Does CGMS insertion hurt more than pump site insertion?

[WestinsMom]

I keep reading about emla-ing for longer on sensor insertion. Does it hurt more than a pump set? We are hoping to start in the next month or so and was just wondering.

[payam7777777]

Does CGMS insertion hurt more than pump site insertion?
u bet.
the good news is that the sensor is not solid, it's a flexible thing and after insertion it's comfortable to wear.

[Reagan's Mama]

It is definitely a bigger needle. The insertor seems to work slower than the Quick-serter, not sure if you are familiar with that?

Our MM rep said if you don't use cream with sites, that you may not need them with sensor, we have found that it doesn't seem to bother Reagan to put the sensor in.

I am going to use Lidocaine next time to see if I can ease my husband's mind. I think seeing the bigger needle going in is harder on us.

[WestinsMom]

Is the needle bigger in diameter or longer? or both? We have used the silhouette before (for reference). I don't have a problem with bigger, but would like as much time to prepare myself as possible. I have use all the inserters on the market (MM).

[payam7777777]

Is the needle bigger in diameter or longer? or both?

both!
but it's practically not that bad.

[sammysmom]

Payam, is your nephew on a cgm yet?? Did you post about it and I missed the post??

shannon

[bkfkmc]

According to our rep, the sensor needle is similar to the Silhouette needle and the inserter is similar to the Sil-serter. She said the Silhouette needle is smaller but similar. My son must have a low tolerance for pain or just a psychological need, but we use numbing cream for both infusion sites and sensor sites. Everything goes smoothly and without a fuss. I realize that some people prefer not to use numbing cream. My son uses the quick-sets right now and there is a considerable difference between the needle on the quick-sets and that of the sensor. However if you are using the Silhouettes, you probably will not notice a huge difference.

[Rachel]

We've only been at this a couple weeks and have only done 2 insertions, but so far have done them with no cream with no fuss. We've never needed to use it with the QuickSerts either.

I'd use it if we needed it but tried it without first in the hopes that we wouldn't need it. He said they didn't hurt - and has told me the few times a Quick Sert did hurt so I know he would tell me if it did.

Let's see how it goes this afternoon though when I try to do it myself, without the DH there for moral support. :cwds:

[rickst29]

For me, the pain is about the same and I use a Lidocaine-only gel called 'Topiciaine' for both of them. Maybe just a tiny bit worse on the Sensors.

Slightly OT:

You are aware that the FDA considers multi-active-ingredient formulas (such as EMLA) to be more dangerous than Lidocaine-only products like LMX-4 and Topiciaine, right ??? They say that using multiple ingredients in smaller quantity makes the risk of overdose significantly WORSE (NOT better) than using a larger portion of only a single active ingredient.

A few of the CWD "big-shots" (e.g., Judith) don't like using these anesthetics, because there's some risk of developing allergies (and then not having the anesthetics available for dental work, ER stuff, etc.)

Others (such as our founder, Jeff) feel that pain is under-medicated in kids, and the problems which can result from inspiring FEAR whenever you're doing treatment is more serious than the small risk of creating allergies-- which, if they're gonna happen, can also happen just from occasional dental stuff anyway. (I'm with Jeff on this question.)

But even though I LIKE to use topical anesthetics, I think that using a brew of multiple active ingredients creates more risk of creating such allergies... and if multiple allergies DO develop, you're gonna be left with fewer alternatives for dental and emergency stuff.
- - - - -

So *if* you do choose to use one, as I do, then I strongly recommend against using a multi-ingredient formulation such as EMLA. Use LMX4 or one of the other Lidocaine-only products instead.

Just because it's still widely sold and popular doesn't mean that it's the best choice. The FDA's research was quite recent, and this position (against multiple ingredient formulations) was only announced in December 2006.

[EmmasMom]

I thought the FDA warning was against using LARGE amounts of the cream. The people who had those reactions were covering huge areas of their bodies for hair removal and such, and then covering those huge areas with plastic and leaving it for hours. Brilliant!

I like LMX 4 myself, but I think the tiny dollop that is used prior to a "poke" is much less risky than what was in that FDA statement. We just found out that Emla is covered by our insurance and the $75 tube of LMX is not, so I may try Emla for the sensor sites. We've never used anything for the pump sites, but I like to make sure the area is numb for the sensor.

[payam7777777]

Payam, is your nephew on a cgm yet?? Did you post about it and I missed the post??

shannon

mm rep here said they'll give us th cgms in a month. so we're not on cgms yet.

few people on earth [have] read as much as i do about cgms daily. believe me.

[Twinklet]

We just found out that Emla is covered by our insurance and the $75 tube of LMX is not, so I may try Emla for the sensor sites. We've never used anything for the pump sites, but I like to make sure the area is numb for the sensor.

$75 for LMX 4? We pay $40 for the biggest tube at Walmart, $20 for the smaller tube. Do you have a Wallyworld nearby?

[jpb286]

I think another good question that has not been presented thusfar in this thread is discomfort using multiple manufacturers sensors.

(i.e. Does the MiniMed Guardian sensor hurt more than the quickset, silhouette, rapid-d, etc...)

(i.e. Does the Dexcom sensor hurt more than the quickset, silhouette, rapid-d, etc...)

I just got my dexcom crap and it looks to me like the sensor insertion would hurt LESS than the MM Quicksets I am currently using (which dont bother me that much)

[bkfkmc]

This depends on your pharmancy plan, but we get a generic Emla for a $5 copay at Walmart.

[EmmasMom]

$75 for LMX 4? We pay $40 for the biggest tube at Walmart, $20 for the smaller tube. Do you have a Wallyworld nearby?


We do, I've never looked for it there... but a large tube of Emla is covered at $20 on my plan, and they also have the generic equivalent for $10!!

I wonder the LMX4 was so much more at my pharmacy?

[rickst29]

I thought the FDA warning was against using LARGE amounts of the cream.
The FDA covered 3 different subjects within their December warnings and news releases on this topical creams, and somewhat "mashed them" together:

(1) The widesread creation and marketing of products like these from "compounding pharmacies". In spite of the word "compound", the issue here wasn't the use of multiple ingredients as a "compound" product: It instead refers to issue that nearly identical products (i.e., LMX4, EMLA,, etc.) are readily available from _REGULAR_ pharmaceutical manufacturers.

(2) Several Deaths due to product abuse, massive overdoses following hair removal treatments. IIRC, at least one case did involve one of the "compounded" products from an "under-regulated labs", covered by the warning (1). But others cases involved products which continue to be available, not related to the warning letters issued to certain "compounding pharmacies". (Not all products involved in the deaths were subject of warning letters, and the warning letter REASON wasn't the deaths.)

And finally, (3): The interesting and new research result which I focused on here: Products which contain LESS QUANTITY of two DIFFERENT ingredients actually have *less* "headroom" before reaching overdose risks than products which use, for example, twice as much of only ONE active ingredient. This is definitely non-intuitive... I would have GUESSED that using smaller amounts of multiple things would have been safer. And this is the item I was emphasizing in my post, EMLA is a multiple-active-ingredient product of the type the FDA specifically indicates to have more risk of overdose than the single-active-ingredient alternatives, LMX4/5 and Topicaine 4/5.

I worry that that kids, with so much less body mass than adults (i.e., both BLOOD to dilute traveling compounds and LIVER to eliminate them), have more risk of overdose than oldsters like me. And the fact that it's already effective in only 1/2 hour, and even less time with some kids, would fit with this worry.

But as long as you're washing it off shortly after it becomes effective, you've almost definitely got the overdose risk well-controlled: As you pointed out, those laser hair-removal salon victims were doing their entire legs, usually BOTH legs, from top to bottom! Totally different than our one-square-inch coverage.
- - - - -
I paid for my own, so I chose the "monster" Topicaine 4% tube at less than $20.00 per oz.

[rickst29]

I think another good question that has not been presented thusfar in this thread is discomfort using multiple manufacturers sensors.

I don't know if there's anyone else on CWD who has used them both. I did, but that was a long time ago. Back when I tried them both (and before I started slapping on Lidocaine beforehand), I found the Dexcom to be slightly LESS nasty than the MiniMed. The difference, however, was kinda small.

A far bigger difference back then was, ripping the tape up from under the the big old Minimed Transmitter. (The Dexcom Transmitter never needed any :D ). But with Dexcom, I of course get to rip "shower cover" tape after showers. For me, Dex won then, but Minimed would probably win now. Times change! :D

[Elena'smom]

My daughter (8) has been using CGMS for 5 months now. We numb the area with ice before sensor and site insertions (silhouette). She says the sensors hurt less than the sites. We don't have any problem at all with that!

Laura, mom to Elena, 8, dx/d 8/02, pumping MM 1/04, CGMS 11/06

[jpb286]

I started my dexcom today. It is unreal....

I compare the insertion to in insulin injection. It didnt hurt any worse and I didnt use EMLA or Lidocaine, it just felt "different". It definitely shouldnt deter anyone from trying it. It has warned me of 3 lows today, only one of which did I act before I was TRULY low (<60), mainly because I have not adjusted to seeing the BG drop and the lag time as well as the steepness of the curve itself. I now know if the angle of the BG decline is consistent, and you have gone from 200 to 80, treat it or expect to go low. If it was "normalizing" at 80, the curve would have begun to "level off" a while ago.

FYI: You CANNOT take acetaminophen(Tylenol, Motrin) or Naproxen Sodium(Aleve) with the CGMS. Ibuprofen(Advil) is okay, and doesnt affect the sensor. It makes the sensor give nutso readings because as the Tylenol is broken down it alters the chemistry of the interstitial fluid and makes the sensor "think" there is a ton of glucose when there isnt. Also the rep told me if this happens, you WILL NOT see steady or sharp inclines in BG data. The thing will literally make squared-off 90 degree RIGHT ANGLES with the plotted glucose data!

[rickst29]

Yep, with Dexcom's graph, you treat the TREND, not just the bG reading. Great job! I can see that you're gonna be one of the users whose graph consistently shows, "yep, he's a FLAT-LINER". (For us, being a flat-liner is :D .). And an A1c of about 4.5 :)

Welcome to the real-time world. Aren't you glad you took the RED pill?