What is CGM?

I have been talking about CGM for several weeks, maybe more.  My family and friends may think that I'm speaking another language.  I guess I am...so here's the translation from the language of diabetes for you.  And thank you for wanting to understand our new language!

CGM stands for Continuous Glucose Monitoring.  We currently monitor Ally's blood glucose levels by pricking her fingers a minimum of 8 times per day.  We prick her finger and use her blood glucose meter  to check levels when she wakes up, before each meal or snack, before/after exercise, before bathtime, before bed, in the middle of the night, whenever she looks pale, acts funny, says she's hungry...  Sounds like we should have all the hours in the day covered doesn't it?  Well, believe it or not there is a lot of time in between these checks that we have no idea about.  Glucose levels in the body are constantly changing.  Spot checking (by pricking her finger) only tells us what her blood glucose level is at that moment.  It's the in between stuff that we want to know more about.  Are we missing highs or lows in that time?  I know that her levels are like a roller coaster of ups and downs...as different things affect blood glucose levels - foods and how quickly those carbs are broken down into sugar, exercise, anxiety, excitement, illness...the list goes on.  But our goal is to try to keep those glucose levels within a safe range, safe for the moment and ultimately safe for her lifelong health.

So how does it work...
The Continuous Glucose Monitoring system (also known as MiniLink) includes a sensor and transmitter which can provide continuous glucose measurements to help you control your glucose levels better.  The sensor measures the glucose levels in the fluid under your skin.  (Blood Glucose Meters measure the glucose levels in the blood.)**  The transmitter takes electronic signals generated by the glucose sensor and sends them by radio frequency to the pump.

So, this is what Ally now wears (not her belly in the photo!).  A pump connected to her with a tube and small cannula inserted under the skin for delivering insulin.  Also a sensor inserted under the skin with the MiniLink Transmitter connected to it which sends glucose readings to the pump.  However, Ally's sites are located on her bum, not on her belly as she does not have enough fat there.

We have the Medtronics MiniMed Revel insulin pump.  The wonderful part about the MiniLink is that Medtronic integrates the CGM with the insulin pump.  Some of the other CGM systems require a separate receiver, which we do not need as our pump functions as the receiver.  However, I know several people who really LOVE their Dexcom CGM.  If you do not have a Medtronic pump, you should check out this post at The Princess and The Pump about their experience with Dexcom.

With the CGM, the pump will display a five minute average of Ally's current blood glucose level, updating every 5 minutes.  It will also show a trend arrow, pointing up if blood sugar levels are rising, and pointing down if blood sugar levels are dropping.  Double arrows if it is a rapid rise or fall.  We are hoping to catch lows and highs before they get to a dangerous level.  The CGM will also allow us to view a 3hour, 6hour or 24hour graph of her blood glucose readings right on her pump.   This information will help us to understand how foods, exercise, insulin, etc change her glucose levels.    Again, our goal is to reduce the risk of long-term health complications such as eye, nerve, heart, and kidney disease. 

Ally is all hooked up to her new pump and CGM.  At this moment, we are obsessed with looking at the glucose readings constantly.  Ally is GIDDY!  No matter what the number says, she will call out "Mom, my pump says I'm 197..hee hee...that's so cool!" 

**I do want to note that you cannot rely completely on the glucose level readings from the CGM.  We still will need to do finger pricks and test blood glucose using the glucose meter - maybe a little less often though.  Most of the time, glucose travels to your blood first and then to the fluid surrounding the cells in your tissue.  Therefore, you must use BG meter readings before treating any low or administering any insulin.

Old Friend, New Blog

A few months ago I was introduced to the DOC (Diabetes Online Community) and to a group of amazing parents of children with Type 1 Diabetes.  One of the first people to reach out to me was a beautiful mother of 3, who has a daughter with T1 the same age as Ally.  I read her blog religiously!  She is supportive and inspiring.  Candy Hearts is a blog you will want to visit....check it out at its new URL http://www.candyheartsblog.com/

Playdate Apologies

I'm just not the mom that I used to be - in many ways, really. 

But for today, my apologies go out to all of my playdate pals.  I was driving home from a playdate the other day and I realized that I had left without helping to clean up.  Once, not too long ago, I would have prided myself on teaching my children good manners.  In this case, good manners would be helping to clean up the toys when you have a playdate at someone else's house.  I am not being rude, I just have so many things going on in my head all the time that I can't focus.  Unfortunately, I missed an opportunity to teach my children this lesson.  And I'm hoping that I did not get the "BAD MOM" label and they will invite us back again!  Please accept my apology and maybe let me explain myself a little :) 

It's like the battle between the good conscience and the bad conscience.  You know, like you see in the cartoons - the angelic one sits on one shoulder and the naughty one sits on the other shoulder, both trying to get inside your head. 

Well my D-conscience is neither good nor bad, its just constantly inside my head...talking to me...ALL.DAY.LONG. 

While I'm sitting there enjoying a little bit of adult conversation, possibly even non-D related....This is what is going on inside my head:

Why is Ally sitting on the swing all by herself?

She's not swinging, just sitting there.

Is she ok?

Back to the adult conversation, but keep glancing back at Ally.

Ok, better check.

"Ally, you ok?"

"Yes, Mom!"

"Then why are you just sitting on the swing, but not moving?"

"I'm just resting Mom."

"Ok."

Back to conversation...although now I have no idea what we were talking about.

After another fun playdate, its time to head home, here's what's inside my head:

Time to go.  Let's clean up.

How long has it been since Ally checked her BG?

How long since she has had anything to eat?

Does she look ok?

What type of activity has she been doing?

Should we check her BG now or when we get home?

How long until she eats again?

"Come on kids, let's go."

Gather up diaper bag, D-bag, kids.  Get in the car.  Head home.

Does she look ok?

I realize that I didn't even offer to help clean up...BAD MOMMY!  BAD FRIEND! 

They'll never invite us back!

Look back at Ally again.  She's resting her head.

"Are you ok, Ally?"

Think again, when was last BG check?

"Yes, Mom!"

How much activity?

She looks ok, but why is she laying her head down?

Duh!  She played hard.

But my Ally can never just be tired or worn out from a day of hard play!  I have to question everything.  I have to think the worst.  I have to check!  Because if I don't she could suffer from hypoglycemia. 

(See definition of hypoglycemia below taken from the JDRF website.)

Low blood sugar (hypoglycemia) is the most common and most dangerous condition for many people with type 1 diabetes. Very low blood sugar may lead to insulin shock, which can be life threatening if not promptly treated. Low blood sugar occurs when the body has too little food/glucose or too much insulin.


The following are all potential reasons that a person with diabetes might have low blood sugar:   Too much insulin taken, Eating less than usual, Eating later than usual, Insulin was injected at a site on the body where the absorption rate is faster than usual, Injecting extra insulin after forgetting about a previous dose, More exercise than normal, Illness or injury , Other hormones, Medication interaction

The following is a list of general symptoms that indicate low blood sugar (the person with type 1 diabetes may exhibit one or more of these):  Dizziness, Nervousness, Personality change/irrational behavior, Blurry vision, Shakiness, Nausea, Crying, Sluggishness, Sweating, Poor coordination, Hunger, Lightheadedness, Irritability, Drowsiness, Erratic response to questions, Inability to concentrate

Severe symptoms (symptoms as listed above, plus):  Convulsions, Unconsciousness

So, while I may be annoyed that I can't multi-task like I once could, I am so VERY grateful to the little 
D-conscience inside my head.  Because I HAVE TO QUESTION......I HAVE TO CHECK!