I need info on CGMS

[Mojo's mommy]

I want to get my little girl onto a monitoring system without being on a pump..is this possible? She is on MDI and is tolerating it like a hero so I don't really need for her to be plugged in yet continually. Lows and highs are obviously a big thing and especially at night and she gets tired of me poking her all the time . I test her a minimum of 10x a day. This is why I thought this system may be good among other reasons.I know you still have to do finger pokes but does it not give you info all the time? How reliable are these systems? Can you have a severe low and the monitor read that your sugar is okay?

So many questions?????

[kiwikid]

yes - you can absolutely use a CGMS without a pump - the MiniMed 522 series use the pump to display the graphs and bsls, the others use a PDA type thing.
heres a link : http://www.childrenwithdiabetes.com/continuous.htm :cwds:

[Momof4gr8kids]

Also the dexcom is coming out soon. It doesn't come with a pump, and is actually a little bit cheaper for the devise although the sensors are the same price. Here is the website. Jamie

www.dexcom.com/

[cure]

Minimed Guardian and DexCom (since March 2006) are two systems on the market. Both update reading every 5 minutes. Our experience with DexCom is that sometimes it can be spot on, but sometimes not, probably depend on the particular sensor and where it was inserted (i.e., whether it hit a capilar blood vessel). Nighttime it can skip reading if placed on the behind. So while it can be very useful, I think you will have to be prepared to accept that it is not very reliable, otherwise you will be in for disappointment.

The third system, Navigator, suppose to come out at the end of 2006, and is believed to be more accurate. But until it is out and tried, I don't know how much of an improvement it is, if at all, over the two on the market.

[rickst29]

Dexcom has been out for MANY months. Minimed also makes a "stand-alone" non-Pump device which competes more directly with Dexcom. (It was released in July, it's also shown on the CWD page). But I don't know of anyone who uses it-- the 20 or so MiniMed people who I talk with (mostly on a Yahoo 'CGMS' message board) are ALL using the 'upgrade to your MM pump' version.

They are NOT as reliable as finger-stick meters, and that's why they tell you to "check your bG with a *Blood* Glucose meter before treating your bG-- you're not supposed to treat on the basis of your MM or Dex reading without confirming it first.

On the other hand, they do work continuously, right through the night. The Dex gives a nice LOUD buzzer when you fall out of your "range". I have my "high" buzzer set at 160, my "low" buzzer set at 80. On most days, it goes off several times. And for me, it's nearly always right when it announces that I've got a problem. (I'm an adult T1, not a Parent.)

For you? you won't know if it's reliable enough unless you try. Dexcom says that you can send it back if it doesn't work for you, so it's supposedly a risk-free purchase. I was delighted, never took them up on the money-back guarantee.

By the way, the CWD forums has a CGMS section with lots of posts. Here:
http://forums.childrenwithdiabetes.com/forumdisplay.php?f=18

[Emma'sDad]

I just had Emma on the Guardian RT for a week. While it was nice to see what she was between finger picks, there was a 20 minute lag between the finger prick and what was on the monitor. She fell low the other day. We finger picked her and it said 2.4, but the monitor was still showing 5.6. About 15 minutes later, the monitor started to beep telling us she was below 4. To me that was a bit un-acceptable. If we didn't treat the 2.4 at the time we discovered it, she could have been unconscience after 15 minutes.

[EmmasMom]

We have used both the Guardian RT, which can be used w/o a pump and the Minimed Real-time pump with sensor.
Our experience with the Guardian was pretty good, it did a good job of alerting us to lows, it gives you a clear pattern of what your numbers are doing, and can be very helpful with insulin adjustments, (once you upload and look at several days of data). However, it did not replace finger sticks for us during the short time that we used it. It was usually about 10 minutes behind and it gave us a few false lows at night.
*They key to this technology is getting good calibration readings. You MUST have a stable blood sugar that is not rising or falling when you calibrate, other wise the readings will never "catch up".

We started using the real-time pump and sensor about 3 weeks ago and it is amazing!! So far our readings have been surprisingly accurate. The pump displays the current BG and a graph that shows the past three hours, another graph that shows the past 24 hours, and arrows that show the current trend and tell you how fast BG is rising or falling. This feature is great because if the screen shows that she's 120, but there are two down arrows, I know I need to test because she's dropping very quickly.
The readings may get a bit behind during rapid changes, but with the arrows showing the rate of change you can easily figure out when it's time to do a finger stick. The absolute beauty of the system is that you can treat trends before they become a problem, and the fewer rapid changes you have the more accurate the real time readings are.
At this point I am only testing Emma about 6-8 times a day which is about 1/2 the tests we were doing before, and her readings are better! Her sensor readings have been so accurate for the past few days that I could literally only do calibrations every 12 hours and be fine. :)

IMHO the technology is much better when combined with a pump. Basal changes make a huge difference in stabilizing numbers. If you get a device w/o a pump you will still have a "site" and a device that has to be carried around with you all of the time. It is wireless, but will lose it's signal if you get very far away, so she will have to wear it most of the time.
If you can do a trial for a week or so, that would be great. She could wear it, and you could work on calibrations and see if you think it's worthwhile to make the investment.

Best of Luck!!!:)

[payam7777777]

EmmasMom,

We MIGHT be able to get a 522 here with the sensor but i'm concerned about the pain factor since as far as i know the needle is kinda longer than that of DexCom and it's not a teflon type one either, moreover it's thicker too. i know and do believe in real timing from the buttom of my brocken heart but it's VERY VERY hard for me to... you know... when it comes to adding yet-another-needle in the body of my litttle nephew. What do you think? Should we go for it?

[EmmasMom]

Hi Payam
I really don't think the sensor is any more painful than the infusion site. The needle is similar to a comfort short, but it has an auto-inserter that makes the insertion very fast. The needle is removed and a very flexible cannula is left under the skin, so it's really just like having another infusion site.
We are using numbing cream prior to the insertions because I really don't want Emma to become afraid of site changes. But, we have done them without numbing the area and she was perfectly fine. The gauge of the needle is very similar to the quick-set, only the needle is on the outside with the cannula in the middle. With a typical infusion set the needle is inside the cannula, so the overall gauge is about the same.

It is hard to have two sites on a tiny person, and I hate having to stick her more often, but so far it's been very worthwhile. Our current sensor has given great results for 9 days, so the extra sticks haven't been a big problem! (4 sensor sticks in 3.5 weeks so far) I'm going to pull it today since I'm afraid of infections, but I think it's possible to get 9-12 days out of a sensor as long as it's really clean and well taped.

Good Luck!

[5miraclez]

I am currently trying to get my insurance to cover one for both me and my dd. The way I see it, getting a shot 2 times every 3 days is so much better than getting shots 4-8 times a day. Currently my dd is getting so many shots her little arms and legs are starting to bruise. I'm also continuely checking her for fear she is going too high or too low. I've even been waking up 2-3 times a night to check her since her sugars are all over the place. The CGMS will give me peace of mind, even if there is a delay, because I'll be able to catch a low before it's 40 and hopefully she'll never have a reading below 60.

For me, I have the opposite problem. My sugars are constantly high. My sugars react to my emotions so much that if I get upset, I know my sugar will be over 300. With the pump, I'll be able to catch those rises and give extra insulin BEFORE it actually gets that high.

I've been following the CGMS since I first heard about it. It is finally available here and I'm going to get one :)

[payam7777777]

9 days

Hmmm... tempting.
So you re-initialize it right?
How long exactly is the sensor?
It's ~$35 per sensor isnt it.
It's ~14mm long right?
i guess i have to review my links/etc about RT.
How do YOU compare it to DexCom?
What do YOU [not]prefer about RT compared to Dex?

[EmmasMom]

Hmmm... tempting.
So you re-initialize it right?
How long exactly is the sensor?
It's ~$35 per sensor isnt it.
It's ~14mm long right?
i guess i have to review my links/etc about RT.
How do YOU compare it to DexCom?
What do YOU [not]prefer about RT compared to Dex?


I just have to hit "start new sensor" and it starts over. The 2 hour initialization is cut down to less than 5 minutes because the sensor is already warmed up and ready to go. No need to disconnect!
I'm not sure of the exact length, I haven't measured it.???
It is $35 per sensor. The initial purchase for the sensor, transmitter and 10 sensors is $999, (of course you need the 522 or 722 pump as well).

I haven't used the dexcom, so I have no first hand experience with it. The one thing that MM has over the competition right now is that it's integrated into the pump. When she was wearing her pump and the receiver for the Guardian it was ridiculous. Two sites is more than enough on a 2 year-old, two "devices" on her waist was ridiculous. I would not use it all of the time if it didn't read into her pump, it's just too much stuff for everyday wear.
I do wish that the transmitter was smaller, but it will be soon.