Why are CGMs still so underused?


#61

Thanks Terry. I will seriously think about it. True that I can’t tell when I am high or low anymore, but i bet it has been close to 20 yrs since I lost that ability. Actually it has been since my A1Cs have been below 5.5, so maybe I should give the theory I mentioned some credence.

As long as I get down to 140 and usually lower within 2 hrs of eating, what difference does it make to know more info? I don’t eat any surprising foods.

Since I am a perfectionist, I am also afraid that I will be glued to the info the CGM gives me. I suppose it would be good to know when I go below 65. I think that will be the only reason to get one for me. I was recently on a hike on the mountain in Manzanita, when I ended up out of it on the path, because my glucose had suddenly dropped. I can count the times that has happened on one hand in 60 yrs. I am sure it would have been far easier on my husband if we could have avoided that.

Is there more than one unit available now? Should I try the Dexcom Seven Plus I own, or has the technology been greatly improved?

Thanks very much


#62

Hmm, I sleep with my phone in my room all the time. It charges right next to my bed and is my alarm clock every morning.

Dr. Bernstein uses a CGM, though he doesn’t like the pump (which I and many others, including many who follow his methods, disagree with). I’m not sure about the other person.


#63

Jen, I haven’t been on the Bernstein site, since I stopped low carbing almost 2 1/2 yrs ago. Interesting to hear that Dr. Bernstein does use a CGM. I know that he feels he can keep tighter control without a pump. Sonia Sotomeyer said she doesn’t use the newer technology, but I know I thought that a CGM
would come in handy for such a very busy person with such a demanding job. Hard to think of her in court pulling out testing supplies.


#64

I think UNawareness that they exist is also high on list. I started in 2007 because a co-worker told me her teenager son was using CGMS.
My endo never mentioned it, even though there was an T1D internal med Dr in same office using CGMS with glowing reviews.

I started with older Sof-sets, which by comparison, were much much less accurate than today’s sensors. But it was still extremely helpful.

The reason I found online T1D forums was BECAUSE I started CGMS, and learned dexcom existed. So switched to dexcom. But why didn’t endo tell me there were options?

That was years ago, but I wonder if some doctors don’t mention or explain benefits to established patients, that they feel are doing OK.

Would be interesting to know how many patients initiated desire for CGMS, vs doctor bringing it up.


#65

It might have something to do with insurance. In most insurance formularies it states that Prior Auths. will only be approved if you don’t have adequate control using strips. So even if you might be able to convince insurance to authorize it Dr.s may feel it is a waste of time to try.


#66

@MM1 - Ditto for me. I’ve seen an endo twice a year for most of my life, and never once did any of them discuss or suggest I look into CGM (I had no idea what they were 4 years ago).

Of all my T1D regrets through the years, not starting on a pump much sooner, along with using a CGM, easily ranks in the top 3


#67

I also became hypo-unaware after several decades, and only felt crashing lows. But after I started using a CGM, and could head off lows before they were serious, I found my symptoms returned. Not fully, but enough for me to once again feel when I’m heading low before I’m actually low.


#68

When you think everything is going okay there is no reason to look for something new. I don’t know what her particular situation is, but I was a courtroom lawyer for 3 years before getting a CGM. It was not something I ever even thought about because my doctor always said I was doing great, I don’t have dangerous hypos and I had other things on my mind than diabetes. Now I know how high my blood sugar was all the time when I was anxious in court and how much easier it is to use a CGM vs. a glucometer. Perhaps she thinks she is doing just fine and hasn’t given it more thought than that. It isn’t a reason for others not to use a CGM.


#69

Before CGMS, I didn’t have dangerous hypos, BECAUSE I kept my BGs high to avoid. Before CGMS, my A1Cs were 8-9.


#70

I believe that prescribing a pump without a CGM is unethical.


#71

I’ll take it a step further…I think a CGM is “medically necessary” for anybody injecting insulin regardless of what your insurance company says. It’s like a life jacket when you are on a boat. Maybe you’ll never use it but it’s there as a safety measure. Just like those glucagon kits that rarely get used…insurance covers those for everybody (I think) but the main safety purpose of the CGM is to get some advance warning (via the alerts) before you go too low.

I’m convinced that the reason CGM’s are so underused is because of the cost. They are expensive enough to motivate the insurance companies to delay or deny coverage, and even if they are covered the co-pays are often too high for many people to afford.


#72

Sonia S doesn’t. But many 1,000’s of others do, including British PM Theresa May.

For anyone considering CGMs, this is worth reading

http://sixuntilme.com/wp/2014/01/21/knew-dexcoms/


#73

If you’ll forgive me waxing philosophical for a moment, I can’t help seeing this in terms of the big tectonic shakeup that happened with the advent of analog insulins, especially Lantus and similar basals that came along, back around the turn of the 21st century. Up to then the flat assumption from the moment of your first shot of NPH was that you were henceforth going to restructure your life to conform to your medication. I was in that box for 20yrs, from dx in 1983 - 2003, and your post reminds me of that experience. It was just a given, not even something I thought about. But suddenly it was replaced by this completely new and alien idea that you could adjust your medication to fit your life, rather than the other way around! I know there are a lot of exceptions, but other things being equal, it’s now a choice, not a necessity to live under that make-your-life-fit-your-medication discipline. To me it was like being released from prison, and that’s what all these new tools—CGMs, pumps, even just analog insulin-based MDI—mean to me. I don’t mean this as a criticism; we all have to make trade-offs and choices (YDMV), but that’s my perspective.

Not unreasonable, but note that sensor filaments are waaayyyy finer than infusion cannulas and I’ve never noticed any scarring. That said, I almost always use my upper arms for CGM placement, an area that totally doesn’t work for infusion sets for me, what with figuring out how to run the tubing to the pump and getting the thing not to rip out every time I take my shirt off. So I use it for CGM and reserve the territory where I can attach an infusion set (abdomen and upper thighs) exclusively for that purpose.

Another location some people use for CGM—one I don’t think would work at all for infusion sets—is actually the back of the calf. Haven’t seen much about it here, but there’s a lot of discussion of it in the 670G/Guardian 3 community. I was skeptical but I tried it there a few times when I was using Guardians and it worked surprisingly well, though I had one painfully bad insertion that kinda put me off it.


#74

I didn’t realize that Theresa May had diabetes. Yes, she should definitely do anything she can to watch her glucose levels.

The article you posted has just about made up my mind for me. I don’t think I will a buy CGM at this time. I know myself well enough to know that all of the writer’s concerns would apply to me. Also I have times when I have bouts of insomnia and I don’t think wearing something on my body will help me sleep.

After 60 yrs with diabetes, with no retinopathy or neuropathy, I think the only reason for me to get one would be to alert me when I am hypoglycemic. I understand that it would be a huge advantage to have that alert, but since I always wake up when low, and can count on one hand the times I have needed help in 60 yrs., and because I have never had to go to the hospital for my diabetes since diagnosis, I think I am willing, for now at least, to not use a cgm. I may at any time change my mind though.

Also, because I am retired and at home with my husband most of the time, testing often isn’t a big deal to me. With an A1c below 5.5 for the last 20 yrs, and with staying below 140 two hours after meals. I am ok.

Thank you for posting the article Jim.


#75

No, I think anyone who wants to should be able to buy and use a CGM.


#76

DrBB,

My life was completely changed when at 30 I got my first monitor for home glucose testing. No more urine testing made a huge difference for me. I don’t recall any hesitancy about changing insulins from pork and cow to human insulin, or other insulin changes.And yes, taking 5 shots daily instead of 1 was wonderful.

I realize that part of my hesitancy about getting a CGM is the technology. I love my new iPad, but I thought my old one was fine.
I do keep this in mind when thinking about getting a new CGM. I don’t think I am being stubborn, but maybe I am. I know the reason I never used the one I bought several years ago was that I just didn’t want to have to deal with it. :blush: Also please read my last reply to Jim.


#77

I wasn’t going to say, but for me the 670G pump falls into this category. For the first time since Lantus-based MDI, that pump made me feel like I was once again working harder to match my behavior to satisfy my therapy than the other way around. So yeah, I understand. We all have to draw our own line in the sand!


#78

Yea, its pretty hard to make a case that your treatment is effective without the data. I feel like its getting even more complicated because of the number of complaints about newer model sensors. There must be a widely reliable model. Sometimes I’m concerned that there isn’t and when my G4 dies, I’m Sh**t outta luck.


#79

I suggest that enlightened medical care would grant access to anyone with a faltering glucose metabolism. In an ideal world, the CGM would teach people with any kind of diabetes about how their body works. Paying attention to and acting on the data it supplies avoids way more expense than they cost.


#80

I don’t mind wearing the CGM, but it took me until the 670G to use the bolus wizard. I wanted to count carbs and calculate my dose. I went low all the time, but I didn’t trust the algorithm. My endocrinologists complained every time I showed up. The calculator has been available for a good 10 years and it took me 9 to get going. Sometimes we just resist things and I don’t really understand why.