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40 days of CGM, setup and thoughts

Discussion in 'Blood Glucose Monitoring' started by zjed, Aug 30, 2015.

  1. zjed

    zjed Type 1 · Well-Known Member

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    This is a bit of a rant, hopefully you find some useful info in it.

    I've been running my complex CGM setup for over a month now, so far it's been an interesting experiment with great results.
    I thought I'd share my setup and thoughts and hopefully give you some management ideas and incentive to go CGM.
    BG: I've had T1 for 43 years, I'm on MDI with Lantus/Novorapid and reduced carbs.

    My GL (glucose level) target is 3.8 - 7.5, here are my current CGM stats with around 40 days of data:-
    - readings (in range 8956/high 224/low 276) (94%,2%,2%)
    - average GL 5.35
    - estimated hba1c: 31 (5%)
    My last official hba1c (before starting CGM) was 36.
    Dropping by 5 points is a lot at these levels, I think this is purely done by early action on upward trends.
    Early action also helps when going low, I don't think I've gone below mid 3s since starting CGM.

    My CGM components:-
    - Dexcom sensors/transmitter
    - wixel bridge (receives signal from transmitter, sends data to phone by bluetooth )
    - xDrip android app (receives signal from bridge, full glucose trend UI and settings, replays data to Pebble and nightscout )
    - Pebble watch with xDrip watchface (shows current GL and alerts )
    - nightscout (CGM in the cloud)

    Running day to day:-
    - GL alerts
    I have GL alert sound and vibration turned off. I rely on alert notifications being sent from xDrip to my Pebble watch, the watch discreetly vibrates and shows current GL.
    This is the real advantage of CGM. Early, discreet alerts that prompt me to take action. They run 24/7 and alert me to any movement without disturbing those around me.
    Going low I have alerts at 4.5, 4.1, 3.8 & 3.1, going high I have alerts at 6, 6.5, 7, 8, 9.

    - Night time running
    My phone shows my nightscout web site while charging on my bedside table.
    My Pebble watch alerts me to movement without waking my wife, I can easily see my GL trends on nightscout, no more finger pricks in the middle of the night.
    I hide my basal pen so I get the right one to give small nudges in the middle of the night.

    - Calibration
    I've turned calibration alerts off. I do a single calibration once a day when my trend line is dead flat (usually when I wake up in the morning), I will delay calibration if trend isn't flat.
    I use the average BGL from both left and right hand, surprisingly they are often quiet different (left always seems to be higher than right??).
    I found that my CGM reading are more accurate from a single cal on a flat trend rather than multiple cals on moving trends.

    - Bolusing/corrections
    Yet another variable in bolus calculation, current GL trend!!! definitely worth +-0.5 unit.
    I generally just correct/bolus from CGM reading, I do BGLs if CGM says I'm low/high and I'm not feeling it.

    A few thoughts on CGM:-
    My use of CGM has been enlightening, from seeing overnight trends for the first time, learning about timing between bolus to food intake, GL effects of protein..., it's all one big learning curve which is still continuing.

    I think CGM is the biggest advance in T1 management since insulin. CGM compared to BGM is the same as having a full time video compared to a few point in time photos. I suspect CGM will be the norm in 5 years, especially as costs come down and governments get on board.

    To get the most out of CGM, you need to be fully self sufficient and confident in your own ability manage your T1, adjust and calculate your insulin levels and food intake on the fly, without time to get confirmation from your T1 team. I can see that people who are not fully confident or engaged in their self management may become overwhelmed with all the data and struggle to convert the information into positive results.

    The early/multiple alerts available from CGM allows you to action changing GLs at the earliest possible time. This leaves FGM(Libre) as a reviewing tool rather than a real time management tool. Well worth the extra couple of $ for a CGM.
     
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  2. DunePlodder

    DunePlodder Type 1 · Well-Known Member

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    I have a similar set up, though no Pebble until I find a cheap one on eBay and I have the Dexcom receiver too.

    An excellent review. I agree with 99% of what you say though I usually do 2 calibrations a day. Also I still do 4 or 5 blood tests a day - some just to keep me legal for driving. If there is a bigger than normal difference I will calibrate then.

    I would just mention that xDrip continues whilst my Dexcom receiver is doing it's weekly 2 hour restart & also when the Dexcom is showing ???. Even when the sensor is dying & giving erratic readings it's often possible to interpret a a line by eye, enough to know whether it's high/low/rising/dropping. I regularly get an extra day or more compared to using the Dexcom receiver.

    I've yet to build the latest wixel bridge but have the most recent xDrip app. I like the statistics & estimated Hba1c screen.

    Amazing results you are getting!
     
  3. zjed

    zjed Type 1 · Well-Known Member

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    The Pebble is the icing on the cake, well worth it. You can see your current reading at a quick glance and vibrates on alerts. It allows me to concentrate on what ever I'm doing and it will alert me when GLs are moving so I don't have to constantly pull out my phone/receiver to see what's happening. I managed to get a cheap 2nd hand one for $60, a new model just came out so its probably a good time to get a 2nd hand one.
    I'll probably look at getting an android wear watch when the next gen comes out, just because it shows a trend line. Depends if they can improve their battery life or not, I get around 5 days on the Pebble.
     
  4. tim2000s

    tim2000s Type 1 · Expert
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    The pebble was available last week on Amazon for £70. Bargain.
     
  5. Blackers183

    Blackers183 Type 1 · Well-Known Member

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    Hey Zjed
    Have I missed something? Why are you using a CGM when you hba1c is 5%, well in control? I had one for a week and it annoyed the **** out of me.
    Cheers
    David
     
  6. zjed

    zjed Type 1 · Well-Known Member

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    Hi @Blackers183, yes, I do feel that I'm well in control for the first time in 43 years.
    I've decided that if I want to avoid any complications I need to have my hba1c at non diabetic levels which is around 5, not the 6.5 as recommended by diabetes organisations for T1s. In the last 3 years I've reduced my hba1c from high 7s to low 5s and for the first time in my life I am not afraid of complications, it's a good feeling. Reduced carb and CGM are the 2 best tools I've used to get me here.
     
  7. zjed

    zjed Type 1 · Well-Known Member

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    What was so annoying about the CGM? The only bit I don't like is the sensor maintenance to keep it on.
     
  8. Lisbet

    Lisbet Type 1 · Well-Known Member

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    Totally agree re best innovation for decades! I've had T1 50yrs and since buying it 2yrs ago I also have best A1c in my life (tho higher than yours - the alarms drive me bonkers and I'm hypo unaware). Also agree that CGM is only for those confident enough to experiment for many months to get the best out of it and willing to really engage with their diabetes. Hard work but hugely rewarding. It's no magic bullet but an outstanding tool
     
  9. slip

    slip Type 1 · Well-Known Member

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    @zjed Out of interest how much does this all cost? (One off payment and on-going costs?)

    Cheers
     
  10. tim2000s

    tim2000s Type 1 · Expert
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  11. zjed

    zjed Type 1 · Well-Known Member

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    @slip it's obviously expensive, the big variable in the pricing is sensor life. I am averaging about 3 weeks per sensor, but I'm learning with each one and should be able to extend that as I get more experience.
    I originally budgeted for 2 per month, so I'm doing ok.
    The sensors are also the most annoying part of this system, they are messy, dirty and ugly.
    I really hope systems like Sensonics get up and going, it would be a much better system.
     
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