Thursday, February 23, 2006

My last blog centered on how I had just been put on the CGMS by Minimed. Before I kind of review this experience, I wanted to address some of the comments on my last posting.

CGMS- is a constant glucose monitoring system, put out by Minimed. It looks similar to a pump, in my opinion, but is slightly bulkier and the screen and buttons are a little different. It has some kind of sensor device which is inserted under the skin with what looks like a Sil-serter and is worn usually for a 3 day period, tracking and recording glucose values.

The system I used, did not make it possible to view the readings. I knew prior to using it that I would have to wait until the 3 days were over, for the results were downloaded by the physician's practice. I admit, I am curious about those readings and, also, the accuracy, but this was the only thing available to me at the time.

As far as I know, it is available pretty much everywhere, but for those interested, I would check out Minimed's homepage to verify this (www. I think there is a lot more information to be found there. Also, I'm sure MM's explanation of this system is a lot better than my own, but I will do my best to try and explain it as best as possible.

The device takes blood sugar readings once every 10 minutes, I believe. However, the user has to also keep taking their own tests, at least 3 to 4 a day, to keep it calibrated. In addition to that, the user also has to keep record of blood sugar, insulin doses, food intake, and misc. info. The CGMS is designed for the person to enter in blood sugar readings at least 3 x a day and also to enter in certain "events". These events include when eating a meal, taking insulin, exercise, or any other significant happening. After the period of wearing this sensor, the doctor, or whomever would interpret these results, would download the readings from the sensor. It would also put a little flag on the graphs and reports it prints showing when these "events" took place. From the results, the doctor could see if certain changes need to be made or if things should be left alone.

Currently, I'm coming to the end of my time wearing this thing and, to be honest, I'm concerned. I'm not sure that this experience is really going to help me. I know, I know...I need to stop being so doubtful of everything, but I guess it's just the pessimist in me. I want this to work for me, I really do, but I can't help thinking that there are problems with this system.

Actually, I've had these doubts even before making the arrangements to try this out. The thing I am most concerned about is what you can really conclude from wearing this sensor. The last three days have been dramatically different from each other. So when that happens, how do you know how to change things or make adjustments? The Rep assured me that by wearing this for 3 days straight, there is a lot that can be told about your current control and regimen, but I am not convinced. Like basal testing and research studies, these things have to be repeated again and again before any conclusions can be made. I've worn this only once for 3 days, I'm not sure that's enough to draw conclusions.

Yes, I know, there's a heck of a lot of readings and things going on that I am not privy to. However, from the readings I've been having(with my flash monitor), I can see that each day has varied greatly from the previous. So my question is, if there's no real pattern, then how would my doctor know how to make changes in my current regimen? The only predictability is that things, concerning my current control, have been and will remain to be considerably unpredictable. I'm beginning to think that's the whole nature to this disease, well, for me anyways.

Then the other thing I'm concerned about is that I don't think it's painting an accurate picture of the problems I've been experiencing regarding exercise and the persistent highs after dinner and before bed. During the last 3 days, those things haven't been happening as consistently as they had been during the last several months- which totally confounds and confused me. For so long I've battling this issue and now that I'm wearing this sensor, my body decides that it's not going to react it's usual way?'s just my luck.

Monday (day of being placed on this system), I exercised in the morning, as opposed to the time I regularly go, which is after work. That night I ate a good dinner and tested as usual after I ate. To my surprise, I tested in at 155 after dinner. This is an extremely good reading for me, considering that most my readings are usually well above the 200 range during this time. However, as happy as I was at this reading, I thought, well, maybe I should have gone to work out during my usual time- so that the sensor and my doctors would be able to see the problems that I usually experience.

So I decided Tuesday to go to the gym after work. Before I went, I tested my blood sugar and, unfortunately, came out with a high reading (255). I honestly didn't feel high- I even felt a little like I do when I am experiencing low sugars. So I repeated the test only to find out basically the same results. On the way to the gym, I thought, I better not taking any chances-so I ate half of a balance bar, just to be on the safe side, and set a temporary basal. I finally got to the gym, did my workout, and left. I noticed that I felt pretty good after my workout- better than I usually do, which I found odd. I tested that night and came in at about 104, which is perfect, but not what I wanted the sensor to capture. Then to top it off, I was still in "good" range after dinner as well. My post dinner reading was 98- ugh. Why couldn't my readings be this good most other days?!

Last night, I again ventured to the gym after work. My pre-workout reading was in the 130s, so I decided that I better have a snack before hand and also set a temp basal. I knew that starting this low, I would drop pretty quickly if I didn't do those things, at least that's what I thought.

Well, I was wrong. I guess both things put me over the edge. My post-workout reading was 190- which, again, was not a good representation of what usually goes on. For the rest of the evening, I continued to stay in the high range, even though I had taken a correction and had taken more insulin than I thought necessary for dinner. I finally started to come down before bed...the last reading for the night was 175.

Yes, it's a little disappointing, b/c I thought the purpose of this device was to capture a fuller picture of the problems and issues we experience as Diabetics. Don't get me wrong, I'm sure it has probably caught some patterns or possible trends. However, I'm not sure that it captured what I was hoping it would.

I guess, on the bright side (I'm trying here!), if it helps in any small way, it will be worth it, but I was hoping it would help to solve the main issues, which is my exercise and the impact is has on my sugar levels. I guess that might mean that my basal testing may continue, but maybe that was the better way to go anyway.


Blogger Scott K. Johnson said...

Hi Andrea,

I know it's frustrating, but stick with it. It takes a lot of trial and error, which is so very frustrating, but it really is the only way.

This is all stuff I'm still working on to - after 25+ years - so I don't say all this as if I've achieved perfection - I just want to offer my thoughts on the subject.

First thing I would do in your situation would be some serious basal rate testing. That is your foundation - if your basals are not right, you can't get any of the other numbers pinned down. They will be as elusive as trying to hold a ball made of Jello.

Here is a guide that walks you step by step through testing and adjusting. This guide is from the cozmo website - it's just what I'm familiar with. I would imagine you could find something similar on the MM website, or in the Pumping Insulin book (have you read that? - it's excellent).

It's all about eliminating variables, and repeating tests to verify the findings.

I really think that's your best first step. It's also important to not make large adjustments based on one test. It's test, repeat, test, adjust, test, test, repeat, etc. It's very time consuming, but it's the only way. There is no easy button to figure it all out for you.

Once your basal rates are good, then you can switch your focus to other parts, such as verifying your insulin/carb ratio (and verifying that ratio for different times of the day), then verifying your correction factor (and again for different times of the day). Then you can work on testing temp rates for exercise (which is BY FAR the trickiest to do).

Again, eliminate the variables as best you can. That's terribly hard, as each day is often it's own day and is very different, but that's what you're shooting for.

I know it's frustrating - but again, stick with it. I know you can do it, and you will feel so confident with your ability to better manage your diabetes and know your body and how you react to things.

Best of luck.

9:47 PM  

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