Has anyone else heard about Hypocompass? http://www.medscape.com/viewarticle/806980
I'm unable to access that article without logging in to Medscape. Perhaps you can tell us about it.
You're right. I tried it too, and it didn't work. But I was able to see it by using the link after Googling it. https://www.google.com/#q=hypocompass
The study concludes that education can make a measurable difference in the amount of hypoglycemia (they define it as < 54 mg/dl) various groups experience. Some groups use MDI, some use pumps, and CGM use is spread across all groups. Turns out that education cuts hypos more than technology.
Wow, education helps to improve hypo awareness. Who would have thought that piloting the glucose level 24/7 needs education?
Okay, some very few people might exist that do not have the capability to connect the sensations they have while being low with the insight that they are actually low. But most diabetics on insulin know their body response to lows very well. It is the year 2014 and people have A1c's around 6 which is an average of 126 mg/dl! The difference from 126 to 70 is just 56 mg/dl! Combine that with the inaccuracy of our current meters and things are not that easy to handle. With an insulin sensitivity of 50 and 0.5 unit pens we can dose our injections for our target in 25 mg/dl chunks. 140 mg/dl can be 112 or 168 mg/dl depending on the 20% inaccuracy of the meter. In one case 0.5 units will lower to 87 in the other to 143 mg/dl. Have I said that many patients have only 1 unit pens? Combine that with the little inaccuracy in the carbs per insulin ratio that will scale up the more carbs we eat. Of 100 lows we experience how many will be detected too late? Was it then a problem of being distrated, unobservant, ignorant or just stupid? How to increase the awareness when the BG just dropped too quickly because it was hot outside or a physically challenging day or the meal slowly absorbed and the insulin overtook the digestion? But foremost I wonder what all the education should bring at night while being asleep! In summary the idea that hypoglycemia can be prevented just by education is very simplicistic.
Okay, the study was about severe hypoglycemia (SH) not mild hypo episodes. But my point is that they do not solve nor address the basic problems of glucose control I have mentioned before. Actually they just used a standard method to treat hypo unaware diabetics. That is to prevent lows at all cost for a period of some months by elevating the average BG with less fluctuations. As a result they see that the patients are more aware for the hypo symptoms than before. Not very surprising for an established standard method for sensibilisation - at least for germany I would call it established.
The real point is that today people have to justify to their medical team if their use of test stripes has increased. Thus people do not test as often as they should. Thus they can not react proactively to catch bad developments early. If medical teams want to reduce the number of hypo episodes in patients using insulin then they have to give their patients the number of test stripes they need and CGM devices if their awareness for lows has disappeared.
In a very simplified sense the trial rediscovered that insulin dependend diabetes treatment is driven by data and its interpretation. The more the patient is able to draw conclusions from his data the lower the likelyhood for severe hypos. This knowledge and proreactive behaviour has more influence on the quality of BG control than technologies like cgm or pump. For me the trial would have been much more valuable with a focus on data interpretation. Which graphical or statistical information helps patients to identify their hypo episodes in their data? The hours with the greatest risk? The recurrence of low patterns? Is it the ambulatory glucose profile or another visual approach? How can patients be convinced to collect all their data for analysis? For our Glucosurfer project this kind of research would be helpful.
About one quarter of patients with type 1 diabetes have impaired awareness of hypoglycemia (IAH), and those individuals are 6 times more likely than others with the condition to experience life-threatening severe episodes, Dr. Little noted.
I am one of those people, except that I'm an insulin dependent type 2. When I'm low and my body lets me know, of course I know. However for a significant portion of my lows, I am completely unaware until it enters the severe range: <50 Sometimes, especially while sleeping, I will not wake up until I hit the low 40's. Other times I know when it hits 75.
Tonight is a perfect example. I went to bed about 10:00, woke up at 11:30 to use the restroom and get a drink of water. Then noticed my vision was a little 'off'. Checked my BG, 45! Or alternatively, I woke due to the pending or currently present low completely oblivious, consciously speaking, at least until it dropped to a level that broke through my unawareness.
I am fully cognizant of how my body reacts to lows. An amazing variety of manifestations, ranging from Adrenergic (palpitations, sweating); to Glucagon related (nausea, headache); and Neuroglycopenic (vision, confusion, Kussmaul breathing). My problem is that many times my body does not present these at a level, or in a manner that I'm conscious of.
Once that threshold is met, I can easily gauge my BG within a few points based on the type of symptoms and their severity. The problem is that the symptoms do not always present themselves until I'm already in trouble.
Good news: My pump and CGM arrived last week. I'm just waiting for my doctor's office staff to correct their rectal-cranial inversion and allow my trainer and I some time in the office to get started. I'm really looking forward to the benefits of the CGM in particular.
Has anybody seen the "compass" part?
I love some good news. Good luck with your pump, I think you are going to do well. I so enjoyed your comment regarding the doctor's office staff. I am stealing it and just wanted to let you know. Made my day!!
I suspect the "compass" is the education piece, not so-obvious nomenclature.