I am asked often if I really think we need a CGM with the DAD, or the DAD with the CGM, or why would anyone need both, or if I think everyone should have both.
I can only speak for my family and our experience. And here’s the thing. The DAD and the CGM serve different purposes for us. And while I think the DAD’s are amazing (if you get one from a reputable organization and work your ASS off to maintain and build on all the training your DAD has received) they work better in certain scenarios or health scenarios, and for the newly diagnosed, can prove to be a downright disaster.
To the first set of questions. A DAD and a CGM provide very different services for us. The DADs provide information for rapid fluctuations in blood sugar, something that the technology of the CGM just can’t provide in real time. And even against a meter, the DAD’s are often sensing quick rises and drops before the meter has a time to catch them. (see my post below). The CGM is often 20 minutes behind real time.
So why a CGM then? Well the CGM allows us to track trends To track corrections. and to fine tune our base rates. While the DAD’s often help us avoid extremes, and allow us to fix issues quickly and aid in lowering our a1c’s, it is truly the CGM that allows us to look at and compare data 24 hours at a time, over the course of days or weeks. We can then take that data and really fine tune our basal rates, knowing that every night at 2:30 we start to see a rise, or to know that everyday during PE we start to drop, and we can make adjustments to our pump and basal rates to account for those. This proves even more effective towards maintaining and lowering consistent a1c levels. And adding Nightspot, with it’s remote monitoring capability, allows us to follow along during the day making adjustments from work while our child is at school. I send texts to Stella with notes like “increase your baseless 40%” or “test and give yourself a bolus”, or test and take a sip of Gatorade.
As for the dogs, here is why we have them. Stella doesn’t feel her lows or highs. She looks absolutely normal at 40, 120, and 400. There are no tell tale signs with her. And she certainly doesn’t wake up from a low. So the dogs provide us with an extra level of protection, often alerting us to issues when we have tested recently and are assuming we know what is happening, but diabetes has other ideas. And with a child that plays sports like soccer or basketball, or is a horseback rider, a dog on the sidelines that is good at it’s job can alert to highs and lows while you don’t have access to the child. With the creation and use of Nightspot and a CGM, coverage is greatly enhanced, but while in the ring Stella can’t wear her nightspot rig, so we lose coverage as she rides around the ring. And as she jumps more and starts competing, nerves have a way of greatly affecting quick fluctuations in blood glucose levels.
We are extremely lucky and absolutely grateful to be able to have access to and the ability to provide these tools to Stella. And if there is something else out there that we think would aid in either our management of this awful disease, or improve quality of life and ease of dealing with diabetes, then we will look at those things to.
Someone asked if we do any of this in an effort to reduce the amount of finger sticks or blood tests. The funny thing is, as you add more devices, more technology, a dog, etc, it has the opposite effect. We do more finger sticks now than ever. If you use these tools to seek tighter management, there will be more testing. Every time a dog alerts, we test to verify. As we see a trend on the CGM and make a correction, there is more testing. We test between 12 and 20 times a day. 12 is a good, easy day. 20 is an up and down, diabetes isn’t playing nice day. Again, we are thankful our insurance and Endo allow us to be able to do this.