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Why I think all diabetics should have a CGM

June_C said:
What a fantastic idea, but sounds expensive though. Whilst waiting for your reply, I checked out the Freestyle Libre as I sort of guessed what a CGM was and to my horror found that the sensor would cost about £28 per week. Can't eek that sort of expense out of a pension :(
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If you could manage it for a month, the first four weeks' complete supply costs £130. It does honestly teach you things you never knew. Im off mine at the mo but I've learned how to time my doses and my A1c has gone down HURRAY !!
 
We can all but hope that in the near future they will be standard kit for the diabetic.

I may be being very naive, but having spoken to a friend who is a fairly savvy electronics expert, he seems to think having an app connect to a transmitter is not too hard as our mobile phones already contain the technology to do that. I think the hard part is the transmitter itself. Yes I have actually considered making a DIY transmitter, but it'd probably take me years of research and they will probably have a much more affordable system out.

It's tempting to ditch the car and self fund a CGM instead. Need my body more than a car after all!
 
Hey.

I've only scan read the thread, but I'll make a few points:

1) The current CGM I've used with my pump (Medtronic Paradigm) is generally pretty rubbish. Quite inaccurate and very painful (compared to the infusion sets anyway). I'd much sooner stick with a BGM machine - particularly something as advanced as the Contour Next, which is an amazing bit of kit.
2) The 'expense' comes principally from the companies that make the pumps and CGM machines needing to make profit. I'd estimate that there is no more than about £250 worth of components (and that's assuming a lot of custom stuff!) in my insulin pump, yet they're valued at over £3500. Obviously you have to take into account the development, manufacturing costs and target audience (only 260,000 type 1 diabetics in the UK, and around 2.8 million worldwide - we make up around 0.4% of the UK population), but even then I think they could be cheaper.
3) Your friend is correct - engineering apps to talk to CGM's is easy enough if you know the communication protocol. There is a remote control available for my pump, but unfortunately I think it uses radio as opposed to Wifi/Bluetooth, so I couldn't even 'hack' a connection to it. :(
4) The ultimate goal for CGM would be like the watch in 'Panic Room' (the movie with Jodie Foster. Or even better, the upcoming artificial pancreases, which render the whole BGM concept moot. :)

I'm also of the opinion that a lot of failings of current mechanical treatments for diabetes (and indeed other conditions) are down to the fact that they're driven by people who don't necessarily know the technology they're dealing with. My doctor knows a lot about diabetes and endocrinology, but she couldn't compete with me on Maths and computer programming. I think that a combination of the two is required to get to a point where everything works together.
 
BigRedSwitch said:
4) The ultimate goal for CGM would be like the watch in 'Panic Room' (the movie with Jodie Foster. Or even better, the upcoming artificial pancreases, which render the whole BGM concept moot. :)
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I was just thinking about this, if the CGM was like a watch and you could view it at a glance that would be amazing, if it read your bg as biofeedback from your sweat secretions that would be a lot less intrusive, beeps when your over, beeps when your under, bob's you uncle. whether that would be possible probably not or they would have done it by now.
 
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I have some ideas in this realm but I am currently in the investigative phase. There is a lot that could be done.
 
I think specifically the good thing about the CGM's is the real time feedback. I'm with BigRedSwitch on saying that they are not accurate. I wore one a couple of years ago (forgotten the brand) and it was as much as 5 mmols out sometimes! But the dexcom g3 I had, was never more than 2 mmols. Of course, that's not good enough BUT the big win, was the trend information it gave me. I could see if I was 5.6 going up, down or stable, which makes a big difference. It also let me see the general patterns in my day and allowed me to make some corrections.

Ultimately, if they can get these things super accurate, then we'll have a closed loop system. That's a big IF of course. Not an easy task at all, but there is always hope. Mobile phones were once incredibly expensive, rubbish pieces of technology.
 
@gateian the Dexcom is a lot more accurate now, no more than 1mmol out most of the time :) We are the G4 now and I think a newer version is on the way or is already here somewhere. I like the Dexcom because you can restart the sensors and get very good use out of them for your money :) As I understand it Dexcom is the most accurate sensor on the market.
 
I've bee using the Freestyle Libre since November, and with a few hiccups (sensors breaking after a few days) I think it is a wonderful system as it allows you to fine tune how you deal with high blood sugar (I jump onto an exercise bike if blood sugars go above 8.5mmol/l).

My HBA1C had dropped from 47mmol/mol (6.4%) to 37mmol/mol (5.5%) since I started on the flash monitor, and whilst the annual cost is around £1,300, the reduction in complications from the drop in blood sugar (I am 38 so have another 50 years) must make the Freestyle more cost effective for the NHS in the long term (how much does it cost for a single hospital admission?).
 
I need CGM in my life! I cant wait for the day my phone alerts me to a hypo or hper and i no longer have to test, Injecting is the easy bit! I work shifts and do loads of exercise - im thinking of paying for it! Does anyone currently pay for theirs?
 
paulioajordio said:
I need CGM in my life! I cant wait for the day my phone alerts me to a hypo or hper and i no longer have to test, Injecting is the easy bit! I work shifts and do loads of exercise - im thinking of paying for it! Does anyone currently pay for theirs?
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A cgm or libre usage does not mean you can stop testing.
 
Sooner the NHS can have concrete evidence CGM will save them money long term the sooner we will all have one... I pleaded for one but was offered a pump instead.
 
Slightly off topic, but still related... I'll be another one to advocate the FreeStyle Libre. I'm still waiting to be added to the list of people who can order the sensors, but I got a sensor and a reader from one of the Abbott reps recently and can honestly say that I think this is more of a game changer than a pump is... It encourages people to perform more tests (I did over 50 scans one day!!) which in turn means people are making those small tweaks that make the big difference.
The Libre system, uses NFC to communicate between the sensor, and the reader. Most mobile phones made within the last 3 years (aside from the iPhone's when NFC was only included in the iPhone 6/6+), have NFC built in too. There's nothing stopping Abbott from writing a mobile app that can perform the readers job, which means one less thing to carry around with us...
Obviously Apple will need to open up access to 3rd party developers to use NFC, but I'm sure thats not going to be far away...
 
tim2000s said:
I think the "killer app" in CGM is the smartphone app. Once you can remove the £900 receiver and stick it in the app, then the price of the transmitter and consumables is a whole lot better, and focus can be placed on selling more and bringing the cost down.
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See my previous post. The Libre uses NFC, so there's not really anything stopping Abbott from releasing an app to do the readers job...
 
CarbsRok said:
A cgm or libre usage does not mean you can stop testing.
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No it doesn't, but the Libre has been approved for dosing insulin based off the results - so there's no need to perform blood glucose finger prick tests, unless a) (obviously) your symptoms are telling you something different to the machine, and b) you are rapidly dropping or rising (which the reader shows you). In my 2 week stint with a Libre, I found the sensor to reflect my symptoms more accurately than the blood glucose meter built into the Omnipod. I used to get hypo symptoms when I hit the high 4's on the Omnipod meter. I swiped with the Libre, and it showed low 3's.

CGM's have a much longer lag time than the Libre, so you'd still need to do blood glucose tests before dosing insulin.
 
sepuku said:
No it doesn't, but the Libre has been approved for dosing insulin based off the results - so there's no need to perform blood glucose finger prick tests, unless a) (obviously) your symptoms
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Has it, can you point me to the relevant information? I understood you had to test before you injected.
 
sepuku said:
No it doesn't, but the Libre has been approved for dosing insulin based off the results - so there's no need to perform blood glucose finger prick tests, unless a) (obviously) your symptoms are telling you something different to the machine, and b) you are rapidly dropping or rising (which the reader shows you). In my 2 week stint with a Libre, I found the sensor to reflect my symptoms more accurately than the blood glucose meter built into the Omnipod. I used to get hypo symptoms when I hit the high 4's on the Omnipod meter. I swiped with the Libre, and it showed low 3's.

CGM's have a much longer lag time than the Libre, so you'd still need to do blood glucose tests before dosing insulin.
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Sorry, but I'm afraid that this isn't true. The bolus calculator works ONLY with the blood test strips.

You can make a note of the insulin you have used alongside a scanned reading, but it doesn't calculate it for you, which is the equivalent of saying that it is not considered accurate enough to use in place of blood tests.

With regard to CGM time lag, if you take a look at the comparison done on this site (granted it is only one person) http://type1tennis.blogspot.be/2014/12/how-much-faster-is-freestyle-libre.html

It will give you a good understanding. The Dexcom seems to be about 9-10mins slower than the Libre, which would put it somewhere near 30 mins behind blood glucose levels.
 
iHs said:
Its true to say that most insulin dependant diabetics would benefit greatly from cgm technology and competition from other companies should help to drive prices down. Good control of bg is not about achieving a low hba1c though, its about staying within healthy target ranges. There is nothing wrong with an a1c of 7%. I had an a1c of 6.9 to 7.2% for about 45yrs with hardly any problems that could not be fixed. 6.1% is too low for me and would involve a few bg levels of 4mmol and below every day which on the face of it, is not that good esp as I also drive a car, so would involve even more need for cgm or even more bg testing just to be ok.
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Have been using Dexcom CGM for 2 years, self funded, which connects directly to my Animas Vibe pump and I fully agree it should be available to all Diabetics, especially Type !. It makes such a difference with my pump set to alarm if my levels go above 11 or below 5, so gives a great early warning system for people who do not have good recognisable Hypo sign. Again I have found not only that i can get 4-5 sessions out of each sensor, when they are one recommended for one 7 day session but also they are recommended to be positioned on the ususl sites on stomach or back but after a visit to the States and meeting up with a user there I started positioning mine on the upper arms, alternating, which is fantastic and works equally as well as other sites.
The other thing I discovered in America that the sensors and transmitters are very significantly less expensive over there, much less than half what we pay over here. I am told that is because there are so few users over here and if more people in the UK used them, the price would fall, its not a manufacturing cost its simply due to the current limited market. Since I was told recently that I am one of four people in the whole of Northern Ireland using CGM full time, I don't hold out much hope for a reduction in price any time soon.
Overall, if you are lucky enough to be able to afford it, get it, its fantastic especially for spotting trends and early warning!
 
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