CGM Beginner

[DunePlodder]

Anyone following the "Thinking of CGM" thread will know that I took the plunge & bought a Dexcom G4 Platinum.
So far I'm very glad I did. If nothing else, the warnings it gives have virtually stopped the hypos & greatly reduced the time with high BGs.

I'm also determined to learn from it but sometimes the amount of information is confusing. I've had some lovely steady BG days but when things are more volatile I'm reminded of a comedy sketch (Ronnie Barker?) from a few years ago, in which there was a quiz where the contestant had to answer the question before last. Diabetes can be like that. Everything has a delay factor:

Dexcom 10 to 15 minutes
Humalog 15 minutes plus (seems to be more like 30 minutes for me)
Food ?? depends on food
Exercise 20 - 30 minutes for my brisk walks.

I'm getting better at allowing for these but sometimes one or more effect just doesn't seem to happen, very frustrating..

 

[kkkk]

I think CGM does show how changeable diabetes can be, even though you stick to eating/exercising the same (shows how clever our bodies are and our pancreas' when they work ) I have had some weeks with fairly pronounced morning phenomenon which only seems to start when I actually wake up - not before I wake up! Some weeks where it is almost flat and despite delaying my insulin in the morning and still eating porridge my after breakfast peaks are back having disappeared for a week!!!! I think the thing about CGM tho does mean that you can be more responsive and you know sooooo much more about what is going on, and it is enormously helpful in cutting down hypos and seeing those patterns and sorting doses out. I totally agree about the Ronnie Barker, when you inject the insulin you are trying to answer the question before it 's been asked as you have to consider exercise, food and anything else that might possibly come your way and it is your best guess (the more information and more knowledge you have the better those guesses can be).

I had a really good meeting with the nurses and a rep yesterday - they are all really interested in it and I've talked about the changes I have made and the peace of mind it gives me and all the stuff I have learnt so far, so I am really hoping that it might help others too. So I am happy, happy, happy

 

[DunePlodder]

"I have had some weeks with fairly pronounced morning phenomenon which only seems to start when I actually wake up - not before I wake up!"

Very interesting you say this. Since CGM I've had 2 "lie ins" where I've taken a coffee back to bed & read a book for an hour before getting up properly. Both times I've watched my BG increase. I was wondering if it was the dawn phenomenon or the coffee (white, one Canderel sweetener). The coffee doesn't seem to make much difference at other times of day.
I don't see an earlier effect - I had a wonderful horizontal overnight graph on Thursday/Friday, about 6 all the way! Not so good last night - a packet of salted peanuts producing a delayed steady increase. Yes I know, but they are very tempting..

So good to hear that your health team are taking a real interest, unfortunately this doesn't always seem to be the case.
Robert

 

[searley]

I am going to get one soon, I think having the graphs will help to keep notes and see what happens in a hope that you can learn the possible outcome

However as you said nothing is 100% consistent

I just want tighter control without the fear if hypos, I currently run high so that there is little risk to my driving license


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[DunePlodder]

I am going to get one soon, I think having the graphs will help to keep notes and see what happens in a hope that you can learn the possible outcome

However as you said nothing is 100% consistent

I just want tighter control without the fear if hypos, I currently run high so that there is little risk to my driving license


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If the police ever ask me if I've tested in the previous 2 hours I can say "24 times"!

 

[searley]

My main concern is I drive for work I can't take the risk


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[DunePlodder]

Yes I can see you have to be extra careful.

The graphs in Dexcom Studio are very useful, but it would be nice to be able to easily add a comment above the graph, rather than printing it out. I have used the Windows Snipping Tool then edited it in MS Paint but it's rather laborious.

 

[kkkk]

When I was at my meeting yesterday with the nurses and rep they were using diasend to look at the information, which is a web based one so you can use it on macs - didn't look that different to the Studio software - not sure whether anyone knows anything about that and whether you can add labels…..having said that you can set up events in the dexcom like notes that you do exercise - and I think you could add in extras via the Studio software so that might be worth looking into too…if I get a moment I will have a play and see what I can find out

Other nuggets of useful information that Mr Gary Schiner was talking about in his CGM talks is that you want you low % to be around the 5% mark, definitely less than 10% ideally. When he looks at the data in Studio 'cos each day is a different symbol you can count the lows and the highs just by counting the number of symbols that happen at that point in the day to look for patterns as that tells you how many days that has happened on (I know obvious really but it gives you a place to start when you are presented with all that spaghetti information ). He also said that you can use the software to compare Mondays over a month and again look for patterns which I figure would be useful for exercise classes and things that you do like that on a regular basis.

 

[DunePlodder]

I'm beginning to get to grips with Dexcom Studio. It took quite a while to realise it was possible to export the data - via the "Patients" tab & Export if you are interested. This can then be read into a spreadsheet. I use Libre Office which is free.

It's a bit inconsistent. For example when viewing the Glucose Trend graph you can easily select a portion to look at the details, but this doesn't seem possible with any other graph.

The "Patterns" graph tells me only 1% of my readings are low. Thanks to the warnings I can catch them, & my lowest reading since CGM was 3.6. Long may it last.

 

[Reggie64]

I have read this Post with interest as my Diabetes Nurse is going to get me fitted with one of these as I drive for a living and it will alert me as and when my BG is dropping so I can rectify it quickly and should not hamper my working day.

 

[Harveer]

Hey guys! Quick question, how much did the CGM set you back? Seems incredibly expensive

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[Jax1106]

Yeah , that's my question . Also the running costs (sensor etc) I asked at my hospital if they would be available on NHS soon and she said NO !!! Boo


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[jodysd6]

Dexcom costs £975 for the receiver and transmitter (receiver guaranteed to last a year, transmitter only 6 months) then £250 for 4 sensors which are supposed to last 7 days each but people often find they last 2-3 weeks. (The actual sensors can also be bought from animas with a letter from your doctor and are a bit cheaper, I think around £180 for 4). The transmitter when the battery dies anywhere between 6-12 months ish is £325 to replace.

If you have a Medtronic pump that you can use cgm with the transmitter is normally £490 plus £275 for 5 sensors. At the moment they are offering the transmitter for free with your first box of sensors plus your 4th box of sensors free but this is only really any use if you have a veo pump, and it seems the Medtronic system may not be as reliable as dexcom.

 

[jodysd6]

Oops forgot the other pump option, if you have an animas vibe pump it has integrated dexcom so start up if you have that pump is £450 including 4 sensors. I am still really mad at myself for not going for a vibe when I switched pumps last year and now have to wait another 3 years for a new pump!

 

[DunePlodder]

I bought the Dexcom G4 Starter kit with 2 sensors from Advanced Therapeutics. This was their 14 day pre sale trial.
This includes:
Transmitter & Receiver £975.00
2 Sensors £125.00
Delivery charge £ 7.50
Total £ 1107.50

£912.50 would be refundable if I changed my mind (I won't)
Yes it is very expensive but I will continue whilst I can afford it.

Jody, you mention the sensors from Animas require a letter from your Dr. What does the letter need to say? Can you buy them if you don't have a pump & have you done so?

 

[Lisbet]

Yes, I get sensors from Animas @ around £186 for 4 and I don't have a pump. Letter just said I was T1 and he and the hospital would support me. This however, was not strictly correct as they both said they were 'out of their depth' so I chose to move hospitals!!

Am self funding but support is available from Input website re. applying for NHS support.

So interested in the post-wake up blood sugar rise as it happens exactly the same with me! Steady when sleeping and then leaps 4-6 points when I wake up and have coffee but NO food. Can't really figure this, but it must be cortisone, so a 'later' type of dawn phenomenon perhaps? Have also watched significant rises if feeling particularly stressed. Fascinating how the hormones affect blood sugar... Helps one to understand just why, even with CGM, it's so hard to keep blood sugars steady.

Had Dex for 4.5 months now and still learning new things every single day. Best support has come from a US endo Stephen Ponder on his Power Within website. Fantastic, sensible advice. He is T1 and uses a Dexcom.


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[DunePlodder]

Lisbet,
Thank you. The increase didn't seem so pronounced this morning, though it was confused by a large calibration difference.
The finger stick test was about 2 lower this morning. Just did one (20:30) & it was 2 higher. I'm on day 11 with my sensor so I wonder if this may be a factor, the difference is usually less than 1.

I had a look at Stephen Ponder's site, some interesting concepts there. I like his little experiments where he takes a quantity of insulin to test the effect.

 

[Harveer]

How much do the animas vibe pump cost? With integrated dexcom it seems perfect

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[DunePlodder]

Today is day 20 with the first G4 sensor. It is still functioning but over the last 24 hours I've had some large (2 to 3 units) calibration differences. Also the graph is rather flat. I'd like to think it's because I'm doing such a good job, but I'm wondering if it's too good to be true.

Anyone else noticed this sort of thing? I was hoping to break the 3 week barrier..

 

[nmr1991]

I'd prefer equipment you can get on the NHS for free, no sense in buying any expensive things I probably won't use that much, even though my blood glucose management is not that bad. I can generally tell what my blood sugar is by seeing how tired I am, and when my muscles start to feel achey as if blood struggles to get to them, when I know that feeling, I know I have a high blood glucose. If I feel opposite to agitated or tired, it's generally below 10 as I am used to that sensation and when I hold onto it, I won't need to test, it's just second nature. And a hypo is a bit self-explanatory, as feeling shaky, drunk and stuttery would be simple signs, with weakness and drowsiness being really low to about 2.0.