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Needing an Intro to CCSM's

Discussion in 'Continuous Glucose Sensing' started by Grace's Mom, Feb 3, 2010.

  1. Grace's Mom

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    My daugther was dx July 19th. We expect that dr will write for a pump at next appt. I think I understand the basics about a pump but I have not been able to grasp the CGSM concept very well. Can someone give me the basics on it, or recommend a link with basic info. I read through several postings here, but they all assumed that I knew more than I do.

    Thank you! I'm wondering if a CGSM is something we need to be asking for when we discuss the pump this month.

    PS My daughter is 8.
     
  2. Flutterby

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    a cgms is a continuous glucose monitor system. Its a sensor, that goes into the innersitial fluid under the skin. a transmitter that connects to the sensor and then a receiver to read the information.

    There are three cgms companies; Dexcom, Minimed and the Navigator.
    Minimed is the only company right now that you can have the receiver also be your pump, so the child is only caring one unit. Dexcom is working with the Animas pump company to do intergration, so only the pump is needed. I believe they are also trying to work with Omnipod. Navigator was working with pump companies but I don't know if they still are.

    Kaylee uses the minimed pump and the minimed cgms. The minilink is the one that is used with her pump, it sends the info right to the pump and graphs it there. There is also the guardian. This is a stand alone unit, meaning you dont need the pump, it has a seperate receiver.

    After you put the sensor in and connect the transmitter you need to calibrate the sensor in two hours (minimed, and dexcom, I believe.. navigator has a 10hour warm up, I believe) You need to calibrate because the sensor isn't actually in the blood, but in the innerstitial fluid, which lags behind the blood. The sensor takes its number, called an ISIG, and the blood sugar reading that you put in and sends over a number to the receiver that we understand, the steadier the blood sugar is when you calibrate the better the sensor will read. It can lag behind, especially when blood sugar is changing rapidly. For Kaylee, its very accurate. usually within a few points of the blood sugar reading. I just looked at the info and the sensor average is 162, and bg average is 160.. so this sensor has been very accurate.

    you can down load the information onto the computer and overlay the days to see trends to make changes.

    MM sensor ends after 3 days, we just hit new sensor, and let it go for another 3 days. Dexcom is worn for 7 days, and I think the navigator is 3 days.

    I hope I answered some of your questions. :)
     
  3. Grace's Mom

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    Okay, so that's huge information, thank you. Now what's the benefit of it? I've heard of vibrating or beeping, when does that happen? Does it 'talk' to the pump and dispense insulin or do you need to tell it to dispense based on the alarms?

    thank you bunches for helping me learn!
     
  4. Flutterby

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    It sends bg information to the pump, but it doesn't make the pump give any insulin. They are working on that. MM (minimed) calls it a closed loop system. Animas/dexcom are calling it an artificial pancreas.

    The benefit is that, for us, its cut way down on finger pokes. We were testing 15 (+somedays), her poor fingers. This allows up to SEE the whole picture. So instead of seeing what her bg was at 9, 12,5, and 10.. ican see what is going on inbetween that.. Compair it to pictures. The finger pokes are the pictures, the cgms is the movie.. you get a better idea of whats going on.

    This is the sensor and transmitter. The clear is the sensor, the shell shaped white piece is the transmitter
    [​IMG]

    this is her pink minimed pump. With a graph just starting. The number to the right is what her number was then, the line on the face of it is the number being plotted into a graph.

    [​IMG]

    The guardian piece, which looks just like the pump above, but its black and has no insulin reseveroir, has a few extra alarms that the pump does. It has predictor high and low, so we get an alram 30minutes before a high and 20minutes before a low. This helps so we can check her and get insulin going before she gets to high and with the low we give a glucose tab and avoid that low all together. We DO NOT dose insulin based off of the cgms, we do a finger poke. A predictive low, we give a glucose tab unless she's feeling low.. she is hypo unaware, so that doesn't usually happen. IT has has rate change alarms. Rate rise and rate fall.. meaning she's falling or rising fast. There are also alarsm for low bg and high bg, all of these alarms can be set to your child specifically.

    We are currently using both the pump and guardian unit..the signal is being sent to both the pump and the guardian.. I, or the teacher, holds onto the guardian, and Kaylee's always wearing her pump. We did this so we can keep the guardian up front in the car, and we can see what she's doing at home without bothering her all the time. The school liked the idea and decided to try it out.
     
  5. ecs1516

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    The Navigator is approved for 5 days. Many people go beyond that to 10 days or a little less by restarting. The same is done for Minimed and Dexcom.
     
  6. Gracie'sMom

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    Hi Grace's mom. I'm Gracie's Mom. My Gracie is 9, dx'd at 7. Most of the units have websites, of course they only tell you the good things:) The nice thing about mini-med is that it's linked with the pump. Dexcom isn't linked yet, although that is in the plans. We use the dexcom, because we already had and liked the ping (Animas). The sensors last 7-12 days for us, we do a re-start at 7 days. It has been great for her. She checks a lot less at school because she can be reassured by looking at the monitor. Also, the nighttime alarms allow you to be more aggressive with doing night-time corrections. We set it to alarm if she is low or very high. It also allows you to see her trends so that you can make changes to prevent the peaks and valleys on the graphs . . . keep her more level. The downside is it's expensive, the sensors have problems and go thru sensor failures, it's another tech device to carry with them, and it's another thing to insert. Still, wouldn't trade it . . .
     
  7. frizzyrazzy

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  8. Stanca

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    Does it hurt?

    Does the continuous glucose monitoring system cause the child discomfort/pain? we are very interested in asking for one of these, but worry about it causing too much discomfort to our daughter who is 8. We are doing MDI with humalog and lantus. She gives herself the injections and has been very brave at school and at home, but she worries about the pump hurting her and about the glucose monitoring system being uncomfortable, too. I read in a book not to be fooled by claims that products are "virtually painless."
    We are fairly new to D. Our daughter was diagnosed on 12/23/09...less than 60 days ago.
     
  9. Flutterby

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    If she's worried (and what kid wouldn't be) get some numbing cream. We use EMLA as a numbing cream for sensors.. we also used it for pump sites but no longer do, its much quicker to do it without and really doesn't hurt.. every once in a while it will hurt Kaylee, but goes away quickly.. she's been pumping since age 3, but if we started pumping now (getting ready to turn 7) I would still start with numbing cream.
     
  10. Stanca

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    Thank you

    Thanks for the tip. I will write this down!
     
  11. hawkeyegirl

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    We are another BIG, BIG fan of EMLA. Jack hated shots and cried for every one. With the numbing creme, he sits calmly on the couch while we change his site or sensor. It is a godsend for kids who are needle phobic.
     
  12. frizzyrazzy

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    add one vote for no numbing cream. Ian's pumped exclusively without numbing cream and had a MM sensor inserted without cream too.

    I really depends on your child's own perception and threshold of pain. I would try it on yourself FIRST too - then you can give her an honest opinion.

    For me, I find neither the sensor or a site to be painful. For your child, I would attempt to do without and then add it in if you think ti's needed, but if you start using it you'll always use it - I see very few families who can get rid of it after the fact.
     
  13. Mom264

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    We used to use numbing cream (generic lidocaine/prilocaine combination) back at age 5 when dd used an insuflon, which has a fairly large needle and no inserter, for MDI and then later when she got her first pump.

    By age 7 she was using ice. But, it happend by accident. She'd been swimming at an indoor pool at a hotel. Her site had come out and she was anxious to go back into the water and did not want to hang out in the room while the numbing cream worked.

    Two minutes of ice, the site was in and she was bounding back toward to pool.

    Once I realized she could do it without the cream, I stopped using it. I also use ice for the CGMS sensors.
     

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