The benefits of a Continuous Glucose Monitor (CGM) for type 2 diabetics

[Art Of Flowers]

I went to see a diabetes nurse at the end of April. I didn't have a blood test, so I decided to begin testing again at home. My previous blood glucose monitor was an Accu Chek Mobile which uses a cassette with 50 tests which expires 90 days after the first time you use it. Problem with that is you need to buy a new cassette if you haven't used it for a while. I was getting some high readings Blood Glucose (BG) on the Accu Chek in the 8-10 range, so I wondered if the meter was working OK. So I bought the most accurate glucose meter you can buy which is the Beyer Contour Next and started testing most days. The Contour Next has an App which records all your readings.

My weekly average fasting BG reading was 7.7 from May 5 dropping to 7.12 for the week of Jun 2.

At the beginning of June I decided to buy a CGM and investigated the alternatives ... see https://www.diabetes.co.uk/forum/th...with-a-continuous-glucose-monitor-cgm.204410/. The Dexcom One+ and Freestyle Libre 2 Plus seemed to be the best alternatives. I decided to get the Dexcom One+ as it is cheaper on a monthly or quarterly subscription.

With the help of the Dexcom One+ my weekly average fasting BG levels then dropped from 7.12 to to 6.24 for the week of Jul 7 and this week it is averaging 5.82.

I think the CGM has helped me lower my average Blood Glucose levels. My GMI (estimated A1C) was 6.5% when I started using the CGM and now it is 6.2% a month later. The other things I changed since using a CGM were drinking lemon water first thing instead of coffee and taking 2x300 mg benfotiamine (fat soluble vitamin B1) daily.

 

[Melgar]

The FDA has recently cleared a CGM aimed at people with type 2 diabetes. It is a Dexcom product called Stelo. It’s a small sensor similar to a regular sensor . It delivers glucose readings 24/7 to a smart phone for up to 15 days. According to Dexcom website it states and I quote “Stelio Glucose BiosensorSystem is an over-the-counter integrated Continuous Glucose Monitor (ICGM).
” It seems to work the same as a regular sensor, nut without all the bells and whistles. Not sure what the price tag will be like. You don’t need a prescription it’s an over the counter sale. Clearly Dexcom can see a market for such a device aimed at T2’s. Dexcom claims “The Stelo Glucose Biosensor may also help the user better understand how lifestyle and behaviour modifications, including diet and exercise, impact glucose excursion”.
It is going to be launched this summer in The US. I have no idea the price tag.
Edited I wrote Stelio in my quote it should read Stelo.

 

[Art Of Flowers]

Abbott is working on 4 new Lingo devices for non-diabetics - glucose, ketones, lactate and alcohol. See ..

The Lingo glucose monitor is available in the UK, but it is expensive ... https://www.hellolingo.com/uk
The Dexcom equivalent of the Lingo is the Stelo - https://www.dexcom.com/stelo

In the USA you need a prescription to get a CGM. These new Lingo and Stelo devices are OTC - Over The Counter, so anyone could buy one. In the UK anyone can but a Dexcom or Libre 2 Plus via the company websites and if you are diabetic, you don't pay VAT.

 

[Chris24Main]

All of this is clearly emotive and current (ie, lots of discussion in various media about the pros and cons of non-type 1 patients using CGM) - just one perspective to add (only from my own experience of spending some time in a kind of diagnosis no-mans-land and being treated with insulin and with a GCM.

Anyway - constant use of a constant monitor is pretty exhausting - you have to be aware of it constantly. You have to have your phone within reach constantly. You have to be aware of the alarms constantly. You are always checking your levels... it's very rare for a unit to make it through 14 days without some error.. you have to be aware of the offset between devices.. and so on.

Ie, it's no fun having to wear one.

Then on the other hand, opting to wear one for a while is a revelation. You get to understand what your body is doing (not what anyone else says should be happening).. and you will learn a lot very quickly. In my case, it was instrumental in managing a transition from injecting insulin as a type 1 to cutting out all meds safely as a type 2 (a situation that almost nobody will or should go through)..

The point being that when it came time to use the last monitor, that was a huge relief... nobody should be under the impression that these (life saving and amazing bits of kit) are things that you should feel will add to your life in the long term. You will learn as much as you need to know with 2 or 3 of them, then figure out what regime is best for you... and maybe use one every so often if you feel anything has changed - but there is a danger in thinking that a CGM for the long term is likely to be a good thing...

Btw - big shout out to Jason Fung @Art Of Flowers - I wouldn't say I agree with everything he says now (actually that's not true, I agree with everything he says, but there are some things he skips over..) - but I totally credit him with opening my eyes to what was happening to me and where to start putting it right..

 

[Angela64]

All of this is clearly emotive and current (ie, lots of discussion in various media about the pros and cons of non-type 1 patients using CGM) - just one perspective to add (only from my own experience of spending some time in a kind of diagnosis no-mans-land and being treated with insulin and with a GCM.

Anyway - constant use of a constant monitor is pretty exhausting - you have to be aware of it constantly. You have to have your phone within reach constantly. You have to be aware of the alarms constantly. You are always checking your levels... it's very rare for a unit to make it through 14 days without some error.. you have to be aware of the offset between devices.. and so on.

Ie, it's no fun having to wear one.

Then on the other hand, opting to wear one for a while is a revelation. You get to understand what your body is doing (not what anyone else says should be happening).. and you will learn a lot very quickly. In my case, it was instrumental in managing a transition from injecting insulin as a type 1 to cutting out all meds safely as a type 2 (a situation that almost nobody will or should go through)..

The point being that when it came time to use the last monitor, that was a huge relief... nobody should be under the impression that these (life saving and amazing bits of kit) are things that you should feel will add to your life in the long term. You will learn as much as you need to know with 2 or 3 of them, then figure out what regime is best for you... and maybe use one every so often if you feel anything has changed - but there is a danger in thinking that a CGM for the long term is likely to be a good thing...

Btw - big shout out to Jason Fung @Art Of Flowers - I wouldn't say I agree with everything he says now (actually that's not true, I agree with everything he says, but there are some things he skips over..) - but I totally credit him with opening my eyes to what was happening to me and where to start putting it right..

I have been given Libre 2 for a month so my diabetes nurse could see what is going on with my levels. She said her thoughts were correct, so next, I have to have couple blood and urine test next week to see what I need to do next. Hoping I don’t have to make changes to regime, option looking as though I ‘might’ have to have insulin in evening, i get the dawn phenomenon Crossing fingers. I was wondering about paying for monitors, maybe I should just hold on.

 

[Chris24Main]

Everyone gets the dawn phenomenon.. it's a totally natural part of the daily rhythm, in fact not having a so called phenomenon is not at all good. Of course scale is everything, but there isn't anything to fear from the fact that you have a raise in BG to get you going.. good luck with your next meeting.

 

[Paule Foster]

All of this is clearly emotive and current (ie, lots of discussion in various media about the pros and cons of non-type 1 patients using CGM) - just one perspective to add (only from my own experience of spending some time in a kind of diagnosis no-mans-land and being treated with insulin and with a GCM.

Anyway - constant use of a constant monitor is pretty exhausting - you have to be aware of it constantly. You have to have your phone within reach constantly. You have to be aware of the alarms constantly. You are always checking your levels... it's very rare for a unit to make it through 14 days without some error.. you have to be aware of the offset between devices.. and so on.

Ie, it's no fun having to wear one.

Then on the other hand, opting to wear one for a while is a revelation. You get to understand what your body is doing (not what anyone else says should be happening).. and you will learn a lot very quickly. In my case, it was instrumental in managing a transition from injecting insulin as a type 1 to cutting out all meds safely as a type 2 (a situation that almost nobody will or should go through)..

The point being that when it came time to use the last monitor, that was a huge relief... nobody should be under the impression that these (life saving and amazing bits of kit) are things that you should feel will add to your life in the long term. You will learn as much as you need to know with 2 or 3 of them, then figure out what regime is best for you... and maybe use one every so often if you feel anything has changed - but there is a danger in thinking that a CGM for the long term is likely to be a good thing...

Btw - big shout out to Jason Fung @Art Of Flowers - I wouldn't say I agree with everything he says now (actually that's not true, I agree with everything he says, but there are some things he skips over..) - but I totally credit him with opening my eyes to what was happening to me and where to start putting it right..

I just wanted to add that wearing a sensor needn’t be too much of a faff. My app is linked to my iPhone using freeware Shuggah & the display is on my wrist at a glance with discrete alarms. It’s a bit of faff the first time you set up but that could just be me& plenty of online help. My Libre 2 sensor has been an absolute godsend on helping me drastically reduce my blood glucose levels & control & monitor them.

 

[Chris24Main]

I just wanted to add that wearing a sensor needn’t be too much of a faff. My app is linked to my iPhone using freeware Shuggah & the display is on my wrist at a glance with discrete alarms. It’s a bit of faff the first time you set up but that could just be me& plenty of online help. My Libre 2 sensor has been an absolute godsend on helping me drastically reduce my blood glucose levels & control & monitor them.

Sure - totally agree. CGM was a life-saver for me; no argument.

Simply that the very idea of the alarm feature is more geared toward type 1, where you need to know in advance that you are headed for trouble - even in the night, even if you are currently asleep.

For a type 2 - the sleep is more important provided you are not on medication pushing down your blood glucose - if it's for information only (which is totally worth doing) - then you should understand that disturbing your sleep can actually directly affect insulin resistance, so you should think about which priority is the right one for you.

 

[WeeBobbyBee]

All of this is clearly emotive and current (ie, lots of discussion in various media about the pros and cons of non-type 1 patients using CGM) - just one perspective to add (only from my own experience of spending some time in a kind of diagnosis no-mans-land and being treated with insulin and with a GCM.

A few months on from @Chris24Main 's post but, as I imagine this is a subject that a lot of people will come to, I thought I'd chip in..

I used a CGM for all of about a week:

Plus points:

It was very interesting to see and learn (mostly confirm) what certain foods did and didn't do..and particularly the impact of moderate pre and post meal exercise. It was most interesting and even just wearing it for that short time was very useful to me.

Negative points (all very much mine, others will differ):

Maybe just the way I lie and move around when sleeping but I was always very conscious of it while in bed.

I just didn't like feeling this thing stuck on my arm. It's very light, but you know it's there.

Checking my BG levels on my phone became intrusively obsessive. Again, this says a lot about me, rather than the system! I was checking real-time numbers constantly and obsessing over every little rise and fall.

Numbers rise a bit after a meal, that's normal, but having this immediate access to seeing them rise, before falling again, as they should, was driving eating decisions that were less than optimum for fuelling and nourishment.

Conclusion (for me):

A useful tool, and many will find it less cumbersome and intrusive than I did. I liked the data-stream, because I'm a geeky engineer, but it was too much for my obsessive nature. My original plan was, at most, to use it for maybe three months, just to build an information base but felt I had a decent grasp on what was going on much, much sooner and, as a T2, as mentioned by Chris, I wasn't dependant on alarms etc.

My conclusion For YOU:

Give it a go, if you don't mind the financial outlay after the first 15-day freebie (from Libre). Find what works for you. If a CGM is part of YOUR answer, even if that is just to give you some comfort that you are doing the right things, then that's a result. Just remember to put the App away sometimes and get on with enjoying life.

BB