Results from Using a Continuous Glucose Monitor
Why Try a CGMS & Preparation for CGMS
Our diabetes program at Children's Hospital of Philadelphia (CHOP) is developing a diabetes technology program that incorporates devices like continuous glucose monitoring systems (CGMS ) into the overall care of patients. Nurse practitioners or endocrinologists can call in a member of the diabetes technology team during patient appointments, as needed. In addition to patient consultation and pump and CGMS starts, the technology team provides educational classes a few times a year at the clinic sites.
Our nurse practitioner used to be one of the insulin pump experts in the practice, but the practice soon realized with new pumps and technologies appearing on the market they needed a more global responsive approach so that all patients could get the information - not just the patients with the most technologically savvy practitioner. Our nurse told us she started to have trouble keeping up with all the different features of each pump and CGMS so she was grateful for the intervention of a designated technology unit and the training and support they provide to the nurse practitioners and endocrinologists.
We took advantage of a five day CGMS trial earlier this school year because Josh had gone through a tremendous growth spurt and we were having trouble regulating his blood sugar numbers. The numbers were all over the place and I suspected the early morning highs may have been the result of missed late night lows. Josh did lots of extra finger sticks and my husband and I did extra middle of the night checks but that data was inconclusive. We were constantly tweaking Josh's basal rates but basal tests showed the basal rates were correct. We presented the CGMS to Josh as an opportunity and a science experiment and Josh agreed to wear the device for 5 days.
The technology program's requirements for wearing the device included first meeting with a nutritionist and providing a one week detailed food log. I thought this was just a hoop to screen out motivated users, but CHOP had found that poor blood sugar control was almost always directly related to diet, poor carbohydrate counting or incorrect food to insulin ratios. They also wanted to be sure our family was willing to keep a detailed food log because a food and activity log is essential to "translating" the raw CGMS blood sugar data. Some family's problems are solved in the meeting with the nutritionist and they do not proceed to the CGMS. Although we did get some new tips like how to cover protein and fat with insulin, our problem was not solved so we moved forward with the CGMS trial.