I think in a few year it might be a little better and might not neeed a second site too, So we put it off to see if the tech. would inprove Because I think this will be soooo cool once it get’s fully there, and maybe insurance will cover it by then. We are going with the animas who is doing trials on there own style of CGM (all the companies are working on it) We choose them because of smaller basel rates shelby can still get .25 untils and we need smaller units also it is waterproof to a point (nothing is fully waterproof even though they claim it!!). But my Best suggestion is to meet with all of them, our hospital does PUMP NIGHT and you can touch and feel all of them see which one you like the best. My first choice was MMT too but we went the other way after seeing all of them. Also you should learn about infusions set with MMT you can only use MMT infusion set with all most all of the other ones you can USE any infusion set. We picked the Inset Shelby thought it was the most comfy after wearing 2 different ones for 3 days ( AND SHE CAN GET IT IN PINK so that made her happy) If you ever want to talk feel free I am getting ready to go through this with a three year old soon to be 4 year old so I love to have people to talk to.
~Korin~


#4

Hi. I began using the CGMS 2 or 3 months ago. I like it a lot. It has alerted me (in my sleep even) that I’m having a low. With the alerts, I’ve been able to self-treat every low I’ve had. My diabetes doctor measured my A1C to be the best I’ve had so far. Those two items (lower blood sugars with no insulin reactions) is a nice result.

It gets easier to use, but it’s not without some work. The user must calibrate the setup via blood glucose testing several times a day. Minimed recommends that the user test blood glucose when a high or low alert is received. Invasive? Well, the lead from the sensor is stuck in me now, in addition to the infusion set. Lucky for me, the don’t hurt and they stick to my skin. I don’t take as many meter readings as I used to . The official word on sensor change is every 3 days. The unofficial word from my pump trainer was change every 6 days. I paid out of pocket for the upgrade from the 515 to the 522 and sensor transmitter, plus the ongoing cost of the sensors.

There’s only one 522 pump model, whether or not you’re using the sensor. If you use a sensor, you simply turn the sensor on via the pump’s screen. You could buy the pump first to see how your 4-year old works with it, and add the sensors later.

I was 11 when I started with diabetes. My folks worried a lot about me. My life so far (after 40+ years with it) has been good.


#5

I’ve just started yesterday. So far I have mixed feelings about it. Most of the time it shows accurate results but when my sugar is raising it seems not to catch it at all. I don’t know, may be it just needs a couple of days of calibration. I’m also using an old version of the sensor transmitter, as the new one is not available in the Netherlands yet. It’s quite big, and for me as a girl that’s a huge minus, and it also needs so many sticking material to hold it on my skin, well just say it makes me conscious of my every move and makes me feel unattractive. And I yet have to figure out how to take a proper shower with the whole construction. But all the inconveniences aside, I think it’s a great thing. There is something so reassuring about being able to see your current blood sugar at any moment of the day or night. I usually test more than 8-10 times a day but with the sensor it’s not necessary. And the alarms, well they were the selling point for me. I suffer from night lows and if this thing can wake me up before I’m going extremely low and I can treat it in time, well life would be so perfect.

P.S. - same as Steve, I have to pay out of my own pocket, damn those insurance people


#6

My endo has invited me to try it, but I am hesitant to rush out and get one because these are still basically first-generation products, and I suspect we’ll see continued improvements in the coming years. I have heard mixed reviews. Virtually everyone has told me the sensor sites will last significantly longer than the recommended 3 day limit, and that they do identify movement trends before you might with fingersticks alone. However, the biggest complaint (besides the price … it seems like highway robbery for something that measures interstitial fluid rather than plasma glucose levels … akin to the Glucowatch, albeit more accurate and comfortable) is the alarm function. The alarm beeps that it makes when BG is either high or low – even once you’ve taken steps to address the issue (either to eat something or take insulin) – cannot easily be turned off, which the company is claiming to be a safety feature, but ignores the practical reality of living with this device 24/7/365. As I noted, the cost is insane, the standalone CGM is just under $2,000 or combined with a pump is around $7,000 (meaning the pump combo is a much better deal), plus each sensor is like $30-$35, and the device must be regularly calibrated with fingersticks. Although more insurance companies are covering the device, the manufacturers aren’t doing much to sell them. Medtronic Minimed really annoyed me; I spoke with the salesman who promised to check with his insurance negotiator … 6 weeks ago … and haven’t heard from him since my initial conversation. For that reason alone, if I decide to get this thing, it will be with a different salesperson, as I don’t want this guy earning commission for such lousy salesmanship. As you may have heard, DexCom now has FDA approval and Abbott’s CGM just got CE clearance in Europe, and it looks like Medicare will cover the CGM devices in certain circumstances, so I’m kind of thinking it may be best to wait a while longer and see what develops.


#7

I am a little bit on the same page as you, Scott.

I am curious about other people’s experiences with CGMS and insurance coverage.


#8

I am very anxious to try this new pump. However, I agree with Scott. This is still a first-generation project and I feel nervous about trying it…especially since most insurance co’s do not cover it yet. If by the time I am due for a new pump (April 2008), my insurance co covers it, I will definitely try it. But if not, I will not be heart broken since I know there must be some inherent quirks that needs to ironed out. God, it’s amazing to even hear myself saying this considering I was looking forward to trying this system out since I first heard of it.


#9

My endo recommended I purchase a pump, specifically the DexCom unit. I took one look at the price (insurance will not cover this) and the fact that I still had to finger stick and said NO!! I may a tech geek with a large number of toys but I certainly do not want any of them attached to me. I’ll wait for version 2.x.


#10

I haven’t tried the MiniMed CGM yet, but I’m dying to give it a whirl. My insurance doesn’t cover it yet (and who knows when it will), but I’m starting to think it’s worth it to pay out of pocket. I got the 522 pump last July and I love it (I had the 511 before and the 508 before that). Kelly, I would definitely recommend getting the 522 for your kid regardless of whether or not you decide to go with the CGM (you can always add that piece later on).

I have an appointment with my endo in a couple weeks and am going to see if I can test drive one of their CGMs for a few days, so hopefully I’ll have some firsthand experience to share before too long!


#11

My son, Reed, age 5, just switched from shots to the Medtronic Minimed 722 pump on July 11th. We chose that one specifically so that we could get the sensor later. We love it. We are waiting for insurance to cover the sensor before we get it because it is EXTREMELY expensive!


#12

Meredith,

I just upgraded to the 722 and my insurance has denied the CGMS, I found out last week. :frowning: I am going to appeal of course because I want it soooooo bad. I know for sure that if your insurance denies you never want to say you want the sensors to eliminate the testing by meter. They will then say they will not approve just based on convenience or making your life easier, they so don’t get it, but you don’t want to use that as a reason. I posted on another thread on this board, documents you can use to appeal if insurance denies.


#13

Hi, there, Kelly! I used the Minimed CGMS and found it did not work very well for me and ultimately I returned it. It would not catch the low readings (would say I was 90 if I was 30). Also, one of the main reasons I bought it was for sports, and I found the range was so limited that it was unusable unless I carried the receiver on me (not possible for me). I had some other issues (verrry painful insertions, allergy issues) so all in all I did not see the value. I know many people have had great experiences with it, so it’s worth a test drive. The transmitter is really small and light. You can use any meter to calibrate it. If you have any questions, I’d be happy to answer them.


#14

Hi Lindsay,

I’ve been on the Minilink CGM for a little over 2 months and the maintenance cost works out to about $5/day. Not much more than a cup of coffee at Starbucks. My sensors generally last 7-days (some people can get 14) and I sometimes go a day or so without one in between sensors. So I use only 4 sensors per month.

The 2 main factors to getting good results are: 1) Only calibrate when your BG is stable and 2) Be very careful to securely tape things so the sensor doesn’t move around. Taping is a lot more difficult than people realize. With a pumps catheter, as long as it doesn’t fall out you’re OK. The same isn’t true with the CGM. If the sensor moves around it can significantly reduce the accuracy.

You should find the best person possible to train you on it’s use. Preferably a T1 CDE (or company rep) that’s actually using it. Otherwise, you won’t get told the helpful tricks that only a user knows. Ask a lot of questions of other users.

Ken