Have you had a Libre Pro or other CGM device to measure blood glucose?
January 3, 2018 2:23 PM Subscribe
Mr. DrGail just got a Libre Pro, which will monitor his blood sugar for the next fourteen days. At the end of that time, his nutritionist will download all the data. At last, he can know definitively how certain foods affect his diabetes! He does not want to blow this opportunity. Any advice?
We understand that this is the chance to test out foods we normally eat as well as those he would like to add back into his diet if they don't spike his blood sugar. And he knows that he'll need to keep records of what he eats so the downloaded data will make sense. Beyond that, we're flying blind. The nutritionist had discussed it with him some months ago, but there was no appointment today. She applied and activated the Libre pretty much on the fly, because he was so keen to do it.
If any of you have done CGM, what guidance can you give? Things you did that really helped? Things you wish you had done, done better, or done differently? Good advice you got from your nutritionist?
We understand that this is the chance to test out foods we normally eat as well as those he would like to add back into his diet if they don't spike his blood sugar. And he knows that he'll need to keep records of what he eats so the downloaded data will make sense. Beyond that, we're flying blind. The nutritionist had discussed it with him some months ago, but there was no appointment today. She applied and activated the Libre pretty much on the fly, because he was so keen to do it.
If any of you have done CGM, what guidance can you give? Things you did that really helped? Things you wish you had done, done better, or done differently? Good advice you got from your nutritionist?
I'm a T2, not on a pump or CGM, but I'm on a board of directors for a community diabetes education group, so I have lots of CGM-wearing friends. (I just use my manual meter.) You didn't mention whether he's using an insulin pump, bolusing for meals, etc., but even if he's wearing the CGM (which will show trending data), make sure he still uses his meter and does finger sticks as usual. Even under the best circumstances, different meters (and meters vs. CGMs) can vary widely. If his insulin use (timing, units, etc.) is dependent on finger-sticks, don't make treatment decisions based on the Libre because it'll take a while to fully calibrate. (I'm guessing he's not been dependent on a CGM for alarms at night? Because if he were, you'd want to wake him and stick him, because my understanding is the Libre doesn't alarm.)
I don't know how often you have to change the sensor for a Libra Pro vs. something like a Medtronic (though one article I'm looking at shows they last twice as long), but you guys may want to read this article to help when you are changing out the sensor (even if he's not working out). Take a peek at Frank Sita's article here, too.
Make sure he doesn't merely note what he eats but HOW MUCH. Portion control can be a big part of things, and not just carbs. (Because fiber and fat impact how the carbs are used.) And, very, very seriously, keep track of his beverages, not just for the carb count, but also his hydration level. Just staying hydrated is often enough to keep my blood glucose performing well, and you don't want any unknown variables to skew results. Good luck!
posted by The Wrong Kind of Cheese at 4:17 PM on January 3, 2018
I don't know how often you have to change the sensor for a Libra Pro vs. something like a Medtronic (though one article I'm looking at shows they last twice as long), but you guys may want to read this article to help when you are changing out the sensor (even if he's not working out). Take a peek at Frank Sita's article here, too.
Make sure he doesn't merely note what he eats but HOW MUCH. Portion control can be a big part of things, and not just carbs. (Because fiber and fat impact how the carbs are used.) And, very, very seriously, keep track of his beverages, not just for the carb count, but also his hydration level. Just staying hydrated is often enough to keep my blood glucose performing well, and you don't want any unknown variables to skew results. Good luck!
posted by The Wrong Kind of Cheese at 4:17 PM on January 3, 2018
I don't have any experience with the libre pro, but I regularly use a Dexcom. It's not connected to my pump. For a two week study, I'd keep track of literally everything. Exercise? Count chores. What you eat, how much, and also how you time your insulin (so did you take your insulin when you started eating, or did you wait twenty minutes, etc.) Honestly, I also did the two week trial and it just taught me that I needed more time with it. COD is right though. Your cgm will be great at giving you trends and warning you if you're getting high or low, but I would never use it as a guide to how much insulin to take because the numbers will vary from an actual finger stick. Personally, I found out that pizza doesn't bother me as much as it seems to cause problems for other diabetics, but chinese takeout will basically ruin my bloodsugar for up to 24 hours. I would also use it to see how long a bolus lasts in your body if you don't know, because my insulin was leaving my system far faster than my doctors and I expected. Hope this helps, hit me up if you have any other questions.
posted by Bistyfrass at 4:29 PM on January 3, 2018
posted by Bistyfrass at 4:29 PM on January 3, 2018
And I'm back! The other thing is it's easy to overreact to the numbers you see. So maybe after dinner you'll expect your bloodsugar to be lower faster. Assuming you aren't really high or low, just do what you normally do and let it record its findings. You can't really learn from the data if you're reacting to it because that will skew the data. Also if you're anything like me or my other diabetic friends with cgms, it's a great way to give yourself too much insulin and go low.
posted by Bistyfrass at 4:39 PM on January 3, 2018
posted by Bistyfrass at 4:39 PM on January 3, 2018
Track time, amount, and type of insulin used in addition to diet and exercise. I have found that, while normally 15g of carbs = 1 unit of insulin, I basically have to double that first thing in the morning. I also found that splitting up my long-lasting insulin medication to twice a day really helped my A1c. But, I wouldn't have known that if I didn't compare the inputs to the outputs against my CGM data.
posted by munchingzombie at 4:40 PM on January 3, 2018
posted by munchingzombie at 4:40 PM on January 3, 2018
Response by poster: Just to clarify, so the answers don't veer off into the value of CGM for post-meal insulin dosing: His DII is currently managed with medications. Insulin (Tresiba) is part of that, but at a consistent dose every day. Plus he won't know the CGM results until the two weeks are up and the nutritionist downloads the data. So the value of the short-term CGM is to more fully understand how his diet affects his blood sugar. He's really excited about experimenting with foods he'd like to include in his regular diet, even if he has to wait two weeks to learn how they affect his blood sugar.
The comment from The Wrong Kind of Cheese about noting food volume is just the sort of advice Mr. DrGail is interested in. And COD's warning about how the CGM devices are erratic during periods of rapid glucose change should prove very helpful.
posted by DrGail at 6:28 PM on January 3, 2018
The comment from The Wrong Kind of Cheese about noting food volume is just the sort of advice Mr. DrGail is interested in. And COD's warning about how the CGM devices are erratic during periods of rapid glucose change should prove very helpful.
posted by DrGail at 6:28 PM on January 3, 2018
Dexcom are usually the gold-standard for a CGM.
I'd second COD's note that Medtronic's CGMs are kinda poor. CGMs measure the interstitial fluid, so it's an indirect reading (the fluid stabilizes/harmonizes with BG via osmosis etc), so if BG is rapidly changing, CGMs are slow to respond.
Googling shows it has an external device, so, uh, you should see the results in realtime, unless your nutritionist is doing some flimflam on you (??) (I don't know if ya'll have enough info/understanding to process the results, but you should at least see the data. Is that what the nutritionist means - they'll counsel you on the results so you can understand them ?)
(Now I'm dubious as heck that the CGM doesn't need fingerstick calibration -- that doesn't sound right. They have weasel words about how you should fingerstick if you think it's off or have hyper/hypo symptoms )
Has the nutritionist not talked about measuring portions with you, and the glycemic indices for various foods ? T2D have some fairly standard guidelines (eg stay under 45g carbs/meal, etc) which should be in the T2D 101/basics class - have you been able to sign up/attend those, or just working 1:1 with the nutritionist ?
posted by k5.user at 8:47 AM on January 4, 2018 [1 favorite]
I'd second COD's note that Medtronic's CGMs are kinda poor. CGMs measure the interstitial fluid, so it's an indirect reading (the fluid stabilizes/harmonizes with BG via osmosis etc), so if BG is rapidly changing, CGMs are slow to respond.
Googling shows it has an external device, so, uh, you should see the results in realtime, unless your nutritionist is doing some flimflam on you (??) (I don't know if ya'll have enough info/understanding to process the results, but you should at least see the data. Is that what the nutritionist means - they'll counsel you on the results so you can understand them ?)
(Now I'm dubious as heck that the CGM doesn't need fingerstick calibration -- that doesn't sound right. They have weasel words about how you should fingerstick if you think it's off or have hyper/hypo symptoms )
Has the nutritionist not talked about measuring portions with you, and the glycemic indices for various foods ? T2D have some fairly standard guidelines (eg stay under 45g carbs/meal, etc) which should be in the T2D 101/basics class - have you been able to sign up/attend those, or just working 1:1 with the nutritionist ?
posted by k5.user at 8:47 AM on January 4, 2018 [1 favorite]
This thread is closed to new comments.
Personally, I'm not sure Medtronic's CGM is worth what it costs us. It's pretty much useless under the conditions when the CGM is most needed, edge cases where your glucose levels are rising or falling rapidly, because you can't trust the readings, and thus can't trust the insulin pump to suspend or un-suspend insulin flow automatically.
posted by COD at 3:31 PM on January 3, 2018