Discussion in 'Parents of Children with Type 1' started by kpoehls, Jul 18, 2010.
We don't have the first clue about CGM, and are wondering if it replaces doing regular bs checks?
I don't think it replaces REGULAR checks - its replaces a lot of the extra checks.
We always still check before a meal. We don't check at 2 or 3 hours after, but we do check if the CGMS beeps high or low. So, some days we could really just check before meals, but another day it could be all day and half the night. so, our checking pattern is just different
No. You have to do a minimum number of checks to calibrate the CGM. Most people still do a check if they are doing a correction. Many people still check before meals, but not between meals unless the CGM alarms.
If I had to guess, I'd say we do 4-5 fewer checks a day on average. But the point of CGM isn't really checking less, it's checking smarter.
We use to do 10-12 checks a day before cgms. While she is with me we only do the calibration checks (2 x a day) and if we decide to do a correction because of a high. A lot of times we only do the 2 checks a day. The nurse at school does not feel comfortable with this. We told her to do what she wants while at school. She usually checks at snack time, lunch time and before bus and then she uses the cgms for gym (before and after) and recess ( before and after). I am fine with this. You have to trust the cgms before you can do this, although.
I dropped from about 10 per day to about 3 per day while wearing the Guardian, which requires 2 per day to stay operational. After I stopped wearing the Guardian, it took a long time to get back in the habit of checking checking checking.
We never do only 2 checks a day. You're supposed to only use fingersticks to make medical decisions (dosing insulin or carbs). Three meals would be 3 fingerstick but we never get that low. The CGM is wrong a lot.
We do 3 checks a day (wakeup, before dinner, after bedtime), and rely on the CGM inbetween for BG readings.
We've been doing this every day for more than 3 years, without incident.
The only time we don't trust the CGM readings without a BG check are:
- If the CGM sensor is very new (within the first 4 hours), or very old (end of 7th day).
- When correcting for a BG over 200, which is infrequent because we use the CGM and correct when BG rises over 100.
- If the last calibration BG check differed greatly from the CGM reading*
- If she has symptoms of a low despite the CGM showing normal**
* - Most of the time, we repeat the test and find that the CGM is right and the BG meter was wrong
** - Very rare
Ideally, every CGM reading would be confirmed with a BG check, but keep in mind that BG checks are inherently innacurate unless BG is stable. We look at the CGM trend (rate of rise or fall) as much as we look at the actual number in deciding if or how to correct BG.
I think you mean every CGM check would be confirmed with a BG check. Additionally, I don't agree with the statement that BG checks are inherently inaccurate. Yes, meters have a variance to them, but I think BG checks are for the most part pretty close to what is really going on. However, one BG check will not tell you if the BG is going up or down, maybe that is what you were getting at. But simply doing another check in 15 minutes will.
We use the DexCom 7 and still do the pre-meal tests and any time the cgm is showing high or low. So I would say that the biggest difference that the cgm made in our life was to give us some peace of mind for overnights. It's our practice to go into her room and check the cgm and not wake her up and do a blood test unless, again, it's showing high or low. For whatever reason, the Dex has been very unreliable this summer. I think it's mostly due to a lot of swimming, so a lot of time away from the Dex.
We check before every meal, and overnight.
For us the CGM just let us relax abit. Ava was very young when diagnosed, is hypo unaware and little ones tend to have some wild swings. So for the first six months, the CGM allowed me to breath.
Now after about 6-7 months, we were able to really figure out pre-dosing SO much better and vastly reduce meal spikes.
It's also a great tool for figuring out overnight basal rates.
And as an amazing added bonus, so many of our friends are willing to watch Ava since she has the cgm. YAY
thanks for that info, I was curious how it works. does she mind having the additional attachment? Is it waterproof? I think its great to be able to see the increase and correct before the highs or lows occur.
personally I liked the mdi better, but my dd loves her pump, and since its her life...I respect her choice. I wonder why we weren't offered a CGM...is it hard to get covered>?
Thanks - I made the correction in my post. As far as BG checks being inaccurate, what I mean is that a BG check is a two-part piece of data, the number, and the direction. The number itself is pretty accurate, but the direction is unknown (rising/falling/flat) which results a 66% probability of the data being used incorrectly. That is what I mean by BG checks being innaccurate. I suppose every BG check could be repeated every 15 minutes to establish a trend, but when using a CGM we also see that BG sometimes starts rising, then falls, then rises again all within 30 minutes. We see this especially during times when basal is high and corrections are given. We'd have to do a lot of blood checks to achieve practical accuracy anywhere near as good as a CGM. With regard to the OP question, we find that 3 BG checks a day is enough to trust the CGM data inbetween the BG checks, and when we have discrepancies and double check the BG meter, we usually find that the BG meter was off. Once nice thing about CGM's, they are not dependent on how clean your fingers are, or if you enter the wrong test strip code at 3 AM.
She does not mind the CGM at all, and in fact she insists on wearing it at all times, and changing her sensor if she is not 100% confident that it's working properly. After what she went through before the CGM, the CGM is her peace of mind. The receiver is very small and easily concealed by her shirt. She started at age 8. Kids who start at an older age might have a different level of tolerance for it. The sensor insertion is not fun, but like everything else it becomes a matter of routine.
The CGM she uses (Minimed Guardian) is waterproof enough for swimming so she gets continuous readings while in the pool or the ocean. Minimed does not guarantee it, but both the receiver, sensor, and transmitter are designed for up to 8 feet depth. We're on our 3rd transmitter and 2nd receiver and she's been swimming year-round with them for more than 3 years without any problem.
Our experience of late is that it raises the number of checks. I would love for Daryl to write a book or guide on how they do what they do but his description is not our reality. Sure, if our BG was 80-140 with rare excursions then I can easily see a reduction.
We check before every meal and when we bolus and in situations where we feel uncomfortable relying on the CGM - like lows. Lately we have been seeing the CGM drop into the 60's when his BG is actually around 100-110. We calibrate and the CGM drops to the 60's again a little later - say 20 minutes. We check and he's still around 100. We calibrate and the CGM goes up. 30 minutes later it's alarming 60-70 and we check and he's 100. This is all happening at night so we can't just ignore the alarms so we feel we have to check. All this on top of recommended sticks (when bolusing) add up to more finger sticks.
Our variability with the Dexcom has been too great to rely on the device as a replacement for finger sticks.
EDIT: To be clear the CGM has helped us avoid a LOT of lows - the trending is a great tool for seeing where the number are going as Daryl described. We have greatly reduced our lows while maintaining an A1c below 7 so I do believe the Dexcom is a valuable tool.
Our experience has been a slight reduction in BG checks, but some days we check just as much, if not more, than before Dex. We usually don't check her in the middle of the night unless it alarms or there are ??? for an extended period and we don't know where she's at.
We always check before any meal and most snacks, unless she ate less than 3 hours before her last meal.
I use it as a guide, it's still not as accurate as doing a finger poke, and I never use insulin on what the cgms says
It has reduced the blood checks for us from 8-9 per day to 5-6 per day when we trust the sensor. Trust is established during the first day of the sensor - usually it's really close to the BG, and is enforced with every pre-meal blood check. Sometimes, when we can't trust the sensor, we end up checking more. But we're new to the CGMS and are still figuring the best places to put it and to calibrate.
The CGMS makes D way easier to manage, in my opinion. At any given point, I can just look at the CGMS and know roughly what my son's BG is. It's a good feeling, to be able to do that in any given situation - in the store, in the car, at night, at a party etc.
I sometimes use the cgm to determine whether I need to test. If it shows high or low, then I test. If it shows "normal" AND it's been fairly accurate then I might just bolus for food and not test.
btw, I don't think that meters are accurate--they have a 20% (+/-) margin of error. I guess it depends on how you define accurate. But if the cgm says 120, even if it IS 120, the meter might say 96 or 144. It's better to just blous for food and trust your cgm and trends than go just by the test. Obviously you need to treat lows and treat/avoid highs, but if you correct a 144 and it was really 120, you're just asking for trouble. Sometimes the less you do the better.
Disclaimer: I'm a testing fanatic and need some sort of 12 step program to get over my meter dependance.
We have actually checked more since the CGM, because we had no idea how much variability her BG had before we got it. We found she was 400 most of the night and often > 300 in between meals, so we ended up checking at those times to bolus. However, when things are fairly stable we end up checking less especially after a low or after a correction, because we can see the trend on our own.
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