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is using a CGM with an insulin pump useful?

Discussion in 'Insulin Pump Forum' started by asa35, Nov 10, 2016.

  1. asa35

    asa35 Type 1 · Well-Known Member

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    Hi - can I throw a question out there please: as somebody who is about to go onto a pump (NHS funded), I have been doing a lot of reading (mostly threads on this site, you've probably noticed!) and compiling lists of pro's & con's; one issue I seem to be focusing a lot on is the CGM aspect. This is because I've used a Libre for a while now and have found it very useful in terms of the 'hidden information' that happens in between meals and during sleep etc (the graphs / charts have given me information I wasn't aware was going on!). But I wonder if I'm putting too much focus on this; the costs are the biggest drawback as I wouldn't be able to afford a couple hundred pound each month and the starter kits themselves are expensive (£250 Dexcom or £640 for Medtronic). I've read a couple of threads where people have mentioned that because the pumps have got their levels a lot more stable, they don't feel the need to rely on a CGM. From your experiences, would this be the case possibly?
    I'm currently deciding on either the Medtronic 640G or the Animas Vibe. I still have the Libre and wonder if I could/should continue to use this (although I know I would lose out on a lot of the pumps 'good' features. Without the CGM my preference is slightly on the 640G.
    I realise I will probably get more confused with all different replies, but if anybody can give me any help information with this, I would be grateful.
     
  2. tim2000s

    tim2000s Type 1 · Expert
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    Okay @asa35, let's start from the top.

    You don't need CGM to use a pump, but some form of continuous recording makes life a lot easier. This is my story:

    I acquired a pump at first in October 2015. It didn't have integrated CGM. I spent 6 months from October to March using the pump with the Freestyle Libre. It worked very, very well, and I'd recommend that anyone starting on a pump goes with a libre as the first additional thing they acquire as it makes identifying the changes in Basal rates so much easier.

    From March, I built xDrip and ran HAPP (an open loop dose prediction app) on an Android phone using a Dexcom G4 transmitter. This told me what to put into the pump as basal rates based on my glucose levels. It's a kind of manual "artificial pancreas" system and I found it worked very well.

    When I finally got funding for a pump, I moved onto a 640G, and because when I went to a festival I lost my G4 transmitter ( :( :( :( ) I elected to buy into the CGM system on the 640G as it meant I had less to carry. I found it to be remarkably good, it meant I had less to carry and I was able to use SmartGuard, which is the best technology available on a pump right now in the UK (the 670G isn't available yet & OpenAPS you have to build it yourself). I found the predictive low suspend really stopped hypos in their tracks. You can extend the sensor life (I was getting up to two weeks out of the sensors, as others have) but not for as long as Dexcom. But if you can afford it, the smartguard is worth every penny.

    You should see if you can trial it before using it though, to make sure you get on with the sensors.

    So, in summary, no you don't need full CGM with a pump. Many use the Libre with it very successfully. But if you are going to go with CGM, make sure you know what that means and what it costs. Dexcom display on the Vibe is very different from the SmartGuard functionality on the 640G. And as far as pumps go, if you like the 640G, you might as well use it. I have no complaints with it as a standalone pump, as I wrote here: http://www.diabettech.com/smartguar...with-the-spirit-combo-that-i-used-previously/
     
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  3. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    In my honest opinion, and I don't use the Libre or CGM....the best thing you can get from them is patterns overnight and during the day....so basal testing.......

    You can then of course get real time sugars that can help you correct if you need to, but remember correcting between meals is something you should eventually have no need for if the dose and timing are correct....

    Spotting hypos early is another benefit to these devices, and for some this is quite important, not so much for others.....I have hypos, but I don't require to know about it until it arrives.....and they are always explainable....most of the time...

    You yourself have the Libre so will actually be better informed....but is the CGM worth the money if it is going to make you struggle financially....I would say no.....provided the above scenario is the case and there are no special conditions...
     
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  4. Engineer88

    Engineer88 Type 1 · Well-Known Member

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    Fully Agree with Tim, When I started pumping 3 years ago the only viable option at the time was animas with dex, there was no Libre (SHOCK HORROR!! lol)

    Since then there have been many improvements and new systems, including a new Animas pump expected next year. I couldnt live without CGM now to be honest, and think i would rather CGM to pump though its a close call.
     
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  5. asa35

    asa35 Type 1 · Well-Known Member

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    @novorapidboi26 , many thanks for your feedback. Valid points, I will bear in mind.
     
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  6. asa35

    asa35 Type 1 · Well-Known Member

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    @tim2000s many thanks again for your useful information. I will have a good read of these points again this evening. One quick question - I rang Medtronic yesterday to get their costs for the CGM system: The starter pack is £687, a pack of 5 sensors £275 and a single sensor £57.50; I asked how long the transmitter lasted, but didn't get a definitive reply - she said it is under warranty for 12 months, if it broke after this I would have to replace it and should also replace it every year!! How long would the transmitter last for?
    Thanks
     
  7. asa35

    asa35 Type 1 · Well-Known Member

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    @Engineer88 ; thank you. it's obviously going to be a personal choice, with costs playing an important part unfortunately.
     
  8. tim2000s

    tim2000s Type 1 · Expert
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    Yes, I'd agree it is expensive, but the transmitters do last 12 months + some, and most people don't replace them just because they are told to. HOw much beyond twelve months is best asked on the 640G facebook group so you get a wide range of views.

    The five sensor pack looks like it costs £275, but if you only use the 640G you can subscribe to a program from Medtronic where you buy 9 packs at a reduced price per pack over the year. That will give you roughly a year's supply of sensors and they come in at around £40 per sensor rather than £55.
     
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  9. Engineer88

    Engineer88 Type 1 · Well-Known Member

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    @asa35 I've Pm'ed you also
     
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  10. yingtong

    yingtong Type 1 · Well-Known Member

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    Hi @asa35 my first transmitter lasted 16.5 months and I use it continually.
     
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  11. asa35

    asa35 Type 1 · Well-Known Member

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    thanks @yingtong - by the sounds of it then, is it pot luck how long a transmitter will last? Although the manufacturers will suggest replacing yearly, if you can get this amount of additional time, then it's something else I'll take in to account.
     
  12. GeminiJohn

    GeminiJohn Type 1 · Member

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    Interesting!...does the starter pack price include the first five sensors??
     
  13. Chas C

    Chas C Type 1 · Well-Known Member

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    I use the G4, my transmitters have lasted between 12 and 15 months.

    Moving to the CGM has helped to change the way I manage my diabetes and to see the impact of the food I'm eating allowing me to adjust my pumped insulin to suit. I've reached the lowest HBA1c in the last 6 months that I've ever had by sugar surfing. Other than the pump its the best change I ever made.
     
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  14. richyb

    richyb Type 1 · Well-Known Member

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    I had a horrendous day today. Changed my set before breakfast this morning. Tested and bolused for food. about 2 hours later felt a bit off so did a scan with the libra flash which i had on( I also changed the sensor on the morning). Horror I was 19.7.with 0.5 Ketones. then bolused via pump but no difference, so used a pen. took a few hours to get levels down. Not felt well all day. On close examination my canula was leaking. This i replaced. Seems I had put the canula on a fold of skin.
    Lesson learnt.. will check more closely in future
     
  15. Chas C

    Chas C Type 1 · Well-Known Member

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    If I get random highs for no apparent reason I always change the cannula, in last 5 or so years I get this about once every 6 or so months, either blocked, bent, dodgy insertion, bad location......
     
  16. AmandaD

    AmandaD Type 1 · Well-Known Member

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    I've used a cgm with my pump for the last six years and I wouldn't be without it.I love it and the information it gives me. Now I'm in Ireland and everything is covered here so I don't pay for a single thing to do with my diabetes so I have had no financial outlay regarding a cgm or pump, I don't know how I'd feel about getting one if I had to pay for it. My first transmitter lasted 3.5yrs I reckon it would've gone longer except there was a big crack in it and I think that's what killed it lol. We get upgraded every 4 years
     
  17. simonfholt

    simonfholt Type 1 · Member

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    Hi,

    I have used Medtronic pumps for 3 years. I found my diabetic control so much better than with injections so I feel you should use a pump with 'normal' testing first and see how you get on.
     
  18. novorapidboi26

    novorapidboi26 Type 1 · Well-Known Member

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    How did you get a CGM......no hypo awareness...?
     
  19. AmandaD

    AmandaD Type 1 · Well-Known Member

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    yup lost all hypo awareness when pregnant with my second child althou at my upgrade last year there were 4 other diabetics also on medtronic who were upgrading and all were given cgms as part of their having never had one before. Hypo awareness came back after 4 years. My consultant likes cgms especially when patients really work with them
     
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  20. Engineer88

    Engineer88 Type 1 · Well-Known Member

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    I disagree wholely. A CGM is just a must as far as im concered and I pay for it myself or find ways to get it paid for.
     
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