Thursday, June 7, 2012

Should I get one of the new continuous glucose monitors?

There are now three types of continuous glucose mon- itors available. They all transmit glucose results wire- lessly from a small sensor placed just beneath the skin via a transmitter whose signal is received by the mon- itor placed anywhere from 5 to 10 feet away. Results are sent from every minute to every 5  minutes  and the trend of the readings can be shown on graphs. One, the Medtronic Realtime System®, can transmit the results into the same unit that is used as the insulin pump. However, even though the same unit acts as both mon- itor and pump, it is still necessary for the wearer to pro- gram and set the amount of insulin to be delivered. Studies have shown that the  additional information provided by the frequently delivered  values and the graphed trends reduces high and low glucose events in the wearer by about half. It is important to note that all the current continuous glucose monitors are approved only for use with and alongside conventional glucose meters. This means that before acting on the informa- tion the continuous monitor provides, you should verify it by obtaining a reading with your regular monitor. Also, the two technologies provide similar but slightly different information. The conventional monitor mea- sures blood glucose from the blood droplet resulting from the finger prick. The continuous meter does not use blood. Instead, it measures the glucose level in the fluid bathing the tissue under the skin. This is in fact derived from the blood plasma itself, but it takes several minutes to adjust to reflect the blood level. The avail- able continuous meters need to be calibrated twice daily (Medtronic  Guardian®, Dexcom 7®) with a conven- tional fingerstick reading, although the newer Abbott Freestyle Navigator® needs only four calibration readings.  

The decision as to whether to get one of these monitors depends on the value to the wearer of knowing his or hereadings on a minute-by-minute basis. For people early in the  course of diabetes, on oral medications, and in good control, they are probably not necessary. For peo- ple on insulin, with a history of low and high readings, especially if they are hard to predict  or explain, the information  provided by  continuous  glucose  sensing may be very valuable. However, approval for insurance coverage is often limited to specific circumstances, such as the  frequent occurrence of very high or low blood sugars that cannot otherwise be prevented.
features  are  important  to  different individuals, depending on  their needs. Probably the best way to answer this question is to discuss some of the  available features. Size is  one  of  the  first  that springs  to  mind.  Monitors  have been  getting  ever

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