I have been using a Continuous Glucose Monitor for 3 years and I’ve worn it pretty much 100% of the time. I did try to go one weekend without it just to feel a little freedom from devices but I only lasted about 24 hours. For me it’s one of the most valuable diabetes tools I have and here’s why.
Before I go on my “spiel” I know that glucose sensors are not for every single person with diabetes BUT they do help A LOT of pwds. AND, I also know that I’m one of the less than 1% of the type 1 adult population in Ireland who actually is lucky enough to have one. Luck should not have a say in it at all!
** Also included in this post is more information about what a Glucose sensor is, the different types of sensors and I've also included a link to tips for getting a CGM in the second half of this post.
HOW MY CGM HAS MADE LIFE BETTER FOR ME
In the 3 years, that I have used a glucose sensor, there are several times a week I have a “I’m so glad I have a sensor” moment and here are some of those moments and how they have made my life and my diabetes better.
Night time hypos
Night time, or nocturnal hypos, are the reason I was approved for my cgm. I would frequently wake up in the morning with a murdering headache, I would feel not well rested and have high glucose/sugar levels. I just happen to read online about the symptoms of nocturnal hypos and I realized that’s what was going on with me. I was sleeping through hypos and not waking up. Not only is this scary but there are occasions where it might be fatal.
Sure enough, within the the first two weeks of sensing I had the supporting proof. I had glucose information from every night and could see that there were points where my levels were too low. I was able to pinpoint where I needed to reduce my insulin and eliminate them.
I could not do this with finger stick checks because I could never catch them.
1.1 Reduced Anxiety
I no longer go to bed wondering is this the night I sleep through a hypo and wake up with a thumping headache. Or is this the night I sleep through a hypo and don’t ever wake up at all. I never even realized this was something I worried about til it was gone.
2. Daytime hypos
Life before sensor - As a family, we often have days out and a number of years ago, while on holidays, we went to Dublin zoo. The ticket line was very long and by the time we got to the desk I felt my hypo. I couldn’t check with my meter in the line as it was moving and I couldn’t step out easily because of the barriers. I shoved a couple of glucose tabs in my mouth to curb the symptoms and as soon as we got through the turnstile I found a bench and did a check. So now, I had to wait about 15 minutes plus have another snack before we could enjoy the day the children had been excited about for ages. Can you imagine? It was like telling them on Christmas Eve night, “no darlings Christmas is not tomorrow, it’s the next day”
Life with sensor - Myself and my family get to enjoy every single moment of all the fun stuff we do. I can have a quick look at my sensor information and determine if I need to top up on carbs or not. No more sweaty, anxious moments in lines while trying to have fun.
3. Hypo Prevention
Life before sensor - the only way I could tell if my glucose levels had dropped too low was if I had symptoms, yes, while I was actually having a hypo. If I was having a Hypo I would have to stop whatever I was doing because the symptoms were clouding my brain, my body would feel like it was on fire and my brain would tell me that I needed to consume the entire contents of my kitchen, which I definitely did not need to do. It would also take at least 10-15 minutes for the fast acting glucose to kick in and bring my levels back to range.
Life with sensor - I have an alarm on my glucose sensor that goes off if my levels hit 4.4 mmols. I have it set at this number because it’s before my hypo states: this means I can prevent a hypo before it happens.
How many 10-15 minute segments of my days have I re-claimed through having a glucose sensor and my family how many have they!
4 Diabetic ketoacidosis (DKA) Prevention
I’ve only ever had 2 cases of DKA. Well one really, because the second was prevented.
Life before sensor - I use an insulin pump to deliver my insulin and every three days I have to switch out the needle under my skin for a new one and refill my insulin reservoir. I usually do this before I go to bed because I’m not rushing around.
On this occasion, I did my set change and went to sleep. I woke up early the next morning feeling really, really tired, thirsty and just not quite right. When I check my glucose I was really, really high: 25 mmols. My first thought was that i was coming down with a bug so I took some insulin and made a pot of tea. I decided to wait for 30 minutes before I ate so that the insulin would be active.
I lay on the couch. I couldn’t even drink my tea I felt that wretched. When the 30 minutes was up I checked my levels again and they were 22 mmols. So a lower number than 25 but were they coming down or was it the margin of error? I waited 15 more minutes, now I was vomiting which confirmed my suspicions about a bug, checked levels again, no change, so I took more insulin via my emergency insulin pen that I keep in my fridge. Waited another 30 minutes, my levels were 17 mmols.
Now, I was ok to nibble on breakfast. However, after breakfast I was back up to 27 mmols and it occurred to me that it might actually be a bad site where the needle is under my skin because I’ve all this insulin in my system and still crazy high levels.
I did a completely fresh set change and when I removed the old needle I could see it was bent over. The insulin wasn’t getting into my system at all. My levels came back into range by mid afternoon but it took the entire rest of the day and evening to recover. Thankfully it was a Saturday.
Life with sensor - The night before our holidays about two years ago, again I did an insulin pump set change and went to bed. A couple of hours later, my sensor alarm alarmed. I have my high alarm set to 11.1 mmols. Nothing too wacky about 11.1, so I took some extra insulin and went back to sleep. An hour and a half later my alarm went off again telling me my levels are 12 mmols. I thought maybe this is the slow releasing carbs effect or impending travel stress, we were going on holidays the next morning and flying, so I took some more insulin. Again another hour and a half later my alarm went off this time telling me my levels are 15 mmols. So I got up did a fresh set change and took some more insulin. I slept the remaining few hours until my “wake up” alarm went off and my levels had returned to normal. I felt a lot tired but I was able to get everybody out of the house and to the airport for our holidays.
If I didn’t have a glucose sensor I probably would have had a repeat of the previous experience and I definitely would not have been able to get on an airplane.
*** Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. See more info here.
I could go on some more because I haven’t even mentioned about having a sensor to keep me and others safe while I’m driving. I haven’t mentioned that I have reduced the number of finger strips I use by half. Or I haven’t mentioned how much it’s improved my HbA1c and increased how much time my glucose levels are between 4.4 and 11.1 mmols.
It’s so much easy to manage my glucose levels and I can’t understand how resistant healthcare professionals are to prescribing this technology. Some clinicians don’t even discuss it with patients they know actually meet the qualifying criteria.
Let’s at least talk about CGM as a treatment options in our clinics!
What are glucose sensors / Continuous glucose monitors / CGMs?
Glucose sensors are small devices that sit on your skin 24 hours per day and take a reading of your glucose levels every couple of minutes. Then, they average that reading over the hour and tell you if your glucose levels are rising, dropping or holding steady. More info here.
A lot of people will have heard about the Flash glucose sensor, the Freestyle Libre since it’s launch in Ireland in 2016 and some Irish people were able to get a hold of it in 2014 when it was launched the UK.
However, CGMs have been around for 10 years, yet many people with type 1 diabetes are unaware they exist.
“Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use. But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.”
says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine.
What’s the difference between Flash and Continuous?
Not a huge amount. The Flash is the Freestyle Libre and Continuous sensors are the likes of the Medtronic Guardian Connect or the Dexcom devices. There are differences such as the cost comparison and how many days they last, but most of their differences are minor.
I’ve used both a Continuous Glucose Monitor and the Flash glucose monitor: the Freestyle Libre thanks to Abbott in October 2017. I found the only real differences between the Flash and the Continuous are:
the CGM alarms, the Flash does not and
in how the data is obtained: in Flash you scan a reader/phone over the sensor in CGM you press a button on a receiver/phone.
Both device types give you 24 hour glucose profile called an Ambulatory Glucose profile AGP and a trend arrow.
The Medtronic Guardian Connect and the Dexcom CGMs are covered by the HSE. The qualifying criteria is strict but actually common in people with type 1 diabetes (if only you had a CGM to find out that you qualify). You can find out more about the CGM qualifying criteria by searching through this copy of the National Clinical Guidelines for Adults with type 1 diabetes.
Here is the link to tips for getting a CGM.