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Arden's Day is a type I diabetes care giver blog written by author Scott Benner. Scott has been a stay-at-home dad since 2000, he is the author of the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal'. Arden's Day is an honest and transparent look at life with diabetes - since 2007.
type I diabetes, parent of type I child, diabetes Blog, OmniPod, DexCom, insulin pump, CGM, continuous glucose monitor, Arden, Arden's Day, Scott Benner, JDRF, diabetes, juvenile diabetes, daddy blog, blog, stay at home parent, DOC, twitter, Facebook, @ardensday, 504 plan, Life Is Short, Laundry Is Eternal, Dexcom SHARE, 生命是短暂的，洗衣是永恒的, Shēngmìng shì duǎnzàn de, xǐyī shì yǒnghéng de
Filtering by Category: DexCom Blog
By Kristina Fiore, Staff Writer, MedPage Today
Published: October 14, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Both pediatric and adult patients with type 1 diabetes should use continuous glucose monitoring (CGM) to measure blood glucose levels, according to new guidelines.
There's high-quality evidence from studies showing that CGM can reduce the risk of hypoglycemia and help maintain good glycated hemoglobin (HbA1c) control in both populations, David Klonoff, MD, of Mills-Peninsula Health Services in San Mateo, Calif., and colleagues reported in a clinical practice guideline from the Endocrine Society. The guideline was published in the October issue of the Journal of Clinical Endocrinology and Metabolism.
"There are still concerns about the high costs of CGM and the accuracy of the various systems available," Klonoff said in a statement. "However, the new guideline shows that CGM can be a beneficial tool to help maintain target levels of glycemia and limit the risk of hypoglycemia."
Standard blood glucose monitoring with finger sticks can provide only intermittent snapshots of glucose levels, the researchers said, and often miss sustained hyperglycemic and hypoglycemic excursions.
On the other hand, CGM allows for more complete blood glucose profiles, though there have been concerns over the accuracy of interstitial tissue sampling compared with actual blood levels. However, newer devices have shown improved accuracy, Klonoff and colleagues reported.
In their review of the literature for creating the guidelines, they found sufficient high-quality evidence to recommend the use of real-time CGM in children and adolescents with type 1 diabetes who are at least 8 years old.
There was also high-quality evidence to recommend CGM in adult type 1 diabetes patients, they wrote.
The guidelines also suggested intermittent use of CGM in both children and adults who can't use real-time CGM, in order to analyze nocturnal hypoglycemia, the "dawn phenomenon," and postprandial hyperglycemia. Intermittent use also can help manage hypoglycemic unawareness, as well as assist patients when significant changes are made to their diabetes regimens.
They noted, however, that this suggestion was made on the basis of low-quality evidence.
The guidelines also recommend against the use of CGM in the intensive care unit or in the operating room "until further studies provide sufficient evidence for its accuracy and safety in those settings."
Arden’s school pictures arrived yesterday and I immediately noticed that she had her CGM on in the photo. I started a conversation about it so I could commend her but as it turns out, she doesn’t need my pat on the back... She told me that as she waited in line for her turn to smile she was asked if, she’d like to take her DexCom 7+ off for the photo.
Arden declined!
If you look closely you can see that Arden wears her DexCom receiver in a Spibelt around her waist. She has many patterns and colors, on this day she was wearing a black pouch with multicolored peace signs.
I can’t tell you how proud I am of Arden for not wanting to hide her Continuous Glucose Monitor. Arden has diabetes and she doesn’t care who knows - so proud of her! Arden’s school pictures arrived yesterday and I immediately noticed that she had her CGM on in the photo. I started a conversation about it so I could commend her but as it turns out, she doesn’t need my pat on the back... She told me that as she waited in line for her turn to smile she was asked if, she’d like to take her DexCom 7+ off for the photo.
Arden declined!
If you look closely you can see that Arden wears her DexCom receiver in a Spibelt around her waist. She has many patterns and colors, on this day she was wearing a black pouch with multicolored peace signs.
I can’t tell you how proud I am of Arden for not wanting to hide her Continuous Glucose Monitor. Arden has diabetes and she doesn’t care who knows - so proud of her!
Have you every looked down at your DexCom and thought, “I wish this thing did ___________”.
Well I have and I wrote a blog about it. That blog post created a way for me to get my wishes into the back office at DexCom.
I wrote recently about an insulin switch that we made (Novolg to Apidra) and in that post I challenged myself and the reader to not become complacent with the ways and tools that we use to manage our children’s type I. I took my own advice and made an incremental advancement in Arden’s care and the results were totally worth the effort.
I don’t want to stop at that... So in regards to the Dex, maybe we start with making some thoughtful suggestions to the good folks at DexCom about what features would assist us in taking better care of our kids (adults using Dex are welcome to join in as well).
Please leave your suggestions as a comment or send me an email. I’ll compile everyones thoughts and get them into the right hands. Maybe together we can help ourselves instead of waiting and wishing and dreaming that someone will help us.
I hope you take a minute to lend your voice! Please know that your thoughts will definitely end up on the desk of the right person. Include your name and website (if you have) so that I can properly give credit to each of your ideas.
**
The following are archived comments from this post. You can post new comments below.
I would love to be able to adjust the pitch of the high and low alert. To me, it needs to be reversed because (in my opinion) a low is an immediate danger. Sometimes the alert as is sounds muffled and I don't always hear it. The high alert always gets my attention, if not scaring the pants off of me.
Also, I wish they had a screen to show average bg's like a meter does. 7, 14, 30 & 60 day averages. I hate having to plug it up and download just to know.Friday, February 18, 2011 - 04:39 PM
I think Dex and all other D devices should speak a common data language. That data belongs to the patient not the tech company and should be in standard formats that facilitate our care not their proprietary business model. It should speak with data analysis tools on the desk top or mobile device of our choosing and facilitate combining pump delivery info, meter info and wizard info entered into any device,
Saturday, February 19, 2011 - 12:25 PM
I couldnt agree more with Sarah on the Low alerts. My son Nate has had the Dexcom for three months, and I have a baby monitor sitting practically on top of it at night to ensure I can hear the vibrate and slight beep when he is going low. I also cannot understand why it doesnt have a better range? My company sells RF remotes that can signal through 3-storys... Dexcom only 5 feet? An RF repeater addition would be nice...
Love it otherwise. A little flakey at times, but cannot imagine life without it!Tuesday, June 7, 2011 - 01:16 PM
Dear DexCom makers,
At some point while I’m coming up my driveway my iPhone connects with my home Wi-Fi. At that moment I could stream content from my phone to any computer or television in my house. Pretty cool I say but you know what would be even cooler?
Being able to link Arden’s DexCom CGM to my wireless...
I’m just an idea man but please stick with me.
If the transmitter and the receiver ‘spoke’ to my
Wi-Fi. There would be no need to wear the receiver while inside. Not to mention no need to sleep with the receiver! Have you ever slept with a hunk of plastic next to you? Not fun.
And the main reason to make this improvement. You could design and sell simple wireless base stations that would alert the house of blood glucose movement. This would be a fine revenue stream for you. Imagine, alarm clocks, wall clocks, base stations, that flash, beep or both.
Your product is fantastic and in most controlled situations it’s perfect. However, it falls short when Arden leaves the room, the floor or goes to bed. At this point Arden has been wearing the Dex for so long that she sometimes doesn’t hear or feel it when it alerts her.
Imagine I’m in the kitchen making dinner while Arden is upstairs in her room, her blood glucose is falling and she either ignores, doesn’t feel it - whatever. Suddenly my wall clock gently changes color like a tastefully designed BatSignal or Ohhh yes, better yet the DexCom app on my iPhone sends me a push notification. Doesn’t that sound nice?
Here is a real world situation that happens all of the time. I, many times don’t hear the Dex beep during the night (you know because I’m sleeping). It’s too far from my room and the receiver doesn’t come close to waking Arden. She has woken many mornings with a low BG because no one heard the beeping. Do you know what would have woken me up, my new Wi-Fi enabled DexCom alarm clock. Honestly, my just imagined DexCom iPhone app would have woken me too as my iPhone docks in an alarm clock that magnifies it’s audio output. While we’re building the app let’s make a version that shows the line graph and outputs the reports... might as well get all we can out of the app consultant that you’ll need to contract. I’d like an iPad app too if you don’t mind... thanks!
How about a Wi-Fi enabled mattress vibrator. What if the clocks in the house switched to the Dex readout during alarms... how damn great would that be! These don’t need to be what ifs and two seconds of market research would tell you that there is market interest.
Okay, that’s all of the consulting you’re getting out of me for free... Get on the stick and get these improvements to us asap.
UPDATE: I was asked to be vague and so I will be. Let’s just say that the thoughts that I’ve had about how to make improvements to the DexCom are already in different stages of discussion within the company, as well as across the entire industry.
**
The following are archived comments from this post. You can post new comments below.
Better yet, on top of Wi-fi, why not do what Amazon does with the Kindle. In the price of the Dexcom include 3G access. That way, my son's Dexcom could alert me to a BG change at home, work or where ever even if he's at school or a friend's house!
Our son is 7 and will soon be wanting to go on sleepovers. This is going to be difficult for us because Dexcom rarely wakes him. With 3G connectivity, no problem. The App you mentioned can now alert me at my house. As long as he's in range of a tower, we're set.Thursday, February 17, 2011 - 11:58 AM
Genius sir, c'mon everyone... I see you on Twitter. Comment and then I'll get this to DexCom. I've been known to make a persuasive argument here and there...
Thursday, February 17, 2011 - 12:06 PM
Love these ideas. LOOOOOVVVVE the sleepover thought.
Friday, February 18, 2011 - 11:37 AM
These are excellent ideas! And since I am a new iPhone owner, I am totally for the push notifications notion!! Everything is becoming a part of wifi/3G technology and diabetes devices shouldn't be excluded from that concept.
Friday, February 18, 2011 - 12:16 PM
To be honest, while all this is great, I just want them to hurry the *ell up and integrate with my Animas pump (or Arden's PDM for that matter) so I don't have two devices to worry about.
Friday, February 18, 2011 - 04:49 PM
my son has been using the Dexcom 7 for about a year and a half now... I requested these same things about a month after we started... the range on the cgm is a real limitation... and as the father of a young son who isn't awakened by the cgm beeps or vibrations, we have a baby monitor set up in his room so we can monitor the alarms from our bedroom... would be really nice to be able to interact with the cgm remotely (clear alarms, check current bg, see the trend graph...)... sometimes we will still have to walk upstairs to his room and do a blood test just to make sure the cgm is giving accurate info... but that would still save us a lot of potential sleep time. My original suggestion was some sort of 'docking station' for the cgm at night... could recharge and allow 'remote' access/control of the cgm through the docking station using weg/wifi/bluetooth/ or even a wired connection to another cgm control in another room... even better would be if you could do away with the cgm receiver altogether and just use a smart phone for all of it... one less device for the child to have to drag around...
Thursday, May 26, 2011 - 11:19 AM
I fell into the trap... I ignored what I was told, only for a few hours but that was enough.
My brother is home for the holidays and last night we went out to dinner to celebrate his last night with us. Arden ate, I bolused and felt great about it because there was no spike visible on her CGM. We went about our evening talking and just enjoyed the time together - it was a great evening!
Now it’s important to say that the food she ate would normally have caused a spike and that more often then not it would have required a maintenance bolus about 90 minutes after she finished eating. About ninety minutes after dinner I asked Arden what her Dex said and she was slightly elevated with a horizontal arrow and she hadn’t heard a beep in hours. I remember thinking that I must be getting better at estimating restaurant carbs and then she left to play with her brother.
Before bed I looked at her Dex and she was 150ish, which I was okay with because she has been dropping around midnight these last few nights. Then I tested her and the number hit me like a cold glass of water to the face - 413.
I re-test and it came up again 400+. Now I can feel my stress level growing and I’m normally pretty hard to rattle. How long has she been this high I wonder. I mumble, “been high for five hours I bet”. Kelly asks me what I’m muttering and I respond in an unpleasant tone. I’m angry now. Angry at diabetes, at DexCom, at myself for thinking that I could enjoy a few hours with my brother. I’m just pissed off. During this mess Arden says, “I think I bumped my Dex a little while ago”. “Poor kid, can’t graze the doorjamb in the car”, I think to myself - and that makes me even angrier.
I take a deep breath, change her Dex transmitter, apologize to my wife for snapping at her and bolus for the high BG.
It’s only a few hours and this certainly isn’t a cause for alarm, Arden is fine. No ketones, no sick stomach she never really knew - but I know. I can’t really ever shake the notion that I just cost her time from the end of her life. I know that I can’t or rather shouldn’t think about all of this in that light but I just can’t help it. I don’t have the same life that other people have, my daughter doesn’t, my son doesn’t, my wife doesn’t, we just don’t.
The real bitch about type I is that when other people make a mistake raising their kids they don’t really know that they’ve messed up. Saying the wrong thing to your ten year old that causes him to seek a therapist when he’s thirty is probably par for the parenting course but there isn’t meter with a test strip that tells you every few hours that you’ve fucked up. When your son tells you that he’s not as happy as he could be twenty years from now you can bury your head in the sand and blame his girlfriend (that you knew was no good for him) and pretend that you were a perfect parent. We can’t do that. If Arden ever experiences a decrease in her vision, a failed kidney or any of the other side effects that come from having the inside of your veins, arteries and organs sandblasted, well, I’ll know that it was me. I forgot, was too tired, mis-calculated, whatever the slip up, I did it. I know that I’m only human and that I’ll make mistakes but boy does diabetes give you a lot of opportunities to make those mistakes. Then just when I’m about to really feel bad for myself I remember that I’m actually good at this and then I feel ten times worse for the people who really struggle.
So in the spirit of the pursuit of transparency about type I diabetes, I give you this post. Our technology failed, I failed, Arden paid, my relationship with my wife took some shrapnel... in short, my family lives with diabetes.
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The following are archived comments from this post. You can post new comments below.
I'm not sure this helps, but I beat myself up about my own management all the time, too. But the silver lining of that self-abuse? Much like your realization that you're pretty good at what you do, it's the reason my last 2 A1c results have been under 6. It's not pretty, granted, but the insane standards we have for ourselves do have *some* payoff. And when Arden's old enough to be managing her own diabetes, she'll know how hard you worked and will be grateful for it.
Wednesday, January 5, 2011 - 10:41 AM
I can so relate to this post. My son was 150 last night before bedtime but felt like he was dropping. He's pretty good at knowing how he feels since he's had the D-beast for 8 yrs (now 13y/o). He ate a few pieces of candy to stave off a low. I gave him 1 unit fast acting with his long lasting insulin in case he overcompensated. Then at 4 in the morning, he woke to 415. Yup, we both screwed up. I'm getting better at not beating myself up too bad, but I have the same concerns as you. How much will those accumulated 4-5 hours affect him over 40/50 years? In the meantime, I'd like more sleep. Didn't really sleep again from 4-6:15 when the alarm went off. Keeping it real....But, reading the adult DOC posts has made me less concerned - knowing they've faced the same challenges and they've made it through 40/50 years of living with the D!
Wednesday, January 5, 2011 - 10:57 AM
After living with diabetes for nearly 25 years, I'm just now coming to the realization that we aren't meant to be a vital organ. For ourselves or anyone else. Because of that, stuff is going to happen. Like the fact that I forgot to bolus for dinner last night and my CGMS was off becuase it threw a Cal Error, so I spent about 4 hours without insulin before I realized it. :/ It happens. Don't be too hard on yourself.
Wednesday, January 5, 2011 - 11:07 AM
Thank for all of the feedback! Please don't worry about me... I don't take it so hard that I can't function, it just is, what it is... I try to speak plainly here on the site and to give a complete look at what it's like to live with type I - both the parts that others can see and the parts that go on at an emotional level. I want it known that it isn't just insulin and carb counting, type I sends every part of our existence a bit askew.
Wednesday, January 5, 2011 - 01:12 PM
Sometimes it just gets to me this life that was chosen for us, and we live with on a daily basis. If you ask me my definition of normal the answer would probably shock most people but yet it is the reality that diabetes is, we just have to accept that and move on with our lives. I hope this incident was just that an incident...
Wednesday, January 5, 2011 - 02:53 PM
Thanks to all for the great comments!
Friday, January 7, 2011 - 07:03 PM
I've just come across your blog and you echo just how I feel. I have 2 kids with Type 1 and although like you I feel I'm pretty good at this, I do sometimes get it wrong. I, like you beat myself up all the time, but I guess it does make you strive for the best results possible. Diabetes never takes time off, but neither does the love for our kids and so we battle on.
AliSunday, February 6, 2011 - 05:03 AM
