Continuous Glucose monitor
Continuous Glucose Monitors
Sriram started using the Dexcom G6 continuous Glucose Monitor this month(September 2018). Initially, I was planning to write about how the G5 CGM changed the way we take care of Sriram's diabetes and how much it has changed the outlook towards highs and lows. But, before I get to it, I just want to take a moment to pause and think about the lives we have lost this month. At least 3 kids have lost their lives to T1D just this month according to various posts in social media. I don't know if they were all using any kind of continuous glucose monitoring systems or not. But, all I know is even with all the scientific advancements we are seeing such loses.
We were told that this is the best time to be diagnosed with this disease as science has improved so much. Well, guess what? No, its not. This disease sucks and probably it always will. Science is advancing by leaps and bounds each day. But, accessibility isn't. There is a sizable amount of folks who are not on these monitoring systems or insulin pumps due to various factors including costs, availability, lack of awareness etc.
We were told that this is the best time to be diagnosed with this disease as science has improved so much. Well, guess what? No, its not. This disease sucks and probably it always will. Science is advancing by leaps and bounds each day. But, accessibility isn't. There is a sizable amount of folks who are not on these monitoring systems or insulin pumps due to various factors including costs, availability, lack of awareness etc.
We were introduced to Dexcom, a continuous Glucose Monitor on the day of the diagnosis. Stanford, being a teaching hospital, hosts a number of clinical trials. One of the study coordinators met with us on the day of Sriram's diagnosis to discuss about a Dexcom G5 study. I can't recall the exact goal of the study as we were overwhelmed with the diagnosis that day. Dexcom G5 was already approved and in use by that time and it was well on its way to get FDA's approval for treatment without any finger pricks.
The basic framework of this system involves a sensor or monitoring device placed on the body and a standalone receiver that gets the blood glucose data from this sensor every 5 minutes. Apart from the stand alone receiver, an iOS device can also be used to get the data via Bluetooth. The iOS device, typically an ipohone(but ipod will work too as long as there is wireless connectivity), sends the data to the cloud when its connected to internet. Caregivers can subscribe to the data using an app on their phones. The whole thing sounded pretty far-fetched to me that day. But, Sriram was hooked into the idea from day 1.
Sriram started using the Dexcom G5 monitoring system couple of months after his diagnosis. It was really scary to see the highs and lows in the first few weeks. We knew that, his blood sugars were fluctuating even before we got the CGM and probably much more before the diagnosis. It is just that we were not able to see the data until we got the CGM.
I distinctly remember his first day at school after he started with Dexcom. His CGM was constantly alerting. Neither Sriram nor his teacher didn't know what to do with those alarms and he ended up spending most of his time in the nurse's room waiting and retesting that day. Sriram was very upset at the end of the day. He started to cry the moment we entered home. That was the only day he cried since his diagnosis.
His CGM was alarming a lot initially. This is despite the fact that his high threshold was 200 back then. On the day of diagnosis, we were told that we have to prebolus, that is, give insulin 15 mins before he starts eating and also not give more insulin atleast for another 3 hours. We tried to prebolus as much as we could do for an unpredictable eater. At the same time, we didn't give any corrections. This resulted in those constant alarms.
I don't think we made a good use of Dexcom until we started hearing the Juicebox podcast. We slowly learnt to prebolus and take actions based on the direction of blood glucose movement in Dexcom. Eventually, we started waiting until Sriram's blood sugar moved downwards and stayed that way for 15 minutes(3 readings).
We have brought down the high threshold to 150 now. Even with the artificial pancreas system, his CGM beeps few times in an hour. It helps me to get in touch with him to make sure that things doesn't go out of control.
A CGM is a game changer because of many reasons. Some of them are,
Having said all that, the only downside I see with the CGM is, its constant flow of information might create anxiety in some care givers. I'm a victim of this to a certain extent. I'm a only child to my parents. They took great care of me. But, they were helicopter parents all through my life. As a result, when I gave birth to Sriram, I made a conscious decision that I will make sure that I'm not going to be a helicopter parent. But, since he started using a CGM, I feel like I have become a drone. This is definitely one of the unintended consequence of the CGM.
The number of alarms has gone down tremendously since Sriram started using the Loop system. Technologies such as Loop or other Artificial Pancreas System wouldn't be here if we never had a reliable Continuous Glucose Monitor in the first place.
I feel that every type 1 diabetic child and even adult should have access to this amazing technology. Mahakavi Bharathiyar, one of the famous poets from my country famously said that "Thani oru manithanukku unavu illai yenil intha jagathinai azhithiduvom !" In English this translates to, "when there is no food for even one single person, we have to destroy the whole world." My feelings towards the CGM would be very similar. I wish there would be a day when every person diagnosed with Type 1 will walk out of the hospital with a CGM.
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I distinctly remember his first day at school after he started with Dexcom. His CGM was constantly alerting. Neither Sriram nor his teacher didn't know what to do with those alarms and he ended up spending most of his time in the nurse's room waiting and retesting that day. Sriram was very upset at the end of the day. He started to cry the moment we entered home. That was the only day he cried since his diagnosis.
His CGM was alarming a lot initially. This is despite the fact that his high threshold was 200 back then. On the day of diagnosis, we were told that we have to prebolus, that is, give insulin 15 mins before he starts eating and also not give more insulin atleast for another 3 hours. We tried to prebolus as much as we could do for an unpredictable eater. At the same time, we didn't give any corrections. This resulted in those constant alarms.
I don't think we made a good use of Dexcom until we started hearing the Juicebox podcast. We slowly learnt to prebolus and take actions based on the direction of blood glucose movement in Dexcom. Eventually, we started waiting until Sriram's blood sugar moved downwards and stayed that way for 15 minutes(3 readings).
We have brought down the high threshold to 150 now. Even with the artificial pancreas system, his CGM beeps few times in an hour. It helps me to get in touch with him to make sure that things doesn't go out of control.
A CGM is a game changer because of many reasons. Some of them are,
- It enabled us to understand how different foods affected his blood sugars. We started to avoid some of the high fat foods as we found it almost impossible to manage even with the omnipod.
- It allowed us to pre-bolus and wait until Sriram's blood sugar starts moving before he started eating
- CGM has definitely enabled us to manage blood sugars effectively during night time. We were told Sriram's blood glucose should at least be 150 when he goes to bed. This means even giving some uncovered carbs before bed. This led to high blood sugars in the middle of the night. We slowly realized that we need not give him carbs to bump up the blood sugar as we have a CGM to monitor and catch the low. This has definitely led to a lot of sleepless nights though.
- Last but not the least, it allows us to confidently give correction dosages of insulin as I know that we can catch a low if we end up bolusing more than whats needed. This includes night time. I don't think that I can sleep even as little as I'm sleeping right now with out a CGM.
Having said all that, the only downside I see with the CGM is, its constant flow of information might create anxiety in some care givers. I'm a victim of this to a certain extent. I'm a only child to my parents. They took great care of me. But, they were helicopter parents all through my life. As a result, when I gave birth to Sriram, I made a conscious decision that I will make sure that I'm not going to be a helicopter parent. But, since he started using a CGM, I feel like I have become a drone. This is definitely one of the unintended consequence of the CGM.
The number of alarms has gone down tremendously since Sriram started using the Loop system. Technologies such as Loop or other Artificial Pancreas System wouldn't be here if we never had a reliable Continuous Glucose Monitor in the first place.
I feel that every type 1 diabetic child and even adult should have access to this amazing technology. Mahakavi Bharathiyar, one of the famous poets from my country famously said that "Thani oru manithanukku unavu illai yenil intha jagathinai azhithiduvom !" In English this translates to, "when there is no food for even one single person, we have to destroy the whole world." My feelings towards the CGM would be very similar. I wish there would be a day when every person diagnosed with Type 1 will walk out of the hospital with a CGM.
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