Entries tagged 'CGM'

Tuesday, July 1st, 2008

CGMS Denial Day

I’ve been lucky enough to be on a continuous glucose monitor for the past two weeks.

Already, I’ve seen trends in my blood glucose readings that have gone undetected with the traditional glucose testing (e.g. my readings seem to rise to 180-200 mg/dL between about midnight and 4 a.m., before dipping by the time I wake up).

While I’ve found my CGMS to still be tempermental at times, and often less than 100 percent accurate, particularly in the first couple of days for a new sensor, this ability to analyze trends has shown itself to me to be a revolutionary advance in diabetes care.

Unfortunately, many (if not most) diabetics face a bewildering and dispiriting appeals process to get their CGMS approved and covered under their health insurance plans.

Been sent to the hospital a bunch of times for out of whack readings? Crashed a car or four due to low blood sugars? Relying on the local paramedics every few months to revive you after you pass out? You might have a chance of being covered.

Just trying to keep yourself out of the hospital and tighten your control? Good luck.

Most that do choose to fight that fight get denial letter after denial letter, often because their insurance companies have decided it’s cheaper to deal with an occasional hospital stay than to prevent those stays in the first place.

Even if you do happen to be lucky enough to get coverage, like me, you’re often left footing a sizable bill — $75/month for me, and I’m on the low side of average.

Today, diabetic bloggers across the country are standing up to say that CGM systems are not experimental, rather revolutionary, and should be covered for all diabetics as a critical part of patients’ efforts to improve blood glucose control, lead happy and healthy lives and reduce long-term medical costs.

Furthermore, these devices and related supplies should be covered at the same level and co-pay as any other prescription, as they are as critical as insulin, test strips or insulin pump supplies to healthy and complete care.

 • Email This Post

Monday, June 23rd, 2008

CGM: Day 4, the Ice Cream Problem

It’s Day 4 with the CGM and my questionable sensor actually seems to be working.

I have found it to be really amazing to watch the graphs of my blood sugar and how they differ depending on my food intake — always smooth, but with differing peaks and slopes.

Today’s challenge? The Diddy Riese ice cream sandwich I ate for lunch today. Usually I’m a pretty healthy eater, but after an early flight to LA and a late breakfast after getting into town, a scoop of cookies and cream squeezed between two freshly-baked cookies sounded like just what I needed.

I took an good amount of insulin for the carbs and even extended 60 percent of the bolus over the next hour and a half to try to deal with the ice cream.

But my blood sugar curve kept rising — for the next four hours! It’s finally on its way back down now, but the slow climb clearly illustrated how much fat was in the ice cream (and how far I really need to run to work it off).

I’m hoping that when I finally start to pull my CGM numbers off my pump that I can actually learn from all of these experiences (and mistakes) and come up with a dosing plan that can survive an attack of the Diddy.

 • Email This Post

Saturday, June 21st, 2008

CGM: Day 2

I’ve made it to day two with my new continuous glucose monitoring system. The first sensor actually did a pretty good job identifying sugars approaching 250 mg/dL due to a kinked infusion set. Score a point for Medtronic.

Given that this is only day two, however, I was pretty upset this morning when my first sensor became so loose (despite the IV3000 dressing) that I had to pull it out. Granted, it was 102 degrees in San Francisco today and I was sweating like a pig, but it is summer, and I’m sure someone has invented a strong enough adhesive to keep a sensor affixed.

I just inserted a new sensor, but noticed that I can actully see where the wire enters my skin. (red circle) I used the Sof-Serter insertion device, so I’m not sure why I got such a FUBARed site, and I’m now waiting the requisite two hours to see if it actually works after it’s calibrated.

I’m skeptical, however, as the Sensor Isig (number the pump converts to a reading in mg/dL) is 24.06, which seems substantially higher than the isig readings I was getting with sensor number one. From what I’ve been able to find, the isig readings generally equal about 1/10 of your actual blood sugar.

That is the whole point of calibration, but I’m betting on the site screwup being the true cause and expecting some CAL ERRORs when the waiting period is over.

But only time will tell. T-minus 40 minutes until the calibration…

UPDATE: 1:02 a.m. Seven hours post sensor change and I’m honestly not sure whether the CGM is working properly or not. The meter is receiving data, but the isig is still pretty high (17.64 for 112 mg/dL) though not out of the ballpark. The readings, however, have varied only from ~70 to ~90 since insertion, despite eating a fairly hearty dinner. Either I really nailed my carb counting or the CGM isn’t picking up the changes. I’m going to stick with this sensor for now (and not waste another $35) and see what tomorrow brings.

 • Email This Post

Thursday, June 19th, 2008

CGM: Day Zero

So after an unexpectedly short battle with Anthem Blue Cross, my continuous glucose monitor arrived yesterday. It’s a Minimed Paradigm system, which integrates with my Paradigm 722 insulin pump.

I usually don’t blog about my diabetes, but felt like I should make an exception this time as CGM is a pretty new technology, just starting to gain traction among the diabetic community. Insurers are generally less-than-thrilled about paying for the $1000 devices and $35 sensors, which have to be replaced every three days.

In any case, “thanks” to my history of low blood sugar reactions, Anthem ponied up 70% of the cost and I was in business.

I was surprisingly pleased when the transmitter came pre-charged (it claims to only need 20 minutes of charging every three days). It’s a little bit bigger than the size of a quarter, maybe a quarter-inch think and waterproof.

The sensor itself looks similar to an infusion set, but with a thicker needle and its own inserter device. The needle pulls out, leaving a thin wire underneath the skin. Unfortunately, it goes in at an angle, something I’ve never much liked, preferring 90 degree insertion angles.

The transmitter clips on to the sensor fairly securely, but does not adhere to the skin at all, leaving this thousand-dollar device looking like it could get knocked off by a rogue waistband at any time. Medtronic includes a series of transparent dressings to cover the entire unit, however, which helps a little bit.

The biggest surprise of the day was that the sensor takes three hours to initialize and calibrate, at which time you check your blood sugar and then (finally) begin to receive readings. The readings, coming from interstitial fluid, lag behind your actual blood glucose readings by at least 20 minutes, which can also be frustrating.

So much for not having to check my blood as much; instead, I feel like I’m checking it even more often.

Anyway, with high and low glucose alarms set, I’m off to bed for the first night with CGM. More to come.

 • Email This Post