Insulin pumps & CGM

There are no NICE guidelines for CGM's or there sensors so it's rare that any PCT will fund, you have to put your case to the PCT board/committe that deals with specialist/individual patient funding...

In theory sensors are replaced every 3 days, but look around the net (many american based ones) you will find information how to extend this time, the longest I've seen is 16 days, but it does depend on whether on how your body reacts to the sensor though... People who chose to go ahead to self-fund generally keep costs down, by using the sensor periodically, either to tackle a specific issue or data collection to better understand there controll..

You need to be aware that even thought the pump says it's got CGM incorparated, this part of the pump isn't included with the pump supplied by the PCT... You need to discuss this with your clinic, as it they may be able to arrange the bits that you need are supplied at a reduced cost to you at the time you get the pump... Rather than the more expensive alternitive of getting it from the manufacturer at a later date..

When used with the Paradigm Veo, Medtronics sensors last an "official" six days rather than three but still expensive! (You can sometimes suck more time out of them but how long they last after that time is a bit of a lottery). There is another consumable cost in that the system transmitter is only under warranty for 6 months and at a cost of £350 each, these are also not cheap. As with the sensors, the transmitters can last longer - I have heard of them lasting 2 years but forewarned is forearmed I reckon and you may wish to factor this into any calculations.

As a pump - I like the Veo but don't have anything to compare it to in a practical sense - it was the CGM ready feature which attracted me and I have self funded a couple of boxes of sensors. No matter how strong a case you think you have for NHS funding, think again and be prepared to be knocked back. Best of luck though - hope this doesn't sound too negative, the CGM system is good!

Alan

My daughter has been using the CGM sensors daily for the last three months and they have been a complete nightmare - so much we have given the pump back and are getting a different version next week. We found the sensors last a max of 4 days after that they became very inaccurate, even after a day they could have large errors eg reading 3 when the actual value was 12. We also found that they frequently required calibrating and if they failed then you needed to replace them - not easy with a child about to go to school and it taking over two hours to get it working and calibrated.

I can see the advantages of CGM but in practice we found that the sensor became a full time job to keep working made more difficult with all the controls on the pump which is attached to a child trying to do other things. AND dont forget it needs injecting into your tummy which my child described as the most painful thing she has ever done - I tried it and I agree!

y

My daughter has used CGM for over 1 year now and we have found it essential for understanding what her BG does under a variety of situations.

They easily last 6 days provided you store them correctly. Once they pass their use by date (on the box) they rapidly deteriorate so only obtain enough to last 3 months at a time.

Bad sensor errors and cal errors do not need to result in a change of sensor, it is rarely the sensor that is at fault unless it has been stored incorrectly or is out of date - it is usually wifi related interference causing communication errors between the transmitter and pump. You need to ensure the transmitter is fully charged, move the pump closer to the transmitter and then keep re-starting the sensor until you get a good reading - check the value of the ISIG on the pump status screen. The sensor does not need to be changed in these circumstances. BTW My daughter (9) wears it in her rump.

You have to calibrate at the right time or the readings will be unreliable. Timing that update is crucial. There is no point calibrating the sensor just before a meal or snack - BGs need to be relatively stable for 15mins or so after the update. Besides, the CGM is no replacement for finger sticks, but superb for trend spotting. Our daughter's HBa1c has been no higher than 6 since she'd had the pump. If you get odd CGM readings - simply restart the sensor, the pump will ask for a calibration in about 10 mins - and off you go again with a more accurate reading.

Couple CGM with the carelink software on the web and you have an excellent tool to spot patterns and meal impact. e.g. we have found that we are using dual and square wave boluses all the time now cos we can see the effect certain food has on BG. Our girl can have her favourite pasta meal now without spiking because we have found that we have to give the insulin over a 3 hour square wave. I don't think we would ever have tried that without CGM. Same with a pizza hut treat.

We have now lived with and without the CGM and would definately recommend trying it - we had the same issues in the beginning as 'ruralweb' but lots of reading of the US forums pointed us toward some excellent tips. If I were self funding I would buy a box of 4 at a time extend their use for 6-7days each which would give a month of use. Take that opportunity to carry out some vigorous basal testing and carb factor testing. Then take a break for 1-2 months and repeat the cycle.

Cheers.

We have recently changed to the Accu-check Combo pump and I must say that its much much better than the Medtronic pump we had before even though it does not have CGM (its coming soon Im told)the control we get is far better due I think to the different way it calculates and delivers the insulin. The big plus is that its remote controlled so no more fumbling about looking for the pump to deliver a dose or check levels.