Continual glucose monitors

Yes, I just finished the blood glucose monitoring bit last week and am waiting for their feedback.

I often saw rises in blood glucose around getting up time from a low overnight despite not having yet eaten. I assumed this was prompted by the hormone glucagon causing release of glucose from my liver as I showed signs of morning activity. https://en.m.wikipedia.org/wiki/Glucagon

However IANAD or a biochemist.

I should try the Zoe programme..

I wore one (well, 2 actually as first fell off) as i got them free from the drug rep. Things i learnt:
It really hurt ME to put them on. Others in the group felt nothing.
they come off quite easly if you 'do things', so I advise active pateints to buy the aftermarket plaster cover thing..
My blood surag spikes are terrifying!!!

DrP

It really hurt ME to put them on. Others in the group felt nothing.

I find mine a bit irritating, feels like I want to scratch it. My wife is totally fine with hers...

The Zoe one comes with a massive sticker to cover it (like 4" wide).

Good they give a sticker... I can see the Drug company (Lilly I think) offering a sticker in the pack, cos if it falls off, THEY supply the replacement.. they're about £45 each, so i can't see them wanting to carry that on for too long.

DrP

My blood surag spikes are terrifying!!!

lolz

- Tomhoward 31 years T1D

Interested in this, so following.

I did their questionnaire and I should be a shoe in for the the CGM, but it's one of those annoying sales things where you can't actually find out how much the bloody thing is. Please can one of you tell me?

I did their questionnaire and I should be a shoe in for the the CGM, but it’s one of those annoying sales things where you can’t actually find out how much the bloody thing is. Please can one of you tell me?

Different options: https://joinzoe.com/plans/choose-plan-58421?country=GB

We signed up last Nov and the kits arrived last week. I *think* we paid for 4 months - so something like 4x £50.

Can't actually recall. 200,000 on the waiting list apparently, although you can get bumped with a referral link from someone who gets to the head of the queue. My wife had been in the queue for months and when she got offered a slot, she bumped me with her referral link, so we started on the same day.

Good they give a sticker… I can see the Drug company (Lilly I think) offering a sticker in the pack, cos if it falls off, THEY supply the replacement.. they’re about £45 each, so i can’t see them wanting to carry that on for too long.

You get two massive stickers:

[url= https://live.staticflickr.com/65535/52657659782_d52cd9af2a_c.jp g" target="_blank">https://live.staticflickr.com/65535/52657659782_d52cd9af2a_c.jp g"/> [/img][/url][url= https://flic.kr/p/2oebgFU ]Zoe GCM sticker[/url] by [url= https://www.flickr.com/photos/brf/ ]Ben Freeman[/url], on Flickr

Is there a sticker there? it's so discreet..can barely see it.... 😉

DrP

Partner started theres on 2nd Jan, and has just got full reports back. Makes very interesting reading, and of course it’s completely unique to you.

The usual bad things to avoid but apparently the magic is in the middle ground where the big gains are for your guts.

I signed up a couple of weeks ago using there referral and mines arriving in April.

Is there a sticker there? it’s so discreet..can barely see it…. 😉

No, that's definitely a crack.

We tried them on a (now ex) diabetic cat, that idea really isn't going to work, till they can make them much smaller and stickier, they are the same size as the humans ones FFS. Mind you the cats ears were starting too look like nettle leaves from blood prick tests, so we were running out of options

shot my glucose right up to 9.

Joking aside, this is rather interesting, obviously this is incredibly beneficial for diabetics, but it is also interesting to see how 'normal' people react to food intake as well.

I've been using these sensors since they fist came out (so possibly 4+ years now) - I suspect some people have a reaction to the adhesive as I've never had a sensor fall off without me skelping it on a door frame/hitting a tree or pulling it off when it has expired. If I'm ever asked, I never recommend anything to stick them down - from my uneducated position, I suspect having a large sticking plaster on your arm for 2 weeks probably isn't great for that area of the body - no doubt that is completely wrong.

I would be interested to hear more about these findings - probably not specifics per person - but just an idea of how blood levels adjust for 'normal' people as it isn't something I tend to think about much.

Mrsofficer is borderline t2, so I'm about to get some of these in an efforts to get her to understand her carbohydrate heavy diet.

Joking aside, this is rather interesting, obviously this is incredibly beneficial for diabetics, but it is also interesting to see how ‘normal’ people react to food intake as well.

I think the idea is there isn't really a 'normal' response, it's highly personal. Eg this is mine and my wife's traces from yesterday (Day 0 or Test Day on the Zoe trial). Both fasted and ate the exact same meals and times. Breakfast and lunch were Zoe muffins with each being a different sugar/fat mix.

My trace is the lower one, my wife's the upper:

[url= https://live.staticflickr.com/65535/52658929285_8ae0241f66.jp g" target="_blank">https://live.staticflickr.com/65535/52658929285_8ae0241f66.jp g"/> [/img][/url][url= https://flic.kr/p/2oehM4T ]Zoe Test Dat GCM[/url] by [url= https://www.flickr.com/photos/brf/ ]Ben Freeman[/url], on Flickr

The three vertical lines are (from L to R).

1. Breakfast muffins after fasting all night
2. Lunch muffins after 4 hour fast since breakfast
3. End of 2 hour fast after lunch

After that we diverged and ate different things, I had fruit, she had some cake, but we both ate the same evening meal...

Yeah, I've got 'normal' in quotes as there isn't a normal - everything and everyone reacts differently, but it is very interesting to see how someone with a working pancreas reacts to increase in carbs/sugar intake and what exercise does as well...it is very interesting, thanks for sharing.

The science of using them in non diabetics is relatively new and fast moving. Having used them with "normal" patients quite a bit I've seen similar patterns developing.

Most find it is initially interesting (but not that useful in reality) to see that sugary drinks/processed pasta meals/breakfast cereals etc all cause big spikes and dips. We could predict that beforehand, and we know they aren't healthy anyway. It starts to get a bit more useful looking at individual responses to healthy wholefoods eg whole porridge oats. But the really interesting stuff is in zooming out a little and looking at knock on effects eg evening glass(es) of wine>worse sleep quality>worse glucose responses the next day. I think you are best using the LibreView web platform rather than your phone for looking at trends.

Exercise intensity and duration can also have (to some extent predictably) differing responses (low vs high intensity, timing activity/exercise vs food) which we can use for health benefits eg effect of a walk after lunch. Of course Supersapiens use a newer version for their analytics but they are targeting performance, which is not necessarily the same as health.

Whilst I think it is exciting and interesting to see what is happening on an individual basis, it is only really useful if it enables long term behavioural change. And if we can be confident that these changes are healthy. Zoe is (I think) the biggest project looking to validate all of this - they are also looking at other metrics of course (microbiome, fat response etc) but is is a fascinating program (I've not done it)

You can buy additional FreeStyle Libre 2 sensors direct from Abbot online - £58 for non diabetics iirc.

For clarity - Type 1 Diabetes is a completely different disease from Type 2. Poor sleep/inactivity/unsuitable nutrition amongst other things increase your risk of Type 2 and by and large that is what we are talking about here when talking about "Normal">Pre-Diabetes>Diabetes - these are all on a sliding scale. Type 1 is nothing to do with this (you Type 1 Diabetics all know this of course- it is the rest of us who get confused ....)

In terms of keeping these ones attached, if you live an active life... I can recommend these from Supersapiens...

Cancel that, I'd misunderstood the Supersapiens/Garmin/TRainingPeak integration thing...it is getting activities from them into Supersapiens.

it is a standard Abbott Libre sensor and they don’t allow data sharing

It's not a technical limitation, it's about medical approval. When sold for non-medical use they can open it up and try and do anything they want without proof, trials and certification. I know a young type1 boffin who has his own closed loop system set up based on the Libre2 sensor... it wouldn't get medical approval though... his system couldn't just be sold on to others.

Most find it is initially interesting (but not that useful in reality) to see that sugary drinks/processed pasta meals/breakfast cereals etc all cause big spikes and dips

My biggest peak so far was after a Nandos chicken burger with some fries - which being 80% protein by weight did surprise me somewhat. Ok the bun is white flour, and the chips processed potato, but the bulk was just two grilled chicken breasts (plain). I didn't even eat all the chips either!

Yeah, that makes sense, ta.

My biggest peak so far was after a Nandos chicken burger with some fries

No surprise there. Nandos is as processed as it comes. Damn tasty, but processed.

Can we see just how high the non diabetic ‘normies’ can go? Sticky toffee pudding with extra golden syrup, washed down with a lucozade and some haribo?

What’s the worst that could happen?

No surprise there. Nandos is as processed as it comes. Damn tasty, but processed.

I was surprised, I assumed the grilled chicken breasts / fillets would outweigh the processed refined carbs as they vastly outweighed them and slow down the absorbtion etc.

Can we see just how high the non diabetic ‘normies’ can go? Sticky toffee pudding with extra golden syrup, washed down with a lucozade and some haribo?

What’s the worst that could happen?

First one to get 'HI' wins

Until you get that flatline high line, where the sensor can no longer follow you up, you’re just playing at it.

I assumed the grilled chicken breasts / fillets would outweigh the processed refined carbs as they vastly outweighed them and slow down the absorbtion etc

On the positive side, it’s a sign that it was relatively low fat.

Until you get that flatline high line, where the sensor can no longer follow you up, you’re just playing at it.

Are you even trying if you don’t get admitted to hospital with Diabetic Ketoacidosis?

Indeed. If you’ve not been admitted you get no bragging rights.

On the positive side, it’s a sign that it was relatively low fat.

So is it fat which slows down sugar absorption rather than protein / fibre?

Yep. That’s why if diabetics go hypoglycaemic, a chocolate bar isn’t the best thing for them.

It’s not the worst thing, but there’s plenty better.

Blew my mind when I learned that, after 20 years…

So is it fat which slows down sugar absorption

Over the next few days you will get the chance to see this for yourself.

Indeed. If you’ve not been admitted you get no bragging rights.

I think I have bragging rights at both ends of the spectrum, I’ve had DKA, an experience I’m not keen to repeat, but also this, which was an effort and a half.

https://flic.kr/p/2oejpkY

Ironically, it was just after that, that the years of less than ideal control started to catch up.

Bloody hell, that is seriously impressive...think I need to up my scan frequency to 3 per hour and do some small micro adjustments if I want to get that good.
Impressive...you show-off! 😉

Was pretty much every half hour I was awake, probably 7 or 8 injections a day, fair few hypos too.

Not sustainable I found, but the consultants face when the HbA1c result came back was priceless!

CGMs are great bits of technology, I’ve been using them for more than 12 years with T1D, with several dietary patterns, and I still find out oddities about myself, lifestyle and diet.

The rise in the morning is mainly your body getting ready for the day and releasing cortisol and growth hormone, which can be influenced by various lifestyle and health factors.

Combining foods (fat and carbs or protein and fat) can cause some quite different BG results, especially if large quantities are involved. Not proportional to just carbs or smaller meals. As said, there are a lot of differences between individuals, even with the same meals, there have been some big studies looking at that.

Over the years, I’ve had skin irritation with lots of medical adhesives. Oddly, I’ve now used skin tac glue for quite a number of years, and never had a reaction. The CGM pretty much stays put for 10 days and I often did 20 plus days when Dexcom could be “restarted”.

Soooo much in life affects how a T1D responds to food and insulin action is very variable. It will be interesting to hear how much variation a person without diabetes has day to day, given the same circumstances.

Mega grateful for CGM, it has been life changing, I couldn’t get a HbA1c of 35 mmol/mol without it. 🙂

I wish my graphs looked like some of these! The Libre 2 has really helped me get my bloods under a better control, I’ve had plenty of time trying to perfect it since I was diagnosed at 9 months old!

I’ll be moving on the Medtronic Guardian soon which is a closed loop system, fingers crossed!

I’ll be moving on the Medtronic Guardian soon which is a closed loop system, fingers crossed!

A chap I cycle with (who is a Renal Consultant) became a Type 1? diabetic a few years ago, mid 40s, when his immune system decided to kill off all his beta cells. He has a CGM and a Insulin pump which talk via a dedicated Android Phone, to create a closed loop system. Although he still occasionally gets the phone out to tweak it a bit....

My 16 year old started on the Guardian at Christmas. Sensor is fiddly to fit and wear compared to the Libre, but less tech waste. Results of the closed loop system are remarkable. We’re impressed.

Yeah I think there still needs to be involvement telling the pump that I’ve exercised etc. I tried the early CGM’s out by Medtronic which required constant calibration by testing bloods, the new ones are meant to be a lot better.

They do look more fiddly to fit and more frequently I think? Compared to Libres 2 weeks. If it gives me good control I’m all for it.

Once a week, and the Guardian transmitter is reusable, just the sensor gets replaced. Is fiddly to apply, not a one handed job like Libre. The software does a remarkable job of keeping in range… but we haven’t cracked heavy exercise yet. Lots to learn still.

There is a lot of plastic waste with the Libre - you throw away about 90% of the kit!

There is a lot of plastic waste with the Libre – you throw away about 90% of the kit!

As someone who endured 30 years of finger pricks (or not, and the problems that causes) I’m good with it.

The battery and other tech waste is quite high with Libre as well, with the transmitter being single use. More of a concern if the non-medical use really takes of.

I think you are best using the LibreView web platform rather than your phone for looking at trends.

So just tried this using the account details Zoe gave me for the App - but not a valid account apparently - so only access via the iPhone App.