MDI & CGM users

Diabetes Technology
1

I typically hear about pumps and CGMs combined, but I rarely have heard about MDI users and CGMs and I’m wondering what experiences (if any) people may have with a combination of the two.

A pump is clearly out of the question for me, but I might have luck with a CGM after a conversation this week with my doctor. Who knows, the offer may not even be on the table, but I wanted to check with the community for responses.

If a CGM is on the table, it will be a rental unit, and likely only one brand. Not sure what that might be, but that also means I don’t have the luxury to shop around.

I’m on Humalog and a generic Lantus equivalent. My insurance covers 120 test strips per monthly visit (not 120 a month, 120 after each doctor’s appointment), and I see my doctor appx every month to 6 weeks. I’m probably shelling out an additional $50 a month on test strips so I can test up to 6 times daily.

2

I was a long term pump user and have used a CGM for the last seven years. I’m now in the second week of an MDI trial using Tresiba as a basal insulin. I don’t think I’d ever willingly go off the CGM. I use a Dexcom and don’t have any experience on any other one.

A CGM can really educate you on your personal patterns. If you pay attention, it will give you valuable information about the meals you eat and how they affect your blood sugar. CGMs are a great safety device for monitoring in real-time but uploading your data to an analysis program can teach you even more. This is a feature that few take advantage of.

Good luck with your CGM trial.

3

May I ask what generic lantus equivalent you’re using? I wasn’t aware that there was one available?

I previously used the Dexcom 7+ cgm while on MDI with novolog and lantus. I found the Dexcom very helpful as a learning tool, but also encountered some annoying issues with it as far as erroneous alarms, etc. I’m told that the newer generations of Dexcom are quite a bit improved. Ultimately i decided at the time that my stability was strong enough that the cgm was no longer justified, but I am glad that I used it for the time I did, and I did learn from it.

If I ever start having major control problems in the future I would again turn to a cgm-- maybe temporarily to help figure out the problems, maybe indefinitely if I was not as stable as I am now. A pump is much further down my list of considerations. I too am using tresiba for basal and it is working so well for me that I can’t really imagine any advantages that a pump might have to offer me at this point.

Ps years ago I started buying my own test strips with cash. I pay $45 per 300 strips for what I believe are on par with the best strips on the market— never going back to any other way.

4

Sam

I’ll be heading back to the doctor’s office on Thursday, so I’ll probably have more information on the generic Lantus. It’s a Japanese made product. As I have heard, there is not one available in the United States. That said, the vial has Eli Lilly written on it (in Japanese), and last I spoke with the doctor, he said it was essentially the same.

I’ll have to keep that in mind. Perhaps a CGM trial (just to see how well I’m in control) might be a better idea. It might be hard convincing my doctor for a CGM, considering that there seems to be no budging on increasing my allotted limit of test strips above 120 without paying out of pocket.

It’s a bit hard buying test strips in Japan, since there are few players in the market. I’ve considered buying them on amazon (in the US) and having a friend ship them to me here, but I’m afraid customs might confiscate them.

5

I used a CGM for a couple years or so while on MDI – the CGM data was just as useful to me then as it is now with the pump. It helped me better verify my basal as well as my insulin to carb ratios. I was also able to use the CGM data to better plan early bolusing so as to avoid post meal spikes at the 1-hour mark that I otherwise missed while just using a meter. The CGM also helped me identify my DP and adjust to better manage that. All-in-all VERY useful.

6

I do MDI and reducing post-meal spikes has been one of the biggest benefits for me, especially at breakfast. Another is being able to head off exercise lows early on.

This is something I am starting to work on. I like that I can print out a report and send data to my CDE before an appointment.

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7

Perhaps Peter is referring to Basaglar (insulin glargine)? It appears to be a “biosimilar” which has been used for a while outside of the US but is still not available here. It was only recently (Dec 2015?) approved by the US FDA.

8

If you read sugar surfing then you will see examples of an MD using a CGM on MDI. It’s a great book.

9

i was on mdi, when i got my cgm, at 1st it was very useful to me, but as time went on, i found out it was not as useful,.

10

I think one of my biggest issues are my post breakfast spikes and the occasional low that dips from the 200s down to the 60s in less than an hour. I’ve tried to correct this with my diet (I wouldn’t call it low carb… I call it a starch ceiling- no more than xx g of starchy carbs at each meal). Not as bad as it used to be, but I hope a CGM would warm me of these kinds of lows.

I’ll mention this to my doctor tomorrow.

11

I’ll ask my doctor about the specifics of the generic I’m using with my doctor tomorrow. He referred to it as a ‘generic’, but it’s possible that they might not a term for ‘biosimilar’ in Japanese.

12

Thanks! All books help. I just ordered a copy of Think Like a Pancreas, waiting for my parents to send it with a ‘T1D care package’.

I’d love to give a copy of it to my doctor here in Japan… I’m sure he would face a bit of criticism within the hospital he works at if he followed recommendations like low carb solutions.

13

I could see this happening. Without a CGM,I try to see trends by uploading my meter to my laptop and viewing the data. Sadly I’m running out of One Touch Ultra strips, so my Freestyle CoPilot App won’t be nearly as easy to use… it’s nice to automatically upload my meter.

My OneTouch UltraVue (Japanese only model) has a data port, but I’m not sure if it’s compatible with the US program. Next test will be to try the Japanese OneTouch strips with a US OneTouch UltraMini. Just need to find a data cable…

14

:confused: Do you? What sort of trends do you see? How detailed a description can you provide?

My difficulty here is that I don’t know you, your experience of D, or how much info you have or even need to have to work well with it.

So, not having any context about you, I interpret comments like this in terms of my own experience. I flash back to where I was a tad over a year ago when I was considering trying CGM.

As I seem to keep saying, my original expectations for CGM were very “meh”. I expected to get a BG chart with a few more data points. Whoo & Hoo & Whatever. Sure, that could be helpful. It’d give me insight I might be able to use to tweak my numbers.

That might take … What? A week? … Two weeks? OK, worst case maybe a month or so. Still, maybe it was worth pursuing. Why not?

As I said, my expectation was “meh”. If I could give CGM a try, I decided that I should go ahead and do that. But I really wasn’t expecting much. After all, I had used a BG meter for decades. This would just be a bit more of the same thing, right?

My first clue that I had been clueless was realizing that a graph with 288 data points on it had more continuity than testing 7 or 8 or even 12 or 15 times a day could provide.

My patterns before were something like “I tend to be high during this vague quarter of a 24 hour day”.

With CGM I eventually saw things like “I tend to start rising around here, continue to do so until I get there, and then I sort of just level off until I start to drop again about x hours later.”

My second clue was when it dawned on me that CGM wasn’t just about patterns, I could use the CGM dynamically. I could wait until my insulin bolus had actually kicked in before I ate a high carb meal to help limit the postprandial spike. And I could also get an idea from the CGM what that spike was like.

I could gauge how much carb I needed to correct for an oncoming hypo from the slope of the drop on the trend graph.

And I could realize I was going hypo at times I really felt I should NOT be doing so. In other words, when I wasn’t expecting (and thus looking for) it.

Bottom line: perhaps it really is not right for you and your context. But at this point if I had to choose between my pump and CGM, I’d keep the CGM. So I know CGM is right for me.

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15

Indeed, I ‘try’ to see the trends… I absolutely don’t seem them compared to how a CGM would allow me to access that data.

Anyhow, I had my doctor’s appointment yesterday. With insurance, the rental and sensor for the CGM would cost about $250 to $300 every 6 weeks.

Curious how this compares to the US?

16

I have been using the Dexcom CGM since last June with MDI, and I think that it is the most important tool I could have to manage my type 1 diabetes. It alerts for those pesky middle of the night lows, helps me when exercising to avoid lows, helps me at snack time to decide whether or not i really need to eat that snack, etc. I’d feel like I lost a very important part of me if I had to give up the CGM. I still finger test, out of bed and before each meal, or if I think the CGM is not reporting correctly.

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17

I’m on MDI and have used CGM in the past and would say it is a hugely useful tool. It helped me see a lot of trends I never would have without it, like overnight lows and adjustments I needed to make with my Lantus. I only stopped because my insurance coverage was poor but I’m working on getting back on it now. I was trying to ration strips as well and it helped a lot for that. I was on the Dex G4. It provided great info, and gave me some peace of mind at night as well

18

I’m in Canada, but we don’t have CGM coverage here so I pay for it myself. The starter kit (receiver, transmitter, four sensors) cost me $1,840 Canadian. Each box of four sensors costs $340. However, although you are supposed to use a sensor every week (and therefore a box would last a month), I stretch sensors out for two to three weeks (or longer, if they keep working), so I only end up using about a sensor and a half to two sensors per month. I’ve also continued using the transmitter ($800), which is supposed to only last six months, for almost a year now. I will do the same with the receiver ($700), using it until it runs out of battery power, which I’ve heard can take two years or more.

So, while it’s still very expensive to pay for (and I lament each and every sensor that dies), it’s about half the cost in reality of what it’s officially supposed to be.

For me, a CGM is 100% worth the cost. It allowed me, for the first time ever, to gain nearly non-diabetic level control after over two decades of not ever coming close to that. Recently I’ve been dealing with extremely volatile blood sugar levels due to some other medical conditions, and I honestly feel I’d have run into some emergency situation at this point if it weren’t for the CGM providing early warning of rapidly chanigng blood sugar that end up being extreme highs and lows. I also live alone and travel a lot, and knowing that the CGM will wake me up if I go low overnight is also reassuring. Even if I switched back to MDI, I would definitely continue using a CGM.

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19

Just picked up my prescription for the generic similar to Lantus.

Here’s what the box says (for what is written in English):
Insulin Glargine BS Inj. [Lilly]
Insulin Glargine (Genetical Recombination) [Insulin Glargine Biosimilar 1]

Upon further inspection, the insulin is made by Boehringer Ingelheim- based in Japan. I looked at Boehringer Ingelheim’s US press release and it appears to be the same biosimilar.

I’m not sure when it was approved in Japan, but I’ve been using it since December 2015.