Sen-Serter

There’s been more CGMS talk out in the blogosphere over the last couple of weeks. Karen is waiting hear if she’s gotten approval, and apparently she meets the requirements so I hope she’s hooked up soon. Also, Allison just got the phone call from Minimed that they would be shipping her supplies to get started on the sensor.

It’s been so encouraging to hear of more success stories lately, but I know there are others out there who are either still in the contemplation stages, considering whether or not they want to pursue getting a CGMS. Then there are plenty of other people who have been battling the brick walls that insurance companies seem to build faster than they can be knocked down.

If you’re only thinking about it, and possibly feeling daunted by the prospects of a protracted battle with your insurance company, please don’t allow that possibility to deter you. It is a wonderful tool, and used in conjunction with regular blood glucose monitoring, can help you catch both highs and lows sooner so you can reign them in before they get out of control.

Sensor

If you’re in the midst of butting heads with your insurance company, I know it can be terribly frustrating. I had initially been approved back in August 2007 after jumping through hoops for the better part of a year. After I was hooked up and had been CGM’ing for almost a year, my insurance company changed their policies and revoked coverage, claiming that CGMS technology was investigational. I was incredibly disappointed to have to stop using the technology that I found so helpful, and of course I was livid about it. I fought with them, and coincidentally or not, after having a complete blubbering meltdown on the phone with some poor girl who had nothing to do with the actual denial I got in August, the decision was reversed. A couple of days later I had a 3-month supply of sensors on my doorstep.

Regardless of if you’re fighting them or thinking about whether or not you want a CGMS, if you’re interested in some evidence to prove the value of CGMS technology, either to convince yourself that it’s worth the effort or to convince your health insurance company, there was a study, Duration of Nocturnal Hypoglycemia Before Seizures, published in the November issue of Diabetes Care (published by the ADA), and an article about the study, Diabetic Monitors Can Prevent Nighttime Seizures, that might be of interest to you.

The abstract doesn’t have that much info in it, and the researchers only had a few cases to examine due to lack of previous research on the subject, but for the cases they examined, hypoglycemia was detected by the CGMS 2 ¼ – 4 hours prior to the seizure. While it is theoretically possible that blood glucose levels could drop so quickly that someone could have a seizure before the CGMS could detect a low due to lag time between the glucose levels of blood and interstitial fluid which the sensor measures, I know the Minimed Guardian has a ‘Fall Rate’ alarm (I’m not as familiar with the current version of Dexcom’s system so I don’t know about comparable features). Thus, depending on the settings of the system, there would be a ‘Low Predicted’ alarm and/or a ‘Fall Rate’ alarm even preceding a ‘Low SG’ alarm (SG=sensor glucose).

Sensor & Transmitter

The researchers had examined cases for which older models of the CGMS were used, which meant two of the cases involved models that didn’t have alarms. In one of the cases, the subject couldn’t hear the alarm because the CGMS monitor was under their bedding. The researchers recommend that the alarms be louder, more “robust”. As much as I hate that thing disrupting my sleep, it will be going off intermittently for a significant time before it wakes me up, and more often than not, my husband usually hears it before me and yells at me to do something about it. There have been nights when I don’t know if the sensor was crapping out and just needed to be changed or if my BG was literally a crazy roller-coaster, but the entire nights have been filled with ‘High Predicted’, ‘Rise Rate’, ‘High SG’, ‘Low Predicted’, ‘Fall Rate’, and ‘Low SG’ alarms, and man, do Jason and I both wake up cranky after nights like that. Of course, I feel terrible too because I chose to use the CGM so I generally accept this is one of the inconveniences of it (even though I complain about it), but I wish I could use it without it having such a negative impact on Jason. It can be maddening, I freely admit. The alarm really needs to have a louder setting at night because no matter where I clip it or whether I use vibrate or the loudest setting, it typically doesn’t wake me up right away. It’s a major design flaw in my opinion, and the researchers of this study have essentially said the same thing.

Hopefully future designs will rectify that issue, but for now, they conclude that CGMS is a useful tool in preventing nocturnal hypoglycemic seizures, and that’s definitely one of the reasons I wanted one. Since I’ve been using it, I’ve had only one unconscious hypoglycemic episode, and if I recall correctly, the sensor had ended and needed to be changed so I had been CGMS-less for that occurrence. If anyone is able to use this study towards getting a CGMS, I would love to know about it. I’m curious to see if this study and the one published by JDRF a couple of months ago are having any bearing on CGMS insurance decisions. If you’re fighting for it though, don’t give up!