Download - Type 1 diabetes self-management: a patient's experience of using CGMS

Original ArticleBarriers to evidence-based practice integration

EDN Spring 2010 Vol.7 No.1 Copyright © 2010 FEND. Published by John Wiley & Sons 15

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Sir, I have had brittle type 1 diabetes for 32 years from the ageof 10, developing cataracts andperipheral neuropathy at 13 years,and autonomic neuropathy andsevere gastroparesis aged 20 causing difficulty in matching myinsulin needs to the rate of diges-tion. In 2000 I gained funding forinsulin pump therapy, allowing meto moderate my basal and bolusinsulin requirements accordingly.My complications have stabilisedand my average HbA1c is always6–7%. I do not have a pump-trained diabetes consultant.

In April 2009 I asked my PCT tofund a CGMS, stating the reasonswhy I have a clinical need for thistreatment, emphasising my frequenthypoglycaemia with no warningsigns. I pointed out that a systemthat could warn me of my blood glucose trends would be of immensebenefit to my quality of life. I alsoprovided the annual CGMS fundingcosts. In May 2009 my PCT agreedongoing funding of an insulin pumpwith integral CGMS.

The CGMS is calibrated 3–4times a day with SMBG levels foroptimal results. I insert the sensorsubcutaneously into my abdomenand it reads interstitial glucose levels every 10 minutes. This signalis transmitted to the pump’s software, forming a graph dis-played on the pump screen. I set my desired glucose limits at4–10mmol/L to gain tighter con-trol with gastroparesis, resulting infrequent alarms as the pump alertsme of predicted glucose trends. Ihave opted to silence the noctur-nal expected high alarms becauseof disturbed sleep.

Many of the alarms are predicted post-prandial highsallowing me to fine-tune my bolusand basal insulin requirementsafter meals. I soon realised that tissue and blood glucose levels aredissimilar. When comparing theaccuracy of a typical six-day (144hours) sensor life, only half of mypaired sensor and blood glucosereadings are the same or within0.5mmol/L, but at least five

readings show a difference of9mmol/L or more.

It is difficult to maintain normoglycaemia without theincreased risk of hypoglycaemia as diabetes control is tightened.However the benefits of using thissystem far outweigh any disadvan-tages in replacing my absent hypo-glycaemia warning signs, allowingme to take remedial action andgiving peace of mind. It has alsoenabled improved glycaemic control which will help slow theprogression of current and futurecomplications of diabetes. I wouldrecommend the CGMS to anyonewishing to effectively self-managetheir diabetes.

Dr Valerie Wilson, Head ofResearch, The Insulin PumpTherapy (INPUT) national volun-tary diabetes organisation, UK, e-mail: [email protected] Diabetes Nursing welcomes letters on any subject.Letters can be emailed to:[email protected]

Type 1 diabetes self-management: a patient’s experience of using CGMS