CGM is the most effective method for monitoring and treating diabetes

[tim2000s]

Having reviewed the data that my Libre has generated over the weekend (and for these purposes the libre is a cgm), I put forward the hypothesis in the title.

From my admittedly small sample size of one, since I started with the Libre I can see that my average glucose level has reduced, my likelihood of having a hypo has reduced and ability to maintain an optimum glucose level, measured by variance, has improved. I have not changed my insulin delivery method. It is still MDI.

I further postulate that with CGM, the Hba1c is redundant as the data set available to a clinician (and user) is substantially better.

My final postulation is that equipping diabetics, who meet appropriate criteria, with CGM rather than pumps, would be a more effective way of improving glucose level optimisation. I'm not saying that pumps don't have a place. I believe they do, but I believe that CGM offers a more effective route to diabetes management, for both HCPs and the diabetic themself.

Why do I believe this? I think the key benefit to the end user of CGM is a psychological one. Personally I want to keep my BG level within the target zone. It's a target and I want to hit it. Secondly, there is no hiding from rogue high readings, whether deliberately induced or not. If you can see them, you can see the damage you are doing yourself.

Then there is the practical side. That you are able to observe and treat highs and lows before they fully happen being one of the most critical, and the second being that patterns are significantly easier to spot and do something about. And when you are doing something, you have a full set of data to see the effects.

These are my thoughts on why CGM is the single most useful tool in treating diabetes. Am I off my rocker?

 

[Kassiedent]

Honestly I can't comment (though your argument seems sound) but wanted to reply because I like your writing style! Lol!

 

[himtoo]

I not only like your writing style but would broadly agree with your conclusion based on your hypothesis.

Motivation is often provided by an ability to "see" the results of one's efforts and real time monitoring of one's BG's( I know interstitial fluid actually ) is indeed an active way of potentially increasing motivation substantially.

I will say that I think Pumps are very beneficial as well -- but if it is an either or choice with the £££££ signs flashing your argument holds a lot of water.

 

[Engineer88]

I agree CGMs should be given out including utilising the Libre more @tim2000s.

I disagree these should be given over and above pumps. My reasons include dawn phenomenon and the ability to set different basal rates, and also the reduction in injections (one every 3 days rather than multiple per day).

One point here is that although the Libre is good if on MDI the Vibe or Meditronic is an integrated system. A cheaper alternative to giving every patient separate systems is to make X number of sensors available to integrated users per year. I know a number of pediatric departments do this (UCL i believe) and each patient can have 10 per year. I do not understand why this is only made available to children.

 

[DunePlodder]

Not sure about "CGM rather than pumps" (I've never used a pump) but I agree wholeheartedly with your other points.

Perhaps a CGM should come before a pump in order to identify problem times like the dawn phenomenon.

 

[Kassiedent]

Can I ask? Are CGM monitors given out to anyone? I'm really struggling and need to sort myself out urgently... Type 1 for 12 years following pancreatic surgery- I had brilliant control for 5 years ( inc 3 pregnancies) then struggled with young family and allowed BMs to run high. Since then I've never got back on track - I've done DAFNE course and have a fairly good understanding but I miss about half of my QA doses! If I'm really honest I just don't organise myself, I have a very busy life (who doesn't?) and I hate the fact that I have to deal with having this & the impact it has on my life. For all this time I've been in denial regarding the damage I'm doing despite very frank discussions with my diabetologist. In reality I'm like to get things right & initially I got a real kick out of maintaining v tight control and I wonder if CGM might help to motivate me.
I'm seeing the consultant this afternoon and I feel that I'm in a better place to attack my previous issues... Any thoughts? Please be kind - I know that my lack of care in the past is irresponsible but hopefully I can sort things out soon.
I am a naughty diabetic!!!

 

[Ali H]

I think you have to want to control it Kassiedent and the only way to do that is to be vigilant about taking your insulin at the right times and for the right amount. No amount of tech can sort that out for you, so I would think that needs to be the first step for you? I find it incredibly hard to forget I need to inject, have you deliberately blanked out diabetes do you think or are you just forgetful? Set an alarm on your phone or watch for mealtimes?

Once you have your diet and injections under control then a CGM will help you see peaks and troughs and refine your control. I have been on MDi since last July and since January following low carb, high fat. It definitely tightens up your range of readings and reduces the need for quick acting. Best of luck, hope you get sorted.

Ali

 

[DunePlodder]

I think most of us have been "naughty diabetics" at some stage. Very few people are given CGMs, unfortunately. However it's worth asking. Not sure if your pancreatic surgery might help your case.
Seeing live figures on your CGM can be very motivating, though of course it also clearly shows when things are going wrong as well..

 

[Kassiedent]

Thanks Ali. I am a bit ditsy but that isn't really the issue. I manage to organise my 3 children, work (teacher), run my home with other half working away but I seem to subconsciously choose not to prioritise my injections & monitoring. I'm not daft but need to get a grip!

 

[Kassiedent]

Dune plodder thanks for sounding real! I'm going to try to take on what's being said and re motivate myself with what I've got! Xx

 

[Ali H]

You can do it!! Good luck.

Ali

 

[LucySW]

Tim, off your rocker you ain't. Your point about making diabetics feel better is a very good one. Giving us control and such a powerful learning tool to get good feedback straight away really makes people feel much better about the whole thing. It's a superb tool against apathy and feeling helpless and can affect our outcomes vastly.

So right on.

Lucy

 

[Spiker]

Tim I agree with every postulate and observation, based on my own experience. The only thing is I don't know the costs to the NHS of CGM therapy vs pump therapy, so I can't say what's more cost effective. I can definitely say that for me CGM is absolutely more effective, if cost is ignored.

 

[Spiker]

@Kassiedent I am like you I think in that the organisation effort of blood sugar monitoring sometimes falls behind organising job, family, etc. That's where the CGM really made a difference to me. It's sort of an autopilot for blood sugar. Not quite but it's half way there. I get alarms before I go too high or too low, so I fix it before it becomes a problem. I get alarms to remind me to do fingerprick tests. And as Tim noted, I get a sense of awareness and control over my BG that is highly motivating.

 

[Flowerpot]

From my sample size of one, I would agree CGM is the most effective way of monitoring my diabetes but my pump is the best way of treating diabetes however, I can only do the treatment part well with the round the clock data from the CGM.

CGM is in my face all the time, usually in a good way apart from 3am alarms, alerting me to what is happening and preventing hypos. It makes me a lot more pro active in trying to keep my glucose level as flat as possible. Near instant feedback is a great motivation.

It's a bit chicken and egg, with CGM and a pump I can see what's happening and with the benefit of a pump I can do something relatively quickly about it. Using my pump without CGM I might be able to get good control but wouldn't be aware of it and with CGM but no pump I wouldn't be able to control or react to what was happening so readily. That's based on my unhappy history with long acting insulin and hypos. If you are able to get good control on MDI then a stand alone CGM is a cracking bit of technology to maintain and enhance good control.

 

[June_C]

I just wish I could get a CGM. I've been waiting for months, but Libre are still not taking any orders

 

[LucySW]

They'll get to you soon. I really found it a huge help, even tho some sensors behave imperfectly. Such wonderful things we can learn.

 

[novorapidboi26]

Completely agree with everything......

Although the delivery of insulin from a pump is much more efficient, thus requiring less insulin, than injecting a single dose into your body in one go......

there's no escaping that.......

 

[LucySW]

Thanks Ali. I am a bit ditsy but that isn't really the issue. I manage to organise my 3 children, work (teacher), run my home with other half working away but I seem to subconsciously choose not to prioritise my injections & monitoring. I'm not daft but need to get a grip!

Kassiedent, I'm sure many can relate to this I know I do. I think keeping to all the virtuous T -1 habits and then getting on with life is one of the hardest things about the Big D. At the moment I'm constantly on the edge of forgetting - in my case because thanks to LCHF, the Libre and luck I got to a really good situation, which is great, but I subconsciously wanted to be rewarded and not have to bother. So I just have to work on my habits.

If and when you can get yourself a Libre for six weeks, that would help hugely. And it's really motivating.

We just can't slack off. Unfair it most certainly is, but we are stuck that way. I should think everyone goes through cycles of doing less well and then better again. Don't worry - some of what has been done can often be undone. Just start? Cosset yourself and accompany yourself thro it?

Gretchen Rubin sent this quote round recently, which I love:

“I know all about the despair of overcoming chronic temptation. It is not serious, provided self-offended petulance, annoyance at breaking records, impatience, etc., don't get the upper hand. No amount of falls will really undo us if we keep picking ourselves up each time...The only fatal thing is to lose one's temper and give up.”

- C.S. Lewis, Letters, January 20, 1942

Very good luck -

 

[Postitnote]

@June_C , I'm still waiting for Libre to get back to me although I only registered in January so I imagine I am near the bottom of their list! I am seriously thinking about a Dexcom though.... I just hate to spend money but I like the idea of the alarm. I would much rather be woken at 3am then wake up in the morning feeling ill!