CGM or random testing?

[Royjk]

So my doctor has recommended a CGM for 2 weeks before my next check-up. How will that help me, as at present I do random testing and fixed insulin dosing. Also is it necessary to replace the sensor after the 15 days or do people do without it for a couple of weeks before fitting the next sensor.
Royjk

 

[grantg]

It will show what levels do between meals. You can make use of the data if something worked well for you or badly repeat again for good avoid for bad. Via logging.

You'll see how exercise etc can effect glucose levels as well.

I've found sensor exceptionally useful in combating lows and indeed highs so far. Highly recommend CGM. Unsure of your regime if fixed long acting dose or with meals or indeed a combination of the two. Instructions do tell you to finger prick to check against highs/lows

 

[KennyA]

A CGM will give you lots of information about how and why your BG changes that you won't get from random fingerprick testing. I've only ever fingerprick tested pre-meal and at +2 hrs, never done random testing as I can't draw any conclusions from results.

A CGM on the other hand will give you a complete 24 hr picture and will tell you what's happening all the time, including when you're asleep. It can be worth checking against fingerprick tests while using a CGM, as they read a bit low for me, and others have found the same.

 

[Royjk]

Hello @grantg and @KennyA ,

So at the moment I do random BG testing because I have a SGLT 2 each day, with fast acting Fiasp insulin at meal times and 48 hr basal insulin before bed. That means I know roughly what my BG will be at any time during the day, before I test. I am on a low carb diet, so I know if I have eaten a doughnut, or rice with my chinese. I have tuned my insulin doses over the past 6 months to ensure that my BG is within the recommended guidlines of my diabetic diary. When a person has a wheelchair or a walking frame, exercise does not make much difference to BG.
My HbA1c came down swiftly from Dec 24, 103 to April 25, 32 after four months, and I expect it to be lower still on my next check up in six weeks time.
So if I have a CGM, I fear that I would try to control my BG too tightly, if I watch and log the graphs every day, and start monitoring 24 hrs.
Now adding CGM I would still continue with some of the finger prick tests, because the CGM may read high or low.
So my dilemma is do I ask the doctor for the CGM for long term or just have the one to see what is happening at the moment.
Royjk

 

[becca59]

@Royjk I would just wear one and see how you feel about it. You may find you love it. On the other hand you may hate it. Unless you have a go you won’t know. What is there to lose. For my part as a type I wouldn’t be without it now after years of using one.

 

[JoKalsbeek]

So my doctor has recommended a CGM for 2 weeks before my next check-up. How will that help me, as at present I do random testing and fixed insulin dosing. Also is it necessary to replace the sensor after the 15 days or do people do without it for a couple of weeks before fitting the next sensor.
Royjk

A T2 here, but I have used a CGM twice now, and did random testing before it became a more structured thing. Random testing doesn't really tell you all that much, unless of course it's because you feel funny and you want to check for a hypo. Then it's worth its weight in gold, of course. Structured testing (around meals for instance) is generally more informative, but nothing beats a CGM when it comes to answering questions you or your doc might have. Where are you when you sleep, what foods affect you what way, does other medication raise blood glucose, is stress a factor...? It can show whether your fixed dose needs adjusting, to avoid constant highs or hypo's, more than random testing ever could. They might not be 100% accurate all the time. As stated, for some they tend to read a little lower (as it usually does for me, by 1,0 mmol/l or thereabouts), but they do give wonderful insight in trends and cause and effect. Being a T2, I just use a CGM when I (or my nurse/GP) need questions answered, which has given me a lot of information in those 4 weeks total I've used them. If I were a T1, I'd never go without, but that's just me.

 

[jaywak]

I'me type 1 and only been using the Libre for just over two years and my opinion is I wouldn't be without it, I love the fact I can control my bg so well and wonder how I would manage now without it , I have had no hypos, which used to be a worry for me at night, since using it and if it does alarm me to tell me i'me going low I sometimes do a finger prick test but the lowest I've ever recorded since using it has been 3.8 the Libre did say 2.9 but I can live with that . Give it a try you may be surprised .

 

[ChrisT2]

Hi Royjk, I wished my diabetic nurse /GP had recommended a CGM for me especially when my annual blood tests started to rise. When I mention any type of home blood sugar testing they look at me with mock horror. Despite their reluctance I have found a CGM invaluable in giving me a much better insight into what is going on with my blood sugar and what I eat, exercise or health in general. I do understand that as a Type 2 it is perhaps not so essential as it is for Type 1's or those on insulin but the health benefits for Type 2's should not be overlooked.
Just to get a visual graphical picture of the ups and downs of your blood sugars is so helpful in giving you the information of what to eat especially if you are wishing to use diet to control your condition. These days I can fairly accurately know or predict where my blood sugar readings are at because the CGM has previously shown me the trend that my blood sugar takes over an average day and night.
Nowadays I try to use one when I am trying out new things in my diet and want to know how they affect me whether good or bad and the information it provides me is invaluable. When it comes to diabetes we are all different and the CGM just helps to see accurately what is right or wrong for you.
If you are self funding they can seem rather expensive but after several weeks you will find they are well worth the investment for your health and if like me you can see a trend or daily pattern you can use once in a while as opposed to every 15 days. Although I do feel somewhat vulnerable in the times I am without my CGM but that is just my own strange musings.
As the others he have said here, "go for it" as there is nothing to lose but everything to gain.

 

[Badger09]

Xerostomia or Dry mouth is a fairly common problem, I got it a year ago. As part of finding a solution a new Diabetic nurse recomended I asked for a free trial of a Libre 2 plus constant glucose monitor to see the exact impact of every meal and every medication and change of medication timing. It was a revelation, I saw that my biome was unbalanced and could process things like porridge and shredded wheat any flour product immediately, no long delay like we are told whilst stews, roasts, English breakfasts did not move sugars at all. So my "good diabetic control" wasn't good at all but with changes within 2 weeks my projected HBA1c was 6.5% or 48mmols.

I could also see the sugar lower and increase as the drugs with shorter effective perids run out of steam so could fine tune the taking of Dapagliflozin and Glicazide to match my peak sugar (meal) times.

I highly reccomend trying this device.

For me, most of the problem seems to be eating wrong diabetic recommended foods and taking tablets at wrong time of day and the need to stop taking Dapagliflozin altogether.

 

[Royjk]

Hello @becca59, @JoKalsbeek, @jaywak, @ChrisT2, @Badger09

Thank you for your information on using a CGM. I have the appointment booked with the diabetic nurse for the 1st of July. So I will wear the sensor for two weeks, before my next apointment with the doctor, this should give a veiw on what is happening with my BS. I will know if my HbA1c is still ok before the doctors appointment so I should be able to see how accurate the predicted level is, and if my other medications, or comorbidities make any affect on BS test readings. I feel inclined to try, but unless there is anything worthwhile comes up, as I am not a T1, I would perhaps use it intermitently. But as becca says if I dont try it I won't know.
Royjk

 

[Melgar]

Hello @grantg and @KennyA ,

So at the moment I do random BG testing because I have a SGLT 2 each day, with fast acting Fiasp insulin at meal times and 48 hr basal insulin before bed. That means I know roughly what my BG will be at any time during the day, before I test. I am on a low carb diet, so I know if I have eaten a doughnut, or rice with my chinese. I have tuned my insulin doses over the past 6 months to ensure that my BG is within the recommended guidlines of my diabetic diary. When a person has a wheelchair or a walking frame, exercise does not make much difference to BG.
My HbA1c came down swiftly from Dec 24, 103 to April 25, 32 after four months, and I expect it to be lower still on my next check up in six weeks time.
So if I have a CGM, I fear that I would try to control my BG too tightly, if I watch and log the graphs every day, and start monitoring 24 hrs.
Now adding CGM I would still continue with some of the finger prick tests, because the CGM may read high or low.
So my dilemma is do I ask the doctor for the CGM for long term or just have the one to see what is happening at the moment.
Royjk

When I first started using CGMs , it was the FreeStyle Libre 1, I obsessed over my levels. I was constantly pressing the scan button to see what my blood sugars were doing. I had frequent hypos. In fact looking back at an old Libre bar graph I had 11 significant hypo events in 42 days. For me that was really important to know when my blood sugars were going low.

Like a new toy, because they are amazing, I got overly obsessed, but you really do get over it, and you forget just how amazing these devices really are.

 

[Royjk]

Hello @Melgar,

Oh I am sure I will do the same, I just don't want to get too obsessed with tight control. This week without a CGM I have reduced my Fiasp by 60% due to a step change in my BG that caused hypos every day. I think it is sorted now but the doctor wants to see what is happening.
Royik

 

[Melgar]

I hear you @Royjk The Libre 2 has a time in range function (TiR) , which to be honest, is far more valuable than an HbA1c test. Basically you set the parameters, say 4.5 to 10.5 or any two numbers you prefer, where you would like your blood sugars to fall within . Then you aim to keep your blood sugars in that range as much as possible. The app then tells you what percentage of time you spend in range and out of range. As far as not wanting tight control, the system allows you to set your own blood sugar parameters. You are in control. If you want a tight range then you adjust your parameters.

I think the only concern maybe once you see what it can do you may find it a valuable device.

 

[Royjk]

Hello @Melgar

So at the moment without CGM, I am aiming for 5 - 7 mmol/l, and I want an average of 5.5 mmol/l. I do not know what other people aim for as I don't actually know any diabetics. So my plan would be to start from what I know. I would want 100% in range.
Royjk

 

[grantg]

I can tell you 5.3 average would be hba1c 34. DSN has complained about mine being that currently as it's apparently too tight much greater risk of hypos. 5to7 constantly will be difficult I've attached couple of my graphs. Breakfast today was 1 wheatabix 13g carbs + whatever was in the milk. Expect to go higher than 7 dont worry too much, as long as comes back down all good imo the last image shows mean dark line high and low. Within that range pre meal and 2 hours after is much more realistic good luck

 

[grantg]

Forgot one other img if I set to 5to7 this is what it would show

 

[saucequery]

One of the diabetes service doctors told me to write this down and stick it on my fridge as a reminder:

"NOBODY can be perfect with diabetic control"

Expect to go higher than 7 dont worry too much, as long as comes back down all good imo

Very much this.

 

[saucequery]

Deleted mis-post.
Edited to add: as to the question about when people replace their sensors, I usually put the next one on the day before my current one runs out.

 

[Tony337]

Hi
I'm alarmed nobody has mentioned the alarm...lol
It goes off at any time when too high or low depending on your settings.

I am the obsessive type and have decent control...My last hba1c was 5.7 or 39.
I've been type 1 for 50 years and simply adore my libre.
I take great pleasure in a good reading and as we speak i am 6.1 and 94% in range over the last 3 months.

Is this obsession causing me harm .....no but we are all different and I'm old school and remember the dark days.

I wish you well

Tony

 

[JoKalsbeek]

Hello @Melgar

So at the moment without CGM, I am aiming for 5 - 7 mmol/l, and I want an average of 5.5 mmol/l. I do not know what other people aim for as I don't actually know any diabetics. So my plan would be to start from what I know. I would want 100% in range.
Royjk

Even a non-diabetic wouldn't consistently be between 5 and 7, so try not to kick yourself around if you see a nine, an 11, something like that. Just as long as it returns to normal levels in about an hour after the spike or thereabouts, you're doing alright.