Discussion in 'Parents of Children with Type 1' started by frizzyrazzy, Feb 26, 2011.
Just wondering if you use CGM as fingerstick replacement, to set basals and spot trends or both.
I voted both, even though we have not (obviously) replaced all fingersticks with CGM. But today, he had a birthday party where he was running around like a madman, 160 carbs worth of chips and dip, pizza, ice cream and brownie, and I think we've checked BG 3 times today as of 5pm. So today it has already replaced 6 or so BG checks.
You have a good point. Initially I read the question as asking whether or not we would dose off the cgms number. We would not. We always check bg for dosing before meals and any corrections. But it replaces all of those extra fingerpokes. I don't poke her during the night unless the dex says she's low enough to need glucose or high enough to need a correction. She doesn't need to stop and check bg when she is being active, swimming, skiing, PE, theme parks, or before a big test at school. Or those times you want to know if the correction or temp basal is working. That is actually a lot of finger pokes.
Our CDE says it's not approved to dose off of but lots of people do. We use it for some meals. It if is way low or high we always double check. Some lows are way lower than it says due to the lag. We treat then sometimes use the dexcom to make sure it went up, other times poke.
At school we usually let her dose off the dexcom. We have not had a Hgba1c yet since getting it, but I am pretty sure hers will be improved. It has to be...our last one was higher that we want it to be. So, once we have her check up next month we will reevaluate. For now, we are doing both.
When we have a good one our testing drops to around 6-8 times per day. When it's not working it goes to 10-14.
It really helps visualize the post-prandial spikes - especially when experimenting with "super bolusesesss".
Trending is also very helpful but mostly, by far, what we rely on it to do is to avoid lows.
We use cgm for trending, spotting highs and lows. We do a fingerstick before meals, activity, or anytime it alarms high or low or if unsure of what's going on.
It helps with basals/trends somewhat, but I really was having a problem with the fingersticks- my fingers were swollen and they hurt all the time and now they don't.
But more than that, the CGMS helps by giving me numbers when they're off. I wasn't catching lows until I was under 40, typically. Now I am. Now I can. It helps me to catch highs as they become highs, not when I'm scheduled to test.
We've been using the CGM instead of BG checks for about 4 years. On most days we do 3 BG checks a day (dd tests before breakfast and before dinner, I do a test around midnight). As long as the BG check is close to the CGM's last reading (indicating that the sensor has been stable and accurate since the prior BG check), we trust the CGM until the next BG check.
When large corrections are needed or the CGM data is questionable (such as in the first 8 hours, or on the last day, or if the ISIG ratio is lower than normal (indicating an old or damaged sensor) we'll do a fingerstick to confirm. On the whole the CGM saves her around 2,000 BG checks a year since 3 checks per day is almost always sufficient.
The biggest uses of the CGM are to catch BG's drifting out of range that we can treat the problem early, changing basal rates in response to trends, avoiding disruptive BG checks during the school day, reducing overal # of BG checks, catching hypo's before they are symptomatic, and catching highs before they get too far out of control
We used the Navigator as a fingerpoke replacement. We don't feel comfortable with the Dex to replace pokes, because it can be too far off. But it does reduce pokes substantially and is useful for trends.
The Navigator is pretty darn accurate - as most people who have used it know. I think a similar question was asked on the yahoo cgms board - which is mostly adult users - and Nav users were about the only ones who said they'd use it as a fingerstick replacement because of the accuracy.
I guess for the "both" answer - how often you use it to replace fingersticks is a separate point. I think most cgms users would probably would avoid some fingersticks every day - whether it is 1-2, 3-5, or 6+, etc.
We sometimes use the CGM as a fingerstick replacement, we've had zero issues anytime I have given a correction or treated a low predicted based on the CGM. We have extremely good accuracy.
However, I hesitate to use it a complete replacement because I don't think dd has enough understanding of when it's appropriate to trust the CGM and when she really needs to do a fingerstick. As she's becoming more independent right now, I think it's important for her to use fingersticks as her basis, and the CGM as her back-up. We use it more to determine when a fingerstick is needed.
For example, our evening meal usually works out like this... I will glance at the CGM # and trend and if there's still enough active insulin from afternoon snack to get us close to the 100 target & the afternoon calibration was acceptable, then we wouldn't do a fingerstick before dinner. If the pump isn't going to suggest a correction, then why check? We would just bolus for the dinner carbs or if I thought a small correction was needed I would enter the # from the CGM.
I always adjust basals based off the CGM.
We don't use it as a complete replacement, we usually check before each meal.. but if she's snacking, I'll go with the cgms. We still use finger pokes for corrections.
For me it was the reverse. Dexcom is lot more accurate and dependable than my Navigator ever was. It helps me catch my lows and adjust basal rates though out the day and night.
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