Cool Gizmo Machine AKA CGM

"Meet Mr. CGM Man!"

I am really wanting to initiate some serious CGM (Continuous Glucose Sensor) sensing in da house full of Diabetics.  My drawbacks were financial, basically couldn't afford the 200 for 4 sensor equation. But we now have a "Flex Account" meaning, I could, if I wanted to, get them covered. Hence my new dilemma.

The new barrier is not the cost, but the size of the Medtronic Sensors.  They could be used to hang up the cork board in my kitchen. Seriously, that BIG!  So I did some research to try to sway me into making a decision. Just Skim it. Thought since I read it I might as well share it!

My Take: 

Battelino and crew took 120 people with type 1 DM. (Randomly - which makes the study better) split them in half, one control group, one treatment group. They followed the groups for six months and concluded the following:

“In conclusion, the results of the current study demonstrated significantly shorter time spent in hypoglycemia in children and adults with type 1 diabetes who used continuous glucose monitoring compared with standard SMBG, with a concomitant significant decrease of HbA1c.”

In a nutshell:

CGM is a good way to stay out of the hypo zone.   It also has an effect on over all control shown by a lower A1C.

 Here is very informative article discussing some “don’ts” with RT-CGM(Real Time CGM) use and insulin pumping, written by Howard A. Wolpret, MD.

Here is the Link to the Article Titled; The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  Here is the Article Link  Lots of cool graphs, talks about things like not shutting the basal off to treat lows, and not pre-maturely bolusing for highs. Good stuff!

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  The authors randomly assigned 272 PWD to use CGM over a period of six months.  This is what they found:

“After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near daily CGM use is associated with a similar reduction in A1C."

Once again the results show that there is a benefit from frequent use of CGM for PWD of all ages.

"MedTronic"

I think there’s a trend here.  Well on a personal note;  in our house full of diabetics  we are the proud owners of  two insulin Pumps with CGM capabilities.  We own one sensor (2800 bucks) and we don’t currently use it. For the aforementioned reasons.

"The Dex"

Unfortunately the Dexcom CGM isn’t available in Canada(I hear from the DOC that it's mucho better) and I have yet to hear anything back from my numerous emails writtem to the company.  I love my Medtronic Pump, and the built in Sensor thingy, but the needle is ginormous! Like Hammer and Nail large.  I can barely stomach it let alone my wee one.

If anyone reads this and knows anything about the Dex and when it is going to immigrate to Canada, please keep my clan posted. 

Trev

Sources: 

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  Factors Predicative of Use and of Benefit from Continuous Blood Glucose Monitoring in Type 1 Diabetes. Diabetes Care 32:1947–1953, 2009.

http://care.diabetesjournals.org/content/32/11/1947.full.pdf+html?sid=4c7cc395-3b1b-48c1-b381-6a43aa732cd5

Tadez Battelino, MD, PHD, Moshe Phillip, MD, Natasa Bratina, MD, PHD, Revital Nimiri MD, Per Oskarsson, MD, PHD, Jan  Bolinder, MD, PHD. The Effect of Continuous Blood Glucose Monitoring on Hypoglycemia in Type 1 Diabetes.
Diabetes Care 34:795–800, 2011

Howard A. Wolfert MD.  The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  http://care.diabetesjournals.org/content/31/Supplement_2/S146.full.pdf+html?sid=21e0bbe2-9439-45b6-825b-69b69aca3cc3

The 40 Year Old....

"Self Portrait"

Almost got you to say the "V" word didn't I.  

Besides I have two years before the big 4-0. The title was more catchy then the 38 Year old Paper-Boy.

No, I am not on drugs, or intoxicated, or having a low blood sugar.

 Get this; I spent Friday night doing my oldest daughter's paper route and I thought of the title; "The 40 Year Old Paper-Boy" resembling the movie title "The 40 Year Old Virgin" (which is hilarious by the way)

So,  I get home from work and the majority of my family are incapacitated due to a relentless head cold.   With the exception of my 10 year old, the toddler and I,  who were healthy enough to move and function.

The first thing I notice is the bundle of newspapers, and sears catalogues awaiting to be delivered for a very cheap, borderline exploitation wage.  Friday is paper route day. So, by default the job landed with the 3 able bodied family members.

I immediately took charge of the situation. Abby, "get dressed" we are doing the route. Off we went.

I drove, with the hatch of the mini-van open, threw a Princess movie in the vans DVD player for the wee one, and we proceeded.

What does this, if anything, have to do with diabetes?  You ask...

More then you may think.  For instance, prior to the days of pumping, or MDI and even basal rates, this adventure would have been far more challenging.

Current therapies enable PWD to fit diabetes into their lives not the other way around. So instead of coming home, timing my meal to match my long acting(like in times past) I arrived, tested, grabbed a quick bite, took a shot of Rapid (I am on a Pump Vacation) and arose to the challenge and task at hand.

I guess I am grateful that we have newer technology, pumps, CGM's, awareness, knowledge, that we can do what we want when we want to, even if that means, becoming a 38 year old paper boy for the evening.

Happy Saturday!

Trev

PS: If you are wondering about my self portrait, read the post on Wego Health

Timing is Everything

In life, timing is often the factor that determines ones path.

Think about this for a moment.  Those serendipidous moments in life where a neigbour or friend pops over and talks you into an opportunity.  What if the timing was off and you weren't home. Running into the right person at the right time happens to us all.

Even in negative situations you've heard the saying; when one door closes another opens.  That is timing!  I personally have left a job, thinking crap, what will I do now, only to stumble upon a better job, timing was right and the opportunity crossed my Path. 

I don't believe in luck, but I do believe in timing, and that; opportunity favours the prepared.

Once again what in the hell does this have to do with Mr Diabetes?  Well not to repeat myself but timing is everything in diabetes management and of course the more prepared you are(knowledge, tools, strategy, support) the better your opportunity will be in managing your diabetes.

Above I mention some keys to diabetes preparedness.  If you have diabetes or care for someone with the big D, then here is your diabetic emergency preparedness plan in a nut sell. The list below is not prioritized as they are all important. So here goes:

1.  Learn as much as you can about diabetes. How you do that is up to you, but read multiple sources. If it's research; look at the number of people who participated in the study, if it was your friend's aunt and your brother and they claim that nutmeg causes poor glucose control that's an opinion and not research.  The more people(sample size) the more accurate(valid)the research result will be.  I could get into more detail about critiquing research but this is a blog and not a book.

2.  Keep learning, yes I am repeating myself, but never stop, I have met folks who have had diabetes for many years, and tell me, "I did the training" and I ask "when?" and they say"1985"  I kindly suggest they go for more training and read more current information. Never ever stop learning, go ahead and get sick of it, but don't stop.

3.  Tools. Not the garden variety, but tools like; meters, CGMs, Pumps, uploads, downloads, new insulin, pens, finer needles, glucagon, medication, and I am sure I am missing an item or two. Point is, use whatever device needed to improve your control and quality of life.

4.  Support.  Includes:  Family, Friends, Co-Workers, Class-Mates, Physicians, Nurses, Social Workers, Dietitians, Endos, and most importantly others with Diabetes, as they are the only folks that unequivocally understand your predicament. Don't dismiss your feelings, they need to be dealt with and this is where support is crucial.

5.  Strategy.  You have to have a game plan.  If you don't make one now, then sit down with some of the folks listed in paragraph 4 and get it done.  If you have a plan you not only know what direction your going but you increase your odds of getting there. With Diabetes you increase your odds of getting there in one piece, or complication free.    It is now Proven (DCCT Study) that good control reduces complications, that's motivation in itself! Know your body. Trial and error. Testing, recording, analyzing, tweaking, and choosing a treatment regime that works for you and controls your glucose. This also includes diet, carb counting, understanding what certain foods do to your glucose. Plans involve setting goals, specific goals like; I am going to test 4 times a day or I will test 2 hrs after I eat to ensure I am taking enough insulin to cover my meal.  Write stuff down, food, readings, mood, exercise, illness. Trust me, it makes it easier to adjust if it's staring you in the face. 

6.  Remember the 80/20 rule. We are human, and it is impossible, actually, totally unachievable to always have your glucose in range, it is impossible to eat perfect every day, it is impossible to keep positive everyday, but it's totally possible to say to yourself, "I did well 80 % of the time this week" That is what counts! Celebrate the good readings, and choices, don't hold onto the highs and lows, let em go and try again the next day.

When the "time comes" you will succeed in managing Mr Diabetes; if you are prepared and have the knowledge, use the right tools, have a good game plan and lots of support!

Trev