72 Hour Glucose Monitoring

[Human Pin Cushion]

My endocrinologist just received equipment for a 72 hour continuous glucose monitor.  I have heard of this but really know nothing about the method.  I'm going in next Tuesday to be "hooked up"...does anyone have experience with this?  Where is it worn?  I know some pump companies require this before a pump is issued.  I will only be the second patient in her office to do this.  

Background:  Type 1 for 40 years, good control but disagree with the constant increase in Lantus she adds every visit)  Too many lows, not associated with Humalog, then too many rebounds after eating.  I have almost perfect days when I slightly reduce the Lantus she prescribes.  It's very frustrating, and she thinks this would be a good thing.

Thanks

[J J's mom]

Is the CGM done in hospital or at home once hooked up?

My son is due to have this done soon, but I can't really see the value of it unless adjustments in meds/diet etc are made and then the test is re-run. This could go on a long time to get an accurate picture and doesn't seem that practical.

We have tried various insulin combos, and the best has been Lantus and Regular with Humalog to correct, or cover carbs. However, we did not avoid dangerous and severe hypos requiring emergency care on a regular basis until we switched to Dr. Richard K. Bernstein's approach. That changed everything. Not one hypo since then, and normal BS most of the time.( Google: Bernstein Diabetes).We have got out of the cycle of feeding excess insulin with carbs, and feeding the highs with insulin etc.

Regarding the basal insulin, Lantus, we were prescribed a dose but left to adjust it according to the level that worked for my son.We were just advised to wait 3 days for each adjustment to see the real effect of the change. I think it really does take 3 days per change to settle down.

[JDRF - Team- SS]

Hello again,

I agree with SGG...it is whatever works for the individual...whether it be shots or the pump.

In our situation, my son is 10-1/2 and wanted more flexibility when it came to food.  Sometimes he just was not hungry and other times he wanted to eat more at one time.  If we had opted for lantus and then humalog to correct and to cover food, I would be running back and forth to school because he was not ready to give shots and we talked about the pump and watched a video about it and decided together.  He has a friend who goes to his diabetic camp and she does the lantus and humalog method, but she gives her shots at school with a humalog (I think it is humalog - maybe novalog) pen.  This happens to work for her.

Please do let us know what you think about the 72 hour continuous glucose monitoring.

Best of luck!!

SS

[Human Pin Cushion]

Thanks everyone for your quick answers.  This doctor is aggressive and I'm ok with that to a point.  After 40 years of this, I won't put one extra unit into my body that I don't think is needed.  Or, I know how far I can "push" myself, then my guard goes up.  This has kept me out of ER's and an active career women.  Yes, even "lived alone" for many years, no dramatic stores to tell even then.  

But I keep trying to explain that my highs are coming as rebounds to the lows from the Lantus.  I can be much more accurate with Humalog at meals if I'm not having to snack and drink carbs all day.  I'm willing to do this, but will switch doctors if needed.  I find this doctor extremely intelligent, but not easy to communicate with.  

I'm very knowledgeable about how the insulins peak.  (Yes, Lantus has a kick at about 4 hours when it starts to level out.)  But, that's not the problem, it's the overall effect.  I was taking an average of 20 units/day and she has gradually prescribed up to 25, which doesn't sound like a lot, but my A1C's have been worse since increasing, not better.  I have to eat continuously to stay at that pace, and I've gained 10 lbs in the last year.

I've been Type 1 since age 7 (40 years) and have never had serious lows or highs.  Just the usual struggle for perfection.
My A1C's have been in the 6.4-7.5 range over the last 3 years, but have been in the high point of this range while seeing her.  I feel due to too much rebounding.  I work hard to keep my weight normal and have had my best month recently by reducing Lantus and cutting back on the low-glucose-snacking-drinking syndrome.  It's a difficult balancing act, isn't it?

I'm open to the pump, but have been very happy with the Lantus/Humalog, at least in the past.  I feel guilty that I want to switch doctors and feel like I need to work with her a little longer.  She's not pushing the pump, but seems to push that Lantus.  I'm worried that she'd push too much basal on a pump as well.

Thanks, sorry for the long post.  Feels good to talk.

[JDRF Team SGG]

While SS has experienced tremendous help with using a pump, and her sister has found that the pump has improved her overall glucose control above what Lantus and humalog or novalog was able to do for her, there are many others who find that the Lantus and humalog or novalog combination work beautifully for them. I personally use Lantus and humalog and my a1c numbers have not varied one bit from a constant 6.1 since I started this combination of insulins several years ago. No serious lows, no serious highs, but a really easy control that avoids glucose swings.

So my point is that each individual must find out what works best for his or her own body, for we are all different. For some patients, Lantus and Humalog or Novalog work beautifully, and for others, pumps work better.  Both of these types of delivery accomplish very similar results. If you cannot find a dose of Lantus that works well for you, then you may want to consider a pump. But perhaps you will be fortunate in that the 72-hour monitor may help you find a good solution with your present insulin delivery system. Perhaps you should be open-minded about possibly changing some things if your control is not ideal now -- it seems that your endocrinologist is trying to help gather information that will help assess where any problems may be. We all wish you the very best.

[Human Pin Cushion]

Thanks for the links.  They were very informative and I've printed.  When I asked the nurse what to expect, she said "she didn't know".  Just great.  Of course, they've only used on one person.  So, I'll be patient...

[JDRF - Team- SS]

Hello Human Pin Cushion,

My son was diagnosed at age 3.  He is now 10.  My sister was dxd at age 24...she is now 33.  My sister did the 72 continuous glucomse monitoring last year.  I think it was right before she went on the pump, as well.  My son went on the pump right before she did, but he never did the 72 hr. thing.

My sis had it inserted in her stomach.  My sister (before pump) was on lantus and humalog doing what they call a "poor man's pump".  I know that it showed trends, but I am unsure how much it helped.  

I accompanied my sister to her appt. to discuss that she WANTED to get on the pump.  I went because my son was on the pump and my sister wanted me there for support.  Her health ins. had a requirement of being followed for 6 months before approving (requesting) the pump and this was close to the 6 mo. mark with this ins. co.  I remember very clearly the nurse saying "your numbers aren't going to change much since you are already doing the pump" (lantus / humalog).  I said to the nurse....Even IF they do not greatly change, it is a matter of convenienece.  Who wants to take 7 or so injections a day?  Well, the nurse was wrong becuase the pump has overall helped my sister's blood sugars.  Here is an example - who can draw up 5.2 units of insulin?  The pump can give amts. that would be very hard to give via a syringe.

I am not in any way bashing anyone who is taking shots.  My son was given NPH & humalog for 6-1/2 yrs. until he went on the pump in Aug. 2004.  All I can say is that we LOVE the pump.

I though about having my son on the CGM for 72 hrs. even now while on the pump, so I can see what is going on at night especially, but he doesn't really want to do it and I would not push him because he takes very good care of himself and is very self sufficient at school and I help out more when he is home.  I go through periods where I set an alarm and test him every 2-3 hrs. at night to see where his blood sugars are so I can see if changes need to be made.  6 mos. ago his A1C was 7.9...at his last visit, last week it was 6.6.  We were very pleased.

Let us know how the 72 hr. monitor works for you so others can learn from your experience.

SS

[JDRF-Team-sgg]

The 72-hour glucose monitor is used often by doctors to attempt to ascertain what kind of glucose patterns a patient is having or how certain foods or activities affect that patient's glucose readings. If you are having trouble fine-tuning your insulin regimen, then your doctor may hope that using this device for a short period of time will help him or her try to establish a better combination of basal dose and mealtiime bolus to keep your glucose levels more even-keeled than they are now.

Below I give you two websites that discuss the 72-hour continuous glucose monitor. The first one gives some pros and cons to using it that are interesting -- apparently, it tests tissue glucose instead of blood glucose and can be inaccurate at times. Check out these two websites to find out more information about location of the device, how it is used and how it works:

http://www.aboutkidshealth.ca/ofhc/news/DB/4149.asp

http://www.diabetesuffolk.com/Managing%20Diabetes/The%2072%20hour%20glucose%20sensor%20monitor.asp

One final note: I find it curious that your doctor keeps increasing your Lantus dose even if you are having lows that don't seem to be related to your humalog. Perhaps you need to have a discussion with your doctor to find out why he or she believes that tthis is necessary. I would guess that your glucose levels are running high at times when not covered by humalog, and that this is the reason for the Lantus increase. Finding the perfect dose really is a balancing act, for I think many of us find that glucose levels do not remain exactly the same day after day. So many things other than foods affect those glucose readings, and so finding the perfect basal dose can be difficult when stress, allergies, hormone swings, activity levels, and occasional viruses cause glucose levels to rise and fall at unpredictable times. I personally find that knowing how all of these outside factors affect my body is absolutely necessary in order to be able to manage the glucose levels and know when to increase or when to decrease the basal Lantus dose. You might want to ask your doctor about how the factors mentioned above affect glucose levels. You might also want to read about them, perhaps by doing a Google search on any of those words combined with the words "affect of ___ on diabetes". Good luck to you.