A new method of assessing glucose control is now available.
Called
the
Continuous Glucose Monitoring System, it is has the potential to revolutionize
diabetes care.
We have entered a new era in diabetes care! Recently, some endocrinologists have reported the results of data from
MiniMed's
continuous
glucose monitoring system (CGMS). While this
device currently does not provide the
user with a continuous readout of
blood glucose levels, it does the
next best thing. When downloaded into
your endocrinologist's computer, it provides
three days of information useful in
identifying problems and adjusting treatment programs.
Several studies have shown that this
does lead to improvements in overall blood glucose control
(lower
glycohemoglobin
values and fewer hypoglycemic events).
You probably are checking blood sugar levels several times a day.
While this
information is important in making
gross adjustments in your treatment plan, 3 or 4 blood sugars is
now shown to be insufficient in fine-tuning. When blood
sugar is checked intermittently, what is seen
is only a
few points in time.
And it is
impossible to tell from a single number
if the level is
rising or falling, and therefore there is a fifty-fifty chance that the
wrong decision will be made
about
what to do.
The sensor provides a true picture of glucose control. It averages interstitial fluid (ISF) glucose levels every five minutes. Therefore, when data are
printed out, you see a graphic representation
of what was going on during the monitored period.
This information can be used to identify
problems, and fine-tune the insulin, meals, and exercise program.
For example, in one
study, the fluctuations occurred in greater frequency than expected; the excursions lasted longer than had been
thought; and there was unrecognized hypoglycemia and hyperglycemia: most
of the unrecognized hypoglycemia occurred during the night, and most
of the hyperglycemia occurred three or more hours after meals (especially after a high-fat meal like pizza!).
How does it work?
A small sterile disposable glucose-sensing device
called a sensor is inserted into the subcutaneous tissues, using the same procedure as when inserting the needle on the end of the catheter used with insulin pumps. This sensor measures the change in glucose in ISF,
and sends the information to a beeper-sized
black box (called a
monitor) which stores the results for three or four days worth of data.
The monitor must be calibrated daily by entering
at least three blood glucose readings obtained at different times, using a standard blood glucose meter.
You will also be expected to enter insulin doses, exercise, and meal information into
both a logbook and the monitor.
After three days, the monitor is taken back to your endocrinologist's office, where it is placed in a docking
station, which is connected to a standard personal computer.
Specialized software then downloads the stored information, so that you and your diabetes team
can review the data and
decide on a treatment plan aimed at correcting any problems.
Later, repeated CGMS testing and followup
HgbA1c levels
can be done to see
whether the changes worked.
The Impact of CGMS
For the first time we can see what happens to glucose levels on a minute-to-minute basis, and
evaluate trends, during normal daily activities. We expect that the availability of CGMS dramatic impact
on the way diabetes is treated.
Contact your
diabetes team to inquire about CGMS availability in your area.
More information can be found on-line at MiniMed's website, at
Continuous Glucose Monitoring System.
ss
Also see
setting performance standards for continuous monitors
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