Continuous Glucose Monitoring - Page 2

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Continuous Glucose Monitoring - Page 2


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Old 06-11-2008, 20:17   #11
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Hi:

Since these Continuous Glucose Monitoring Systems(CGMS) are newer technology most Insurance Companies will not cover them unfortunately because they feel at this point that they are not a Good investment yet. They have some problems so it is advised to still test your sugar with a meter along with the CGMS. New ones in the near future should work much better.

It is Good that Children and Adults are allowed to use them even for short terms so they are able to see what their glucose trends are, more frequently and even when they are asleep.

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Old 09-21-2008, 04:33   #12
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The Freestyle Navigator by Abbott


First off, I'll suggest you to follow this link to Abbott's website, for an excellent description of the Navigator, and a simulator that lets you try out all the buttons on the receiver.

Continuous Monitor

Initial Setup

Abbott does not sell the navigator itself, it has a number of distributors. I got mine from Smith's medical, as they are offering a large discount on it to their customers. The ordering process went very smoothly, I downloaded the necessary forms in pdf format, filled out my part and dropped the forms off at my doctors office. A few days later the Navigator was shipped.

Due to my remote location, and my experience level, I decided to skip having a trainer come here. I read the manual online ahead of time, and tried out the simulator online, which told me tons of things. It's really good, I found no differences at all between how the simulator works and the real thing, as far as how to use it.

Due to the cost of sensors, I did decide to give a call to tech support when I was ready to insert sensors, so they could double check me to make sure I did not miss a step or something else equally dumb.

The call to tech support was answered promptly, I gave them my info and status. The lady answering the phone was not fully trained, and said so, and said there were 2 qualified people there and both were helping people and I would get a call back in 15 minutes. I got a call in about 5 minutes. This is a new product, they are still ramping up, I was very satisfied with this.
I had installed the batteries and set the clock. I elected to put the sensor in my left arm. I found this to be a bit awkward, but with the aid of a mirror on the wall it went ok. A little bit of bleeding, but that stopped rapidly. Did it hurt? Much less than a fingerstick .

After installing the sensor, and putting the transmitter on the mount that holds the transmitter and sensor, the transmitter and receiver started talking to each other in a couple of minutes. This meant I was done until calibration time, about 10 hours later.
Calibration is not on a 10 hour timer, but rather, the navigator keeps testing and looking at the results until it is really stable, which takes about 10 hours. In my case it was within about 5 minutes of 10 hours.

Calibration

Ok, come morning it was time to calibrate. I was low this morning, which is extremely rare for me, but I know why. I have recently been able to increase my walking, and did 5 miles yesterday which drove my glucose down all day.

So, I took a glucose tab, and not long afterword, did the calibration, knowing full well I did not have a stable glucose as you are supposed to have when you calibrate. I wanted to really test the system.

The system started working a few minutes after I did the calibration. I was getting readings 58 points higher that my glucose meter said. I ate, the navigator gradually went up, as expected. Rock stable curve on the graph, no false readings, just not calibrated right yet.

2 hrs later was time for the second calibration. I did this, the system "noticed" it was way off, corrected the readings over a period of 5 - 10 minutes. It gave a reading of 102. My one touch meter used on my arm said 96. It also told me I would have to calibrate again in two hours, which is exactly the way things should be done, IMO. The documentation says you may be asked to calibrate again, in this situation it should.
Once I do this, the next one will be tomorrow morning (24 hrs) and then again on day 3 in the morning.

The sensors expire in November.

My Impressions

At this point I am extremely impressed with how it works.

The belt clip holds the receiver snugly. It does not swivel.
The neoprene cover (skin ?) is really nice, I expect that is what I will be using at all times.

BTW, the calibration at 2 hrs showed 3 pts difference between freestyle finger test and onetouch arm test (I was very stable).
Redoing the second calibration 2 hrs later, Navigator said 108, fingerstick freestyle said 98.
2 minutes later, my Navigator says 98 (it adjusted itself)

Accuracy

I did 15 comparison tests, against my onetouch ultra 2, alternate site testing on my arm.

Equal values reported 3
Difference of 2 points or less 4
Difference of 3 to 5 points 4
Difference of 6 to 10 points 2
Difference of 10 to 13 points 2


Further observations

The Navigator seems to lag a bit further behind than my alternate site testing on my arm, which itself has a lag compared to finger testing. This is somewhat offset by the ability of the system to predict when you will go low, up to a half hour ahead of time. The difference between arm testing and the navigator (on my arm) has not exceeded 13 points, so far, and the lower the rate of change, the closer the navigator is to matching my arm testing.

Data Communications

The receiver both sends and receives in bluetooth. The software for data management on your computer is awaiting FDA approval, they could not submit it until the Navigator was approved.

A note about connectivity between the transmitter and receiver. The specifications say it should work when the transmitter and receiver are up to 10 feet apart. I am happy to report I am finding it works further away than that. I think the actual Bluetooth specification itself calls for 30 feet. I have not measured this, and it would depend on the environment you are in anyway. I will say that in my experience, if the receiver is in the same room I am in, it has worked without fail.


Screen View-ability

In good lighting, the screen is fine indoors. No artificial lighting, daytime, indoors, it could stand to be a bit brighter, but is fine with backlighting turned on. Outdoors - absolutely great in bright sunlight, with or without sunglasses (that is unusual for displays).


Update:

This morning when I came in from my 5 mile walk, I removed my t-shirt, and the sensor and transmitter came right off my arm. I guess I will need to use the overbandage, or some tape. This is the second 5 mile walk I have been on, the first time there was not a problem.

I spoke with the very helpful people at Abbott, they are sending a replacement sensor. I would guess it is hard finding a happy medium between adhesive that sticks well enough, and adhesive that hurts when you remove it.

I have had a number of chats with the experts at Abbott, they are really good. There are tricks to doing things, like getting the transmitter to release from it's mount. It is not yet routine, but getting there.


I also spoke with someone in their data management department. The navigator will work with co-pilot, when that gets approval.


__________________________________________________ ___

Observations after 18 days of use:

The 10 hours time before you can calibrate after inserting a new sensor, seems to be on a timer. 2 hours later when you calibrate again, the reading is compared with your continuous reading, and if it is too far off, or if your reading is unstable (going either up or down), you will get a message that you will need to calibrate again in 2 hours, and that sets a 2 hour timer. This repeats until a successful calibration is made. While this can be inconvenient at times, it seems to be the cornerstone of the high accuracy that is achieved.

Most people will want to avoid starting a new sensor in the middle of the afternoon, because the calibration would need to be done in the middle of the night.

The graphs you get are very useful for seeing patterns. You can also look at readings at 10, 60, or 120 minute intervals. The 10 minute interval works well when accessing how your control was last night, for instance.

Observations after a month of use:

I have not had one false alarm, nor has the navigator failed to signal an alarm when it should.

-Lloyd

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My book Successful Diabetes Management is available @ Amazon
Type 2 17 years, Metformin/Apidra via Pump
2011 A1c 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<----Pump 6.9 (Mix)
2006 (Lantus) 7.8 (Pills) 8.5 (Pills) 8.7 (Pills) 7.1
2005 8.4 6.9 7.4 (Pills)2004 6.2 5.6 6.4 6.0 (Pills)
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Old 09-21-2008, 16:13   #13
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Thanks Lloyd, that is great stuff!

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Old 09-22-2008, 23:24   #14
 
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Thumbs up CGM Navigator Questions

Lloyd

So great to be able to communicate with someone who has some time logged on these devices. Hopefully, you have seen Richard's post on his experience with the MiniMed Guardian. I am looking at the Paradigm combined pump/CGM, but was really disturbed to see the wide inaccuracies of Richards set.

From what I could tell, the Navigator also uses interstitial fluid -- and very accurately for you. Do you know if their device has the same problem relative to acidity in insterstitial fluid? Some have reported that this is the source of the problem in the MiniMed.

Reading the website info, I gathered that the Nav is purely a CGM and does not have a pump. Is this correct?

thanx

reido

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Old 09-23-2008, 00:51   #15
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Quote:
Originally Posted by reido View Post
Lloyd

So great to be able to communicate with someone who has some time logged on these devices. Hopefully, you have seen Richard's post on his experience with the MiniMed Guardian. I am looking at the Paradigm combined pump/CGM, but was really disturbed to see the wide inaccuracies of Richards set.

From what I could tell, the Navigator also uses interstitial fluid -- and very accurately for you. Do you know if their device has the same problem relative to acidity in insterstitial fluid? Some have reported that this is the source of the problem in the MiniMed.

Reading the website info, I gathered that the Nav is purely a CGM and does not have a pump. Is this correct?

thanx

reido
The Navigator is pretty new, so I don't have another report for you besides mine. Reports from the beta testers were really good though, which weighed in on my decision. It was approved in March I think, and began shipping this summer.

Yes, it is cgm only. Unlike the MM unit, the range between the transmitter and receiver is really good. I set it down and can walk anywhere in the room without loosing connection. It sits by my computer, or on the arm of the sofa where I can easily see it. My pump remains in my pocket, except when it it time to bolus.

-Lloyd

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Well controlled diabetes is the leading cause of NOTHING. - Dr. William Polonsky

My book Successful Diabetes Management is available @ Amazon
Type 2 17 years, Metformin/Apidra via Pump
2011 A1c 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<----Pump 6.9 (Mix)
2006 (Lantus) 7.8 (Pills) 8.5 (Pills) 8.7 (Pills) 7.1
2005 8.4 6.9 7.4 (Pills)2004 6.2 5.6 6.4 6.0 (Pills)
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Old 09-23-2008, 00:52   #16
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Wow!! Thank you for the elaborate and Very informative summary of the Navigator Lloyd. Seems like you finally got it all set right for yourself. That may have been the problem with the Guardian that Richard was using. He only had it for 7 days and it normally takes longer than that to get it calibrated properly for the person who is using it.

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Old 09-23-2008, 03:35   #17
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Terrie, the Guardian is Minimed's CGM. Minimed did some research on the people for whom the Guardian was not working. An excess of some kind of acid was found in the fluid which their CGM samples to obtain the readings. The CGMs do not sample blood. The body fluid they do sample is supposed to give numbers that correspond closely to blood tests given by our meters. If there is too much acid in that body fluid then the numbers will not correspond closely. I may have too much of that acid. I already have too much uric acid and that has caused me to have gout. I take medication for that. Another friend found out about the research and the acid problem that he believes he has. The Guardian did not work for him but it worked very well for his wife, who is also diabetic.

It is also possible that I did not have enough time to get things going smoothly. My trainer said that a week is enough time for determining if a CGM is going to work or not. That was Mary Ann who told me that. Of course I believe everything Mary Ann says. If you saw her you would know why! Lol!!!

Richard


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Old 09-23-2008, 04:36   #18
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I don't think 1 week is enough time and.....oh ya, it was the acid problem. That's certainly unfortunate.

Mary Ann Mary Ann .....I'm phoning Anita tomorrow...........to ask her why you hate Hockey.

I would think that my Husband's Occupational Therapist that showed up today is equal or moreso than your Mary Ann. She even got to measure..... him. I'm think I'm tired. Continue having Fun with Mary Ann.

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Old 09-23-2008, 18:28   #19
 
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Default Cost of CGM Sensors

Lloyd and Richard

I have read that the sensor that gets set into your skin costs about 35 bucks and has to be changed out every 3 days (possibly 5 for some makes), and that insurance does not pay for these. Yikes!

Have also read that some units require expensive batteries as often as 6 months -- again, no help from health insurance.

Does any of this ring true?

reido

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Old 09-23-2008, 22:50   #20
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Quote:
Originally Posted by reido View Post
Lloyd and Richard

I have read that the sensor that gets set into your skin costs about 35 bucks and has to be changed out every 3 days (possibly 5 for some makes), and that insurance does not pay for these. Yikes!

Have also read that some units require expensive batteries as often as 6 months -- again, no help from health insurance.

Does any of this ring true?

reido
The Navigator sensors cost me $56.25 each (you buy 6 at a time) and last 5 to 10 days.
The navigator uses watch batteries for the transmitter, which they give you with each batch of sensors, and heavy duty AAA for the receiver which you buy for yourself (lasts a couple of months).

__________________
Well controlled diabetes is the leading cause of NOTHING. - Dr. William Polonsky

My book Successful Diabetes Management is available @ Amazon
Type 2 17 years, Metformin/Apidra via Pump
2011 A1c 5.0 5.0 5.2 5.0 2010 5.3 5.3 5.3 5.4 5.4
2009 5.4 5.4 5.3 5.2 2008 5.0 5.1 5.2 4.9 4.9
2007 5.3 5.5 5.7<----Pump 6.9 (Mix)
2006 (Lantus) 7.8 (Pills) 8.5 (Pills) 8.7 (Pills) 7.1
2005 8.4 6.9 7.4 (Pills)2004 6.2 5.6 6.4 6.0 (Pills)
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