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Does CGM reduce the number of finger pricks?

Discussion in 'Parents of Children with Type 1' started by Cheetah-cub, Mar 17, 2014.

  1. Cheetah-cub

    Cheetah-cub Approved members

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    We are wanting to get a Dexcom 4G. My 10-year-old does not feel any of her lows.

    Will the Dexcom reduce the number of daily pricks? Currently, we check blood sugar at least 5 times a day. I have heard that with a CGM, you only need to prick the finger once a day, is this true?

    Also, since our child was diagnosed on Dec 4th, we do a 2AM check for her every night. Will the CGM eliminate the nightly 2 AM check? Can it alert us if she go low in the middle of the night?

    Thank you. I appreciate any feedback and tips with a CGM.
     
  2. nanhsot

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    You have to calibrate it with a minimum of two a day. If it's running accurately and you feel comfortable with the numbers, then, yes, you can skip that 2am blood, but you may still need to get up to check the unit. It's unlikely to waken YOU, unless you have a system to amplify the sound, it's not that loud. It does alert, just not enough to really awaken others or really even her (though there are tricks to make it more of a wake up).

    Not sure how to say this without sounding rude, so forgive me, but 5 a day really isn't a huge amount. Without CGM my son averaged closer to 8 a day, with some days more and some less. So for him it did reduce the amount of finger pokes, but got it down to maybe 4 or 5. So CGM can indeed lower finger pricks but you have to be pretty in tune with it and check accuracy. It can easily be off by 20 points or more, so for me the predictive ability (is the arrow going up, down, or holding??) is it's true beauty.

    Days 1-3 tend to be the least accurate, IME, then you can tend to trust more.

    Thing with nights is that you can't ever really know if it's quiet because they are level, or if it's not working, pulled out, etc. But it's still much nicer to just do a quick read of it than have to draw blood and test. The new unit has a much larger reach, and I can keep it upstairs if I want to (mine is a teen though, and never let me, but it DOES work at that range, I tested it!) So if your home allows, you can have the receiver with you and just check it every so often to make sure all is well.

    CGM is pretty awesome, so don't let this dissuade you. It's true value is knowing directionality of blood sugar. So if they are low but heading up with 2 arrows, you know to hold and see where they land, vs giving more glucose. If high but double arrows down, or if 100 but dropping, etc. It's not the number you really learn to rely on but the trends. It's also wonderful for making basal changes because you can clearly see where the problem areas are.
     
  3. StacyMM

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    For us, yes. My kids test/calibrate twice a day. If they happen to check an extra time because they feel higher or lower than it says or if we're checking to see if a low is coming up, they might get an extra calibration.

    We also use the Dexcom to wake us instead of setting alarms. If the kids drop below 70 or go above 170, it alarms. We keep the receivers in our room so we hear them. There are louder settings available but my kids don't want them super loud at school and I would never remember to switch them back and forth every day/night.
     
  4. Cheetah-cub

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    Thank you for your replies and sharing your CGM experiences with me.

    Mostly, we want the CGM because my daughter does not feel her lows. The kid feels fantastic when her Bg is at 39. We like to get a better handle on her blood sugar throughout the day, and yes, we want to know which way it is heading. But to get less pricks would be a much appreciated added bonus.

    Currently, we do a minimum of 5 checks a day, not an average of 5 checks a day. We check before each meal time, and bedtime, and 2 AM. Of course, each day presents opportunities for extra checks, before and after a sports activity, and battling lows, etc. There are small calluses forming at a few of her poor fingers.
     
  5. Mish

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    Answer: yes and no

    Yes: I will say that before CGM we were testing about 10 times a day. More when we had lows or highs that we were following, and rechecking. Now, we check about 6 times a day. My son does not bolus off the numbers, so one check at every meal, one after school, and one before bed, minimum 5. Then the other random ones thrown in. So, somedays more, some days less. Gone are most of the rechecks when we're following up on lows or highs as we can simply watch the CGM.

    No: you cannot only check once per day.

    Yes: It will help you in the middle of the night

    No: There are still nights when I set my alarm just to be certain, if he was running exceptionally low before bed and I want to be certain I check.
     
  6. nanhsot

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    I think you'll love the CGM. I wasn't being judgmental, I was just not wanting you to have expectations of only 2 finger pokes a day. The thing with CGM is also that you really can't/shouldn't TREAT based on CGM results unless you are fairly certain the number is correct; a high or low needs to be verified before adding insulin or glucose. Now, my son actually does treat based on CGM but he's also fairly intuitive and does feel his highs/lows fairly keenly, so the CGM does help verify what's going on for him. But a child who doesn't feel the low will need to have the CGM number verified.

    It's a great tool, you'll wonder how you made it without it.
     
  7. hawkeyegirl

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    Our experience is pretty much what everyone else is saying. Overall, yes it does reduce the number of finger pokes. But what's better is that the finger poke you DO do are so much smarter. So often when we would have done a finger poke before CGM, we now will just look at the receiver, and if things are good, he just goes on his merry way. We do rely on the CGM to alarm at night. Our alarms are set pretty tight, so we often get an alarm during the night, but some nights we don't have any checks. (And I admit that we do treat/bolus off of CGM numbers when we know the sensor is right on.)

    CGM is about so much more than reducing finger pokes, though. It's invaluable to know if that 120 is heading up fast, staying steady, or dropping like a rock. You'd treat each of those situations differently, but you can't tell which it is with just a finger poke. It's an incredible tool.
     
  8. MomofSweetOne

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    We still test often - before meals, bed, etc., but especially if your daughter doesn't feel her lows, YOU WILL LOVE CGM. The stress-release having a monitor on is monumental. My daughter feels dreadful with both highs and lows (except when sleeping - and then she doesn't wake for either), so it has dramatically improved her quality of life with greatly reducing the number of extremes. We like being able to go hiking, etc. and move the low alarm up to 100 and not bother with finger sticks.

    I don't set an alarm at night. I respond to the CGM alarms. Some nights are calm, and others anything but. One time I do. not. rely. on. CGM. for reliability is when we're having the teen-girl-lows-that-take-more-carbs-than-eaten-all-day-to-come-up events. The lag time in showing what is truly happening is just too great. After one particularly bad night, I counted that I'd done 13 blood tests during the night.

    Your daughter is 10? You'll definitely want one before puberty hits with a vengeance.
     
  9. mamattorney

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    We've eliminated fingersticks due to the cgm, although that has come in the more recent past as she has begun to trust the cgm more. We still do three meals and before bed (and usually the before breakfast and before dinner/before bed serve as the calibration checks), but if she's in range, she boluses for carbs for snacks with no test, she no longer tests before walking home from school or before PE and if she feels low and the cgm agrees with her, she'll often treat without testing.
     
  10. Cheetah-cub

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    Thank you all for your input. We hope to get a Dexcom real soon. We are getting our Omnipod this week!!

    With the Dexcom, I guess we will have it use it, and learn for ourselves to see how much we can trust it to replace finger pricks. But definitely a minimum of 2 pricks a day.

    One of you mentioned the Dexcom can be not working, due to being pulled out of the site. From your experiences, how often does this happen?
     
  11. KatieSue

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    The only time we really treat off the CGM is for lows at night. If it's a high at night I have her test. I keep it on my nightstand face up. Between the light from the screen and the buzz it wakes me up without the loud alarm setting.

    You still need to test but it really does just help you test smarter.
     
  12. nanhsot

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    It's fairly rare, and you usually know when it does happen~my son had a few come out during sports for example. He ripped a few out on purpose when they were irritating him. :p:rolleyes:More common is for the sensor to simply quit relaying to the receiver, for whatever reason, and sometimes you have to restart and such. That has happened at night before. Still not that frequent a problem though, just one of those things you need to have awareness about. When my son lived at home (he's off to college now) if there was anything unusual going on (big sports day, persistent highs/lows, illness) then I'd set an alarm and just take a peek at the CGM to make sure it was working during the night. Waking up to check wasn't a regular event. Nice part for younger kids is being able to set it at your own bedside and check it.

    edited to add that there is also sometimes an issue with false lows/highs, when they lay wrong on the sensor. It's usually pretty obvious by the fast drop and return to previous graph, but still something to be aware of when treating off cgm.
     
  13. andiej

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    Wow interesting thread. My son is also 10, and was also diagnosed in December 2013. It's next to impossible to get a CGM here in the UK without paying for it directly. I would love one for the night time peace of mind, however my sons BG levels aren't to crazy whilst he is honeymooning, as this changes I may take the decision to pay for one ourselves, we couldn't afford for him to wear it every week but could do one week a month to spot trends etc, and to have peace of mind at night for one week a month. Let us know how the Omnipod start goes for you. We have just applied for funding for the Omnipod for my son too. Good luck.
     
  14. Darryl

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    We're using the Dexcom now after switching from the Minimed a few years ago. I recommend 3 checks each day - morning, before dinner, and bedtime. 2 checks is usually enough, but if there was a bad calibration or other problem developed with the sensor during the day, you would not want to wait 12 hours to find out. We have been treating BG based on CGM readings for 7 years without doing confirming fingersticks, except when then CGM data seems suspicious (gaps in readings, big jump after a calibration, extreme low displayed on the CGM with no symptoms, etc.) or when BG is very high (over 250) and we are deciding on a large bolus. Going to the CGM isn't only about fewer fingersticks, though, it's about getting much better control of BG and having peace of mind.
     
  15. swellman

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    I will answer with "No". In our experience it will increase your finger sticks on average but I will qualify it by saying it does so necessarily because you will catch more highs and lows and will need to stick to correct. On the other hand it will decrease your need to stick when unnecessary like 2 hours after eating. If you have a good sensor and things are running close to meter then all you have to do is glance at the meter to see if your're on track.

    So, decreasing finger sticks, in my opinion, is a really bad sales pitch for a CGM. Getting a better handle on BG extremes is a much better pitch.

    EDIT: For the record, Darryl is the only person I have seen that relies as heavily on the CGM as a meter. Anywhere.
     
  16. sszyszkiewicz

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    Around here It reduced the number of fingersticks by a couple. say from 8 to 6/day. It helped at school a lot. After gym/recess for example he can just have a sense of where he is at without pulling out his kit, and he doesnt have to get checked at 2:00PM just before the nurse leaves for the day.
     
  17. kt_mom

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    For us its a yes and no. Some days the CGM allows us to test less, some days more depending on what her blood sugar is doing that day. We always test before treating high or low. Some nights I sleep all night and rely on the CGM. Some nights I know going into the night that we may be facing lows and I'll set my alarm to make sure I wake up and check the CGM. It usually wakes me but sometimes I'll sleep through it. But being able to tell if she's going up or down makes a big difference to us, especially when dealing with borderline lows. I can also treat a low and go on back to bed which is nice. Unless she's really low then I tend to wait in her room until I see it going back up good.
     
  18. Melissata

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    We have gone down to 6 pokes a day on average, from 10 plus. Nights are when it is most valuable for sure. I can't even imagine now only checking at 2am, because there are some nights that I am up several times. My daughter was sleeping through the alarms, so I now keep it outside her door, on the hardwood floor so it makes lots of noise. It won't stay connected any further than that in our house. Don't depend on it to get more sleep either, but the sleep you get will be better because you are not wondering if they are high or low. Last night we had a sticky low from midnight till past 2am, so I was up responding to that. My daughter recently had a mystery virus and her blood sugars were crazy high, we had to double her basal and still do a lot of corrections for a couple of weeks. There is no way I would ever want to go through that without a Dexcom. That being said, we do have sensors that are pretty inaccurate at times so there is no way that I would have her testing less. My son does rely on his more, and probably only tests twice per day most days.
    For the person that posted about possibly using it just one week per month due to paying out of pocket. We can almost always get two full weeks out of it, having to add tape to it at least once. We will be paying out of pocket for the Dex for my daughter soon, she will be relying on Medicaid only which will not pay for Dexcom.
     
  19. Darryl

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    Just wondering how often you do a confirming BG and have actually changed the treatment decision as a result?
     
  20. rgcainmd

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    Great point! Granted, we have only been using our Dex for two (glorious) weeks, but we have not once changed our treatment decisions after confirming with fingersticks. And we just finished up 4 crazy days of insane highs and lows due to an upper respiratory virus!
     
    Last edited: May 14, 2014

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