CGM

Continuous Glucose Monitoring (CGM)

There is a lot of interest these days in Continuous Glucose Monitoring (CGM) and how beneficial they are to help manage type 1 diabetes. This post is a compilation of what options are available to you if you would like to get a Continuous Glucose Monitoring (CGM) in Ireland. I've compiled information from the two years that I have been using one of these devices myself, from talking to/emailing representatives from each company and also from the Diabetes Online Community.

It's worth remembering though that using a CGM can be information overload and lead to more anxiety around managing your diabetes that before. Always remember that everybody's diabetes is different and what works for you may not work for someone else!

This post is divided into three sections: What is a CGM, Which ones are available in Ireland at the moment and the piece you are probably most interested in, What are my Funding Options if I want one?

Firstly, What does it do?

A continuous glucose monitoring system monitors glucose levels 24 hours per day. It takes a glucose value every 5 minutes and gives the wearer an average blood glucose level and where it’s heading (trend arrow) for that hour.

One very important element of a cgm is to always remember that the glucose measurement is taken from the fluid between skin cells (interstitial) and not from capillary bloods in your fingertips like a traditional glucose meter. The reading from a cgm is approximately 10 minutes behind the reading from a glucose meter.

There are lots and lots of online articles on the benefits and disadvantages of using a cgm, google will provide that list for you. However, I have been using a cgm since November 2015 and I wrote about my experience with it here, here and here. And you can find out more about how they work, the advantages and disadvantages here

The system has three parts:

(If you know this bit already, skip ahead to the How do I get one section).

Sensor: This is the part that goes under the skin. It’s also the part that costs the most because the sensors have to be replaced between 7 to 14 days. A flexible wire is inserted under your skin, held in place with an adhesive patch and has a plastic cradle on top of the skin that the transmitter clips into.

Transmitter: The transmitter sits on top of the skin, collects the glucose information from the sensor and transmits them to a receiver.

Receiver: The receiver receives the information and displays it on a screen along with a trend arrow and often a graph of up to the previous 24 hours. (The Libre displays more than that).

Sometimes the receiver is built into an insulin pump like with the Medtronic Veo & 640G series or the Animas Vibe. And sometimes the information can be sent wirelessly to a compatible smart device.

 

There are three CGM devices available at the moment:

Dexcom G4 or the G5

Dexcom have a good reputation in this field and have been leading in accuracy. As far as I’m aware Dexcom can be integrated with only one insulin pump: the Animas Vibe meaning that you don’t need a receiver. It’s one less thing to carry around.

The G4 has been around for awhile but Dexcom are now focusing on their G5® Mobile CGM System where the Transmitter sends data wirelessly to your compatible smart device or your receiver where you can “View your glucose trends in vivid colors to know when it’s high, low or within range.”

Medtronic Guardian Connect

The Guardian Connect was launched in Ireland April 2017. It’s not integrated with any insulin pump just yet but I imagine that will happen in time. This CGM also transmits information wirelessly to the Guardian Connect app on your iPhone or iPod Touch only.

However, there is currently a global shortage of Medtronic Enlite sensors. The company has made the decision to maintain existing customer supply and has placed a freeze on any new CGMs being sold until next spring in Ireland. 

Flash glucose monitoring- Freestyle Libre

The Freestyle Libre is, Technically, not a cgm but a flash GM. The difference being that the wearer has to scan the sensor to get the glucose value and trend information. Here is a review that co-founder, Rebecca Flanagan wrote on behalf of her daughter who continues to use it. 

CGM's IN THE PIPELINE

Senseonics’ Eversense: a 180-Day CGM which received it's CE mark approval in Europe in September and is being trialed in many European countries at the moment. Also in clinical trials is the Nemaura SugarBEAT patch. The first-generation sugarBEAT® received CE approval in early 2016.

 

What are your options for getting a CGM?

I believed for a long time that they only way I could get a Continuous Glucose Monitor or CGM was through my diabetes team in my clinic. However, I have since discovered that there is more than one option to get your hands on one of these and more than one funding option. Read more about your funding options for CGMs here.

Thriveabetes 2018 Registration Now Open

It's finally here! I don't know whether to take a deep breath or to release the relief that we are getting there. Registration link is below. The team and I would like to say that we are really proud of the programme we have put together this year. We feel that you will be pleased and we have taken on board all the feedback we received from you over the years.

Thriveabetes is a conference organised completely by people with type 1 diabetes and focuses on the psychological impact of living with a chronic, lifelong condition. We aim to provide “Inspiration, Motivation and Information” to all people living with type 1 diabetes (adults, parents & children over age 5 years). It's going to be a great day:-D

Saturday, February 24th 2018 The Red Cow Hotel, Naas Road, Dublin.

The first thing you will notice is that our Registration fee has increased significantly. Thriveabetes 2016 didn't break even financially. We did have some funds left over from 2015 to cover the shortfall. This years registration fee reflects this but does cover a hot lunch and refreshments valued at €25.

 

Additional Conference Information;

Diabetes Bright Spots and Landmines; Book Review

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During the summer, I got a message from Niamh Downes about a new diabetes book that she was really impressed with called "Bright Spots and Landmines, The Diabetes Guide I wish Someone had Handed me". Some of you may be familiar with Niamh as the founding member of the FaceBook group Diabetes in Ireland and one of the founding members of the Dublin Adults with Type 1 Diabetes Group. Since Niamh messaged me I have started to read "Bright Spots" but of course it's going to take me a bit longer than Niamh, so I asked her if she would author a review of it. Thankfully she said yes.

 

Diabetes Bright Spots and Landmines by Adam Brown A review by Niamh Downes

I came across this book a couple of months ago through an article by Adam Brown on a website called DiaTribe. I’m signed up to their newsletter and regularly click in to have a read when they land in my inbox. In this case, the article that caught my attention was entitled “The Best and Worst Diabetes Food Advice I've Seen”. Definitely my kind of thing! Adam opens with that oft heard, well-meaning line, “You can eat whatever you want, as long as you take insulin for it.” This is a line I have often used myself and believed for a long time. But then, Adam said something that really struck a chord with me, as it took me a long time to realise and accept… this is possibly the most misleading diabetes food advice I have ever gotten. Theoretically, I CAN eat whatever I like, but in practice, despite my maths, my dual wave bolusing (insulin dose feature on an insulin pump that allows slow absorption of insulin), my clever little attempts to conquer the carbs, the fact is, the more carbs I eat, the less likely I am to have a good number. Which is very disheartening when you really are trying your best to get it right and you are certain that you got your sums spot on!

Having read this article and realising there was a book expanding on Adam’s experiences as a person with Type 1, I had to download it. And I am so glad that I did. While I don’t think I could ever be as disciplined as Adam I certainly took some very helpful and insightful things from Bright Spots and Landmines.

The book is split into 4 sections; Food, Mindset, Exercise, Sleep. I thought Food and Exercise were going to be the main areas of interest for me but, actually, I found Mindset and Sleep quite enlightening as well. In each section he looks at the Bright Spots; the positive behaviours and choices we make, the things we do right that we want to do more often, and the Landmines; the mistakes we make over and over again that affect not only our BG but our mood and life in general.

In the Food section, something that stood out for me was how he opts for 30 grams of carbohydrates at one time. While I can’t say that I stick to this, there is no denying that when I have 30g of carbs per meal, the positive effect on my BG is there to see. So now, where possible, I do try to stick to 30g-40g of carbs per meal. I opt for more veg over potatoes, pasta or bread, berries and yogurt over a bar of chocolate. I still eat crisps and cake, don’t get me wrong, but I try to make choices that won’t lead me down the landmine path and potentially ruin my day! At least now when I make the 90g carb meal choice I am under no illusions what I am letting myself in for.

In the Mindset section he speaks of our BG and trying to get yourself to think of your readings as just a number. It is information to make a decision. I think he describes it very well when he compares it to flying; “Would I trust a pilot using only three GPS readings over the course of a 15-hour flight? Or would I feel safer on a plane flown with GPS information updated every few minutes, plus trend arrows to guide safe flying? The plane’s current location is information to drive an action. Diabetes is no different! Frequent BG data points are my friend and help me navigate the daily diabetes journey safely: 1. Confirms the plane is flying smoothly; or 2. Shows the plane is NOT flying smoothly and a course correction is needed.” In the Exercise section, his suggestions on how to navigate the effect exercise can have on your BG, to avoid those highs and lows and the corrections that need to be made as a consequence, are practical and useful. He advocates doing exercise you find fun and look forward to, uncomplicated workout routines you can easily do at home so there are no barriers or excuses.

In the Sleep section, he emphasises the importance of getting enough sleep, and quality sleep at that and the effect it can have on your BG. He discusses the night-time highs and lows that disrupt our sleep and offers some tips and tricks to keep these to a minimum.

Overall, I found that everything Adam suggests is doable. There are no expensive gadgets or equipment required, no radical idea’s suggested, no upheaval to your life necessary. Yes, these are lifestyle changes and mindset changes, but they are achievable, they are easily done a little bit at a time and they do have positive results.

I know I won’t ever manage to do everything that Adam does, but I also know that everything he has suggested makes sense, and there is a lot of it that I try to incorporate into my life and I can always refer back to his Bright Spots and Landmines to correct my course and navigate my journey safely when I need to. Diabetes is manageable, yes, but it’s tough, it's “my other full-time job”, and just like my regular full-time job, the more prepared I am, the better my day goes. You may decide that some of his suggestions aren’t for you, but I guarantee you will find something in this book to make you stop and think, something you can incorporate into your life to ultimately help reduce the number of landmines in your path and make the most of the bright spots.

The book is available to download here for free but you can make a donation. I would; it’s totally worth a few euro!!

*** Thank you so much Niamh for your review.