pump with or withour cgm

[Tommo]

Hi - my 2 yr old little boy is soon about to start on the pump. (I think it is a medtronic 515) Does anyone have any advice about the CGM that can also be attached..we were advised that as he is so small there might be problems with the amount of tummy area available for all the tubes etc? that we will soon be able to get close management without it. Any thoughts would be very welcome : )

[Tommo]

also if the CGM is good, how many times do you still need to test - we are testing about 30 times a day at present (!)

[Tommo]

and just another thing : ) is there a pump with an integrated cgm?

[Momof4gr8kids]

minimed has the intergrated CGMS.

I don't want this to sound wrong so please don't think I am trying to be rude, just trying to understand. Are you testing 30 times a day for your comfort level, or is your sons b/g fluxuating that much?

My understanding of CGMS is that anytime you have a reading out of target range you need to confirm it with a finger stick.

There are other parents here with them, some younger then your son, so he could probably do it.

Good luck! Jamie

[miss_behave]

Its the Minimed Paradigm 522 and 722 that have the integrated CGMS

[Tommo]

thanks for that....still can't work it out though :confused: ....but do they still have to have a separate sensor? re the testing: we are testing so many times to gain better control I spose, when he is at good levels we try and keep it there for as long as possible ...which does mean constant testing and topping up with small amounts of glucose if necessary. If he is too high :mad: obviously we don't feel the need to check him all the time (only to see that he is on his way down) maybe a bit obsessive but he doesn't mind finger sticks at all and shows no signs when he is low...

[Boo]

At this time, even the minimeds have a seperate sensor. It requires another "site", which I believe needs to be at least 3 inches from the pump site. The sensor piece is quite large/bulky at this time, but there is a lot of talk (from Minimed reps) that a much smaller device will be on the market soon...like within a few months.

I believe it is still quite hard to get insurance to cover the CGMS. At this time, it is on a case by case basis.

Due to your desire to have such tight control, this might very well be something for you to look into. I can understand your desires to keep your son's blood sugars within range, but keep in mind that even if he doesn't seem to mind the finger sticks at this age, you may be setting him up for some nerve damage on his fingertips in the future. He has a long road ahead of him. I'd suggest talking with your endo about this.

[Tommo]

ok, thanks. Also for finger sticking advice - its not that I am trying to have really tight control...just keep him within the 4 to 8mmol range which is so "fragile" and almost impossible with a 2yr old - I hadn't thought this could be doing nerve damage...will try and cut down!

[Boo]

I always have particular admiration for those of you who go through this with babies and toddlers. Fortunately, (I can't believe I consider a diagnosis fortunate in any way!) my son was diagnosed at the age of 8, so my experience starts there. I simply cannot imagine what you all have to go through to keep even a minimum of control. You are to be commended for that...diabetes is a tough balancing act.

[selketine]

ok, thanks. Also for finger sticking advice - its not that I am trying to have really tight control...just keep him within the 4 to 8mmol range which is so "fragile" and almost impossible with a 2yr old - I hadn't thought this could be doing nerve damage...will try and cut down!


William was dx'd at 26 months and we routinely went through 20+ strips a day at that point. I can understand that you're not looking for tight control. With William he could (and did) drop from the 400's to 70 and below in 30 minutes. He was just so sensitive to insulin and food it was impossible to get him steady on shots. Before you cut down on the testing you should talk to your doctor. I am not so sure that nerve damage is a big risk but cutting down on testing could lead to severe lows or highs which are much more damaging - in my opinion.

One thing that really helped us was to get diluted humalog (novolog does not have a dilutent). We used the syringes with half unit markings and could give him 1/4 unit doses that way.

A CGMS would be a great way to go if you can get it. However I'd want the MM pump that talks to the sensor rather than having to get two devices. If you have to get two devices and you have the option of the Animas pump you should check that out. The Animas pump is better for younger children I think, because it has the ability to give smaller doses of basal insulin - in .025 increments. They both give the same size bolus doses.

Hang in there and don't feel bad about testing - it is very difficult when they are so young and it sounds like you are doing a great job.

[Momof4gr8kids]

Actually the animas can give a bolus of 1/20th of a unit, or .05, and the MM can give a 1/10th of a unit or .10.

[EmmasMom]

We put my daughter on a MM 515 pump when she was 14 months old and it really helped us gain some control. We wanted a CGMS as soon as possible and tried out the Guardian RT with decent results, but when we upgraded her pump to a 522 and got the new real-time system our results were really amazing!
There are some down sides, the transmitter is bulky, extra tape can irritate the skin, and it won't replace all finger sticks, BUT it will cut them way down, it will give you a clear picture of what's really happening 24/7 with blood sugars and you will always know where the blood sugar is heading. The graph is sooo helpful and trends are very clear. You can strive for better control, (extremely difficult with little kids), and keep them much safer at the same time. When the new smaller transmitter is released, sometime this year, the downsides will be cut in half!!

I'll post some pictures for you so you can see exactly how big it is on small child and how it all works. In the first picture Emma is about 20 months wearing the sensor. The second is the pump screen with graph and current blood sugar. The third is one print-out option from the software that shows the sensor line, the actual finger sticks, the insulin basal and bolus doses, and carbs eaten, (the carbs are cropped out here to save space), this makes adjusting insulin much easier!
She doesn't mess with it at all and it has never seemed to bother her. You cant see it under her clothes, so once she's dressed the only obvious thing is her pump pouch.


http://i117.photobucket.com/albums/o74/nabholmes/DSCN0008.jpg


http://i117.photobucket.com/albums/o74/nabholmes/IMG_2477.jpg
http://i117.photobucket.com/albums/o74/nabholmes/scan0001-1-1.jpg

[Tommo]

thanks so much for all that! and such a beautiful lil girl too! very useful to be able to see the size of the CGM - and your results are brill..particularly the night time ones - will do some more research and have another chat with the diabetes team...wonder how long off the smaller transmitter will be...we are not getting it on insurance here so could all be very costly! many many thanks again, speak soon!

[Boo]

I vote for Emma as the new JDRF poster child!

That picture is so precious...it just breaks my heart. I am glad you have had so much success with the CGMS. My son, who recently reluctantly agreed to try the pump, said that he might be interested in the CGMS when the smaller version comes out (hopefully very soon). I have high hopes that it will be routinely covered by insurance in the not too distant future as well.