GGM discussion, pros, cons and benefit analysis

Diabetes Technology Glucose Monitoring
1

Hi,
I have been pumping for a several months now and things are coming along nicely, my basals are finally set correctly and my control and standard deviation has tightened up nicely
.
So as logical progression to this new technology I have been considering the purchase of a CGM system, most likely the Dexcom 4. However, I have a few concerns, I am hoping that those with direct experience of CGM will be able to provide some insight.

I understand that for many CGM has been incredibly useful, e.g. that the data provided has enabled individuals to get a real handle on their numbers, has assisted with exercise and that CGM can also be useful in the early detection of lows and the associated of peace of mind that comes with it.

However, everyone in the UK I have spoken to face to face (only 4-5 people I admit), appear to have no end of issues with their systems (minimed system, dexcom).

My main concerns currently being..

• Accuracy, everyone I have spoken to directly has stated that their systems are plagued by inaccuracies, often alarming too late, or not at all. This seems like a serious issue, I am loathed to spend hundreds of pounds on a system that is not accurate; this seems like a serious flaw in the technology.

• Site issues, although I am new to pumping insulin I am already seriously enamoured with it (pun aside, I am sure it is unhealthy to be this attached to an inanimate object). I see it being my long term solution for insulin provision, therefore I regard my infusion sites as somewhat precious, looking at things with a positive bent I hope to be infusing insulin for many years. Do I really want to increase my chances of scar tissue by using CGM, thus reducing my years of successful pumping in the process, as if I don’t have access to decent sites in the long term, then pumping is going to be problematic?

The people I spoke to allowed me to have a look at their sites and those using the Dexcom and the Minimed system all had a large number of site hole scars, they also admitted that after a few years on both CGM and the pump that they were struggling to find sites and suffer from tissue hardening.

• Anxiety, OCDiabetes. I have noticed personally that an increased focused on my HbA1c and my BG control has bought about an increased in anxiety, perhaps an almost obsessional focus on my diabetes.

Although this has been excellent for my control overall, I do feel that the overall quality of my life (in the short term I know) has taken abit of a hit. My life has become a sea of numbers, carbs, trends, finger pricks and so on. I used to be such a foodie and I know I see meals as part of an equation rather than something to be enjoyed; my blood glucose level is never far from my train of thought. I worry that adding more data, alarms and technology to worry may further add to this problem. I worry that whilst the CGM may add provide me the illusion of control, it is offering me little that cannot currently be obtained by testing 15 time a day (that although irritating to have to do is accurate, quick and painless)?

I do believe that there is a tipping point and that although no one can argue that increased focused on BG values is a good thing and is a goal that we should all aim towards, that there is a point where it can become almost unhealthy and that it can start to unnecessarily impact on other areas of our lives. I have always wanted to “manage my diabetes” rather than the other way around! I don't want to be defined by this illness, nor do I want it to be my primary focus.

In short I guess, do the benefits of CGM outweigh the costs? I am not convinced at present, I understand the proposed benefits and I don’t wish to offend those who have had great success with it.

But for those long term users of CGM, can you honestly say that the hassle and cost has been worth it and that the benefits you have achieved could not have been achieved by regular testing 10-15 times a day?

Thanks for your time and apologies for the long, rambling post ha..

Buckley.

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I think the benefits outweight the costs. I have the MM, widely maligned as not as good as the dexcom but for me, the single gizmo is a big plus. I'm sure it's possible to get gear to lug the sensor around running but to me, the package seems a lot cleaner. I've neither touched nor seen a Dexcom in person and most people suggest they are very nice.

re your quesitons,

Accuracy: There are days where the CGM would run "off", particularly as I stretch them out to 6 days instead of every 3 because day 4-5 are usually great. Day 6 not so much. Day one sometimes will also run off.

The thing is, I can sort of control this by eating more moderately and getting smoother curves and, if the thing is not flying all over the place, I will have a lot of days where I can very flat lines *and* be +/- 5-10 points all day. It's sort of inspirational or maybe like a coach? A lot of my strategy is to have larger carb hunks in the evening when overbolusing a shade isn't that big of a deal, I'll eat, watch it run up to 120 and fret and then see it peak and start to drop and settle in nicely. To me, that's a big win and makes me pretty jolly. And the CGM is "warmed up" by the evening, even of day one, and usually reading pretty accurately, at least 5/6 days/ week.

The CGM has helped me catch numerous drifts in rates by alerting me to #s that aren't where they are supposed to be. This is also a big plus as with a meter, I would probably only catch that with a log, which I pretty much haven't ever bothered with. Even if it's not as accurate, say +/- 20 pts, it may still show you that trending higher or lower. The "lag time" that may seem to make it useless -- "If I'm at 40 and it's at 60, what good is it"-- is something else that you can get pretty used to as the CGM 60 won't happen in a vacuum

2) Sites. I am occasionally a bit nervous about this. I'll be 4 years pumping in April and 2 years on the CGM. I think the 6 day use of the thing helps w/ healing but I'll deal with it when I get there.

3) OCD? What are you talking about


:-)

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If you can afford go fot it .
I used cgm for six moths and i loved it specialy the new enlite sensor..
accuracy never has a problem for my Bg ans Sg were most of the time identical by the way i use my sensor for almost 9 days .

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I use MM, and I love my CGM and get REALLY close results I'd say over 90% of the time with it to what my meter is showing, sometimes the same exact reading. BUT despite how close I've managed to get my CGM I still do NOT treat based on what those results show.

I've found for me, the key to getting mine so successful is calibrating it when your BG is stable. Meaning if you are low. Hold off on calibrating as you might be dropping very rapidly, same if your BG is high.

I think as long as you keep in mind testing your BG using your meter is still ESSENTIAL, CGM is not a substitute for that, and you go to some of the CGM specific sites here and read up on what others have done in order to get the most out of their CGM, you will find it very helpful.

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You raise some very legitimate concerns. The decision, for me, was easier as my insurance covers 80% of my supplies.

That being said, I am as attached to my Dexcom as I am to my pump. I feel totally naked without either. If you were a woman, I'd say it's sort of like forgetting to put in earrings LOL I have never gotten less than 2 weeks from a site (I've been using it for 9 months), and usually closer to 3 weeks. The accuracy actually improves as it 'marinates'.

I freely admit that I'm OCDiabetic. The first few weeks with the Dexcom I must have looked at it every 5 minutes, but I'm like that with any new tech toy. It's actually reduced my anxiety a lot. I can sleep at night, knowing that I won't bottom out at 30 so not having to wake up to check, which produced a lot of anxiety. Mine is set to alarm under 70/over 120, so even if it's 20 points off and 10 minutes behind a fs reading it's not a disaster. It also alarms if you're having a rapid rise or fall.

I absolutely love the data/charts. Despite it's inaccuracies, overlaying a week's worth of readings really gives me a good picture of trends and allows me to make basal adjustments based on real data. I've had much better control - my standard deviation last week was 19. I like having it right there when I'm at physical therapy or exercising as I can check it with no effort, frequently, and catch downward trends before they get ugly.

I haven't had any site issues. The sensor is about the thickness of 2 human hairs, and the sites disappear more quickly than my pump sites. I am pretty fanatical about rotating, and given that the sensors last so long I might reuse a site every few months?

I feel that it's another weapon in my arsenal that allows me more control - my D controls me less than it did pre- Dex. Now that I've used it, I'll do whatever it takes to keep it even if for some reason I end up having to pay out of pocket. As acidrock said, it's really satisfying to see a flat line and a challenge more than a concern when a number is 'off'.

HTH

6

Your concerns are valid and I had the same concerns when I initially started with my Dexcom. While I've only been using the Dex a couple of months, I wish I had this tool long ago. For me, the benefit has more than outweighed my concerns. I too feel naked without my Dex. I sleep better at night knowing if something goes bad quickly high or low, I'll get an alarm.

The greatest benefits for me have been tightening control and lessening the swings, flattening the lines. Can you do this without the CGM? Yes, I think so. But I think the CGM makes it easier because of the ability to see where you're trending and how fast. To be able to catch trending higher before it gets really high and to catch a low trend and bump it up a bit without having a bad low. It's given me the confidence to be patient in treating low trends without overtreating.

The Dex has helped me tremendously in a short period of time and I'm still on MDI. I'm hoping to go to a pump soon and get even better results using both tools and better able to dose in smaller increments to fine tune.

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Dear Buckley83,
I will simply say what I did. To me, the benefits outweighed the costs. I limited the costs.
I did the Dexcom for one year. The Dexcom because the lumen of its introducing needle was smaller.
One year because I believed that if I couldn't test all the reactions to foods I ate repeatedly during that time, it wouldn't happen.
I decided what foods needed testing first, then progressed onto a second set, and a third set. Starches were first. After I tested reaction to single foods, I put them in combinations. I was after what my BG was at 1 hour and at 2 hours postprandially. I wanted to stop my spikes, and I learned what to eat and not eat.
Accuracy? Remember a CGM is riding 15 minutes behind your blood glucose. I never found inaccuracies.
Site: it must be in fat, given a couple hours to get bathed in your fluids.
Hole scars: #22 needles don't normally produce hole scars. When you deal with bigger, yes, you'll have scars.
Anxiety: Because I was focused on researching my body as best I could, anxiety didn't enter into the equation. This was as scientific as I could make it.
Foodie: Food is only as good as it supplies the body its various needs. I learned I needed to go low carb to be able to settle back and not deal with roller coaster rides. Insulin didn't "cover" certain starches. If I wanted to be free of above 140 numbers, I needed to confine what I ate to proven delights. And I have many.
I also designed various levels of exercise and learned my BG with as high as 1/2 hour at 4 mph to as little as running the stairs several times.
Number of tests per day. Yes, one must calibrate. I believe 7 was the highest number of tests I did, and I normally do 6 now.
So, use a CGM for your own purposes. When you don't find it is fulfilling what you want as your goal, get rid of it, pass it on. Take a charity deduction. :) Give it a chance to give you specific feedback.

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Thanks guys,

I think I will bite the bullet and give it ago. I should have got the new Animas Vibe with inbuilt Dexcom pick up in this case, but ho hum.

I like the idea of approaching it scientifically and using it for one year to really get a handle on things, it would be useful for getting a handle on my dawn phenomena and I do see it being useful for exercise so time to get the bank card out...

That is a very handsome flat line acidrock I have to admit ha!

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If you do Buckley, please keep us posted!

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I think this is a very personal decision and you've gotta find what works for you. I've tried both the Dexcom and the MM CGM (the one that is integrated with my Revel pump). Here are my thoughts:

1. Like AcidRock, my preference is for the MM CGM because I don't have to carry around another device.

2. While the Dexcom was a bit more accurate (not much), both gave me too many instances where the reading was WAY off from what my meter said. I had too many alarms telling me I was low when I wasn't (which resulted in my treating said lows and then ending up wicked high). Perhaps it's my interstitial fluids, but I just could not get accurate results with either.

3. I found that having a CGM made me a bit lazy, and I would bolus based off what the CGM was reading (BAD, BAD, BAD, I know!).

4. I have had some skin issues with my pump sites (rashes, itching, etc). When I remove a pump site, it takes awhile to heal up, especially during the warm summer months. Therefore, I don't have a lot of sites to mess with and I just found that I was losing valuable real estate when using a CGM. I'm fairly petite and keep my sites under my clothes (belly, lower back). For me, my pump is a necessity because I'm so insulin sensitive. I can live without a CGM.

5. Cost is a factor. Even after insurance, I was still paying more out-of-pocket and, combined with pump supplies, test strips, and insulin, it was all just too much.

6. For some reason, I find that traditional BG testing via a finger prick makes me more in tune to my diabetes. I don't know why but there's something about having to stick to that whole process that just keeps me in line. Perhaps it's because that's the way I've been doing it my whole life, but it just works.

7. I really did find the ability to look at trends very helpful. I was able to use the CGM data to make some tweaks to my basal rates that were good changes for me. I kept my MM sensor and will use it periodically if I'm having trouble with my basal rates.

Of all the issues I had, the skin issues were probably my primary concern. I want to be able to pump for a long time, and the concerns about scar tissue and the slow-healing skin irritations I have were just too much. I am very diligent about keeping my pumping sites clean and I just could not handle another site. But that's just me.

If you can afford it, I would say go for it. Most people seem to find CGMs helpful. Dexcom does seem to be the gold standard of CGMs, but I didn't find it that much more accurate than my MM CGM.

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