GCM

[jeepnik]

Over the years there have been threads that deal with diabetes and more specifically insulin. Turns out there are more diabetics on the forum than I would have thought. And, some pretty good information has been passed along. In that vein I want to relate my recent experience with a continuous glucose monitor or GCM.

I'm type two and have followed the usual progression from diet to diet and oral medication to eventually using insulin. This progression is very common in my family. Genetics sucks sometimes. Each step has been brought on by the failure of the previous step to provide adequate control.

When I went onto insulin it was a whole new learning curve. There were highs and worse lows in my blood glucose. Those who have ever suffered a serious low know how miserable and potentially fatal it can be. I went along fine doing finger sticks and thinking I was doing a pretty good job, except for those lows. Lately my A1C has been high, even though my finger sticks looked pretty good.

The doctors solution was to increase the frequency of testing, literally a pain. But I still wasn't in good control.

Now, I had been hearing about GCM's for several years. They sounded like a good idea. I even met a little girl that had her insulin pump slaved to one. It changed her life. The problem is they aren't exactly cheap.

I finally cornered my doctor and ask him about them. Well yes, the insurance did cover them. But only if certain criteria were met. I ask what those were and lo and behold I met them. So after practically threatening the guy he wrote out a perscription. I've been using the thing for over a week. And, it has literally changed my life.

I have learned an entirely new way to manage my diabetes and manage it much better. In this short time, I have figured out some of the things that caused the highs and made changes. Most importantly this thing has alarms and it has prevented several lows. The bottom line is I think they are something every diabetic should be supplied with, period. Of course we all know the reason they aren't is to save the insurance company money.

This part is a bit of a rant. But, one of the things doctors swear to is to "First do no harm". But by suppling the very best in medications and equipment to their patients they are doing harm. Particularly with something like diabetes. It's insidious. Mildly high glucose has no overt syptoms, but it slowly ravages things like nerves, circulatory system, kidneys and more. The lows do have symptoms, but sometimes happen so quickly it's a race to take before serious harm can be done.

Rant off. The bottom line is even if your doctor doesn't mention them, take a look at them and see if they might work for you. Then if they do research both our insurance and some of the low cost programs that the manufacturers provide. If your insurance does provide for them pin your doctor down. Sad to say that today that's just necessary sometimes.

[AJMD429]

.
Patient who I have had use them find that it is interesting because some of the foods that we would expect to throw their sugar off don't, and other foods that aren't supposed to throw their sugar off actually do. I think that illustrates how individual each patient really is. Exercise normally lowers blood sugar but I have a patient who has sugar Spike when she exercises, not that I don't want her to exercise, but it certainly changes what we would do with her insulin if she plans to do a workout.

Keep in mind that you do need to kind of recalibrate each week and want to always be able to double check with a finger stick.

[Alan Wood]

My boss at work has some sort of patch that interfaces with his phone that does this. i gather that it has been educational in the ways that AJMD has mentioned but it apparently tricked him into an ill advised insulin dose at one point. Blood sugar got down to 60! Cant say that I blame him for being wary of high blood sugar as he was hostpitalized for several days after a 3 day blackout and blood sugar over 600 on arival to the ER!

[Tycer]

My boss at work has some sort of patch that interfaces with his phone that does this. i gather that it has been educational in the ways that AJMD has mentioned but it apparently tricked him into an ill advised insulin dose at one point. Blood sugar got down to 60! Cant say that I blame him for being wary of high blood sugar as he was hostpitalized for several days after a 3 day blackout and blood sugar over 600 on arival to the ER!

My -100 year old neighbor managed her diabetes according to her mother’s recipe which included some sort of tell, a protein like eggs or peanut butter, and white rice. She used insulin daily for decades but hated sticking her fingers.

It’s nice to see the GCM is helping people. I know a couple of people I’ll share this with.

[AJMD429]

.
Just like the woodworkers say, "...measure twice, cut once..."

So never rely on one measurement for anything critical, medical or otherwise, no matter how technologically sophisticated the instrument is. So yes, if the CGM says to do something major, consider verifying with a finger-stick.

[jeepnik]

The literature that accompanied the system makes it absolutely clear that finger sticks are still necessary from time to time just much fewer. But the real advantage is being able to see a trend. If it’s rising too quickly you can take a small dose and catch the swing. More importantly if it’s dropping sharply you can act before things get bad.

Used wisely it helps prevent insulin stacking (taking insulin while a previous dose is still working). The idea of more real time information to keep you in your target range a greater percentage of time isn’t just used in medicine.

In my work we used control systems to monitor water chemistry and then make adjustments. A well controlled system rarely got out of parameters. Folks new to the systems usually make too many changes too rapidly abd get wild swings. Experience tempers this. I have a leg up on some because if that experience.

After all , the human body is just an electro chemical mechanism with a soul.

[Rimfire McNutjob]

I've been on the Freestyle Libre for about forever. It's really helpful. It does tend to read a bit low when sugars get low. For example, last night it said 41 but I didn't feel like I was that low. The finger stick said 62. Still low, but not the shaking and sweat inducing low that a true 41 would have been.

I also use an OmniPod pump. They don't talk to each other but I obviously use them together to maintain control. The best thing about a pump is the basal rate ... a continuous low dose to augment what your pancreas puts out. Without this, your sugars are more up and down like a yo-yo. It's also key to take a bolus hit before you eat so that the insulin will become active when the sugars hit from the food and help suppress the spike. I get into trouble there sometimes when I bolus and then get busy and forget to eat what I had planned. It's not long after that I get "that feeling" and realize my mistake and make a run for some juice from the fridge. I have those small tubes of Glucotabs spread around the house and in the cars just in case.

[jeepnik]

I’ve read the libre 3 has the ability to communicate with pumps but no software yet. I suspect, like many things getting approval takes time. Getting the 3 approved for use without the pump was probably pretty simple as itoan upgrade.

As to the yo yo’s the swings are much smaller so far. I tightened up the alarm range so I get notified before I get out of range. Same trick I used with water chemistry control systems.