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Insulin Pumps and Continuous Glucose Monitoring

By Dr. Francine Kaufman

Chief Medical Officer

Posted:  7/17/2012 3:11 PM

Tags:

Editor’s note: We were excited to hear that our very own Dr. Kaufman worked with the American Diabetes Association on a new book, “Insulin Pumps and Continuous Glucose Monitoring: A User’s Guide to Effective Diabetes Management.” We will be giving away 10 copies of the book by random drawing – to enter, please send us a comment below and tell us what diabetes management tip you would like to share.  In the meantime, we asked Dr. Kaufman to share her process and reason for writing this book so that we could share it with you.

I am so thrilled to have my book out and available for patients and providers.  Writing a book for the ADA is an honor and a lot of work, as you can imagine.  But this book flew out of me.  I had the help of an incredible young woman, Emily Westfall who I met on a plane by serendipity.

We were flying on a Southwest plane from LA to St. Louis.  I had planned to begin getting myself organized to write the book on the trip, and as a result, I was hogging the middle seat.  She sat on the outside seat and stared at me. I thought she was upset with me taking over the middle real estate until she timidly asked, “Are you Dr. Kaufman.”  She has diabetes and had heard me lecture. We began to talk, and by the time we landed, she and I had a business arrangement essentially written out on a Southwest napkin.

Emily was amazing in helping me, and I am thankful she sat down next to me that day.  With her help, I think the book gives a very fair view of what insulin pump and CGM therapies are, how they can be optimized and all the tips and pearls that make using these technologies beneficial.

Editor’s note: to find out more about the book, or how to purchase, please check out the ADA’s web site: http://www.diabetes.org/for-media/publications-press-releases/new-diabetes-technology-helps.html
 

Comments

Megan

Posted on Tue Jul 17 15:42:26 GMT 2012

I have found eating a protein bar (10 or more grams of protein) before my 3-5 mile runs helps to keep me from bottoming out during the run.

Mary Christy

Posted on Tue Jul 17 15:42:33 GMT 2012

The best diabetes management tip I know is to educate yourself. Talk to specialists, ask questions, read all you can stand about controlling your disease, so that you can feel well and have the energy to enjoy your life.

Janis Landers

Posted on Tue Jul 17 15:44:27 GMT 2012

Morning everyone,I was just curious if the book has anything about diets and eating right for myself(which I ma a Type 1 and my husband a type 2)?? Seems like insurance is paying for less and less and they WILL NOT pay to see a Dietician so I am at a stand still. I was diagnosed at age 43 with Type 1 and still my Drs can't figure that one out anyway I have gained like 60 lbs and am 5ft tall so I am a butterball. I know exercise is the best but my feet just keep getting worse and worse. I feel really bad about the way I look my teeth r even suffering because of it so if u could help I would really appreicate it. Have a Wonderful Day :)

Carol

Posted on Tue Jul 17 15:45:35 GMT 2012

Looks like a great resource. As a mom with anew pumper, my tip wouldbe- bolus before meals. It's pretty easy to come up with a common amount toget started with and bolus more if needed.

Jana Wardian

Posted on Tue Jul 17 15:45:39 GMT 2012

To use a CGM to its fullest, I download the information every 2-3 weeks and use the trends to make adjustments to my basal rate.

Tanya Cook

Posted on Tue Jul 17 15:48:48 GMT 2012

My five year old and I have been battling this diesease for two years now and it would be wonderful to have some input of what I could be doing better to manage his glucose levels better. It would be a great opportunity for me to learn more for his sake from your book.We have had him on the insulin pump for about 6mths

Claudia Johnston

Posted on Tue Jul 17 15:49:36 GMT 2012

Medapore tape is awesome in covering and securing my CGS. It works well with sweating and showering.

Ryann Herrera

Posted on Tue Jul 17 15:49:50 GMT 2012

I love both; my pump, and CGM. They have helped me survive..
It's really tough trying to keep everything even and taking so many shots.. These things make it a LOT easier for sure. Thank you.

Sarah Sutton

Posted on Tue Jul 17 15:57:31 GMT 2012

If you have to take steroids to treat other conditions like I do - chronic allergic fungal sinusitus - I've found it's best to ramp up my basal rate before hand rather than chase high sugars with boluses. It's amazing how high the steroids can push up sugars. I've been a T1 for 35 years and have been pumping for over ten.

Janet

Posted on Tue Jul 17 15:59:45 GMT 2012

My question is: WHY the ADA??? Everything I see from them is about type 2. I am interested to read the book, nonetheless. But, it irks me that it was done in conjunction with those who always seem to forget about the T1D's out there and tend to refer to all diabetes the same, simply as 'diabetes' rather than clarifying type 1 or type 2 - further complicating things and blurring the differences between the two and not helping in the realm of awareness at all. :(

That being said, my son is on a MM pump and has been for almost a year now. He went on it about 5 months after his Dx. It has been a blessing; that's for sure. Can't say as much for the CGM in his case, though, however unfortunate that is. We are just waiting for the Enlite to come here. Can't get here soon enough for our taste!! ;)

Editors Note: Enlite Sensor is an investigational device in the U.S. and is not approved for sale in the U.S.

jeffery innis

Posted on Tue Jul 17 16:03:23 GMT 2012

i have been on the pump 4 about 5 mos. & i was getting a little flusterated because my blood sugars werent where i thought they should b . but the lady that helps me is so nice & she helps me alot! shes great! ...now im starting to see some improvment . not where i should b . but getting better......

Tom Goffe

Posted on Tue Jul 17 16:03:49 GMT 2012

With gastroparesis, I find that carefully examining post meal BG changes for each meal menu I use helps to anticipate how to bolus when I next have that particular menu. When eating out, I try to have a "favorite" menu for each restaurant that allows me to know the carbs, in sulin requirements and post meal BG curves. Gastroparesis really makes keeping in control a challenge and takes plenty of work and attention to detail.

Deanna Bohn

Posted on Tue Jul 17 16:03:52 GMT 2012

Can't wait to see this book. My daughter is a Type I Diabetic, but still taking insulin with pen needle. Being a teenager, she would like to try the pump to have more freedom from her schedule. Unfortunately, her father refuses to even discuss it with her doctor and due to legal reasons, both parents have to agree before the doctor can even talk to her about the pump. I can only hope, when she turns 18 and can make her own decisions, she can use this book to guide her. I plan on reading your book in order to help my daughter make the right chose for her. Thank you and Emily Westfall for taking time to write about such an important topic.

Betty Macomber

Posted on Tue Jul 17 16:05:23 GMT 2012

I have medtronic pump and cgm, and would love a book that could teach me more!!

Michele Becker

Posted on Tue Jul 17 16:09:19 GMT 2012

My son is 4 and was diagnosed at 17 months. We started pumping at 20 months - best decision ever. Would love to start on CGM but worried about connecting ANOTHER device to his little body....Anyway, my tip is to pre-bolus for everything except ice cream. Seems my little guy doesn't need insulin for ice cream until almost 2 hours later. The dual wave and square wave boluses are lifesavers for fatty foods!

Maria de Lourdes Cartaya

Posted on Tue Jul 17 16:11:47 GMT 2012

From Caracas, Venezuela
Education, education and more education!
Thank you Dr. Kaufman!

Mary Fairweather Dexter

Posted on Tue Jul 17 16:16:38 GMT 2012

I have been pumping for 6 years, on a CGM for over a year. If you have any problems with the equipment, download to CareLink and then call as soon as possible. Medtronic's helpline personnel are wonderful. They are able to be even more helpful if you call as you are having the problem and if they can look at your downloaded data.
I could really use this book.

Marcie Ortmann

Posted on Tue Jul 17 16:19:49 GMT 2012

I wear and insulin pump and CGMS and am so glad I switched to the pump versus syringes. It gives you so much more freedom. My tip is to make sure you monitor your blood sugar a little more in this hot weather. This heat can make your sugar get low a lot faster so maybe eat a little cool applesauce!

Anitha Desikachari

Posted on Tue Jul 17 16:39:57 GMT 2012

I've been a T1 for 25 years and have been pumping for over seven years. Eating whole grains like brown rice over white rice gives better glucose control, lesser bolus values and prevents weight gain.

Andrea Neske

Posted on Tue Jul 17 16:45:02 GMT 2012

I am a type 1 diabetic with both an insulin pump and continuous blood glucose monitor. I recently switched forms of birth control and have been suprised by how much birth control effects my blood sugars. I would love this book to get some tips on how to properly use these two tools

Julie Penndorf

Posted on Tue Jul 17 16:45:58 GMT 2012

I look forward to reading this book! I've had my pump for 10 years and can't imagine life without it, especially in regard to being pregnant and having children. Pumping has enabled me to complete one healthy pregnancy and now I am in the middle of another. Very thankful!

Shelbi

Posted on Tue Jul 17 16:56:44 GMT 2012

My daughter was dx'd at age 5 and started pumping at her 6th birthday. She has been pumping for 12 years. She has greatly benefitted from the CGMS, and the long battle with insurance to get it covered for a patient under 18 years was worth it! This book would be an excellent resource to give to my daughter to read and study as she gets ready to go to college in less than a year. We have been handing the baton of care off gradually, and this mom would love the comfort of knowing that my daughter has a resource like this to use when she is "on her own." Thank you for writing this book!

Ben Ezzell

Posted on Tue Jul 17 16:58:00 GMT 2012

Best tip I can offer is ... a diabetic alert service dog. Mine is named Keiser von Schnauzer, he's silver, 24 lbs and is my constant companion day or night. And, yes, he visits my doctors with me and, while the operating room was off-limits, was waiting for me in recovery. Granted, even the best SD is not a machine (not 100% infallible) but they sure make up for it the other 99.9% of the time. However, I'm still interested in continuous monitoring ... just as long as Keiser remains with me as well.

Sharon Blutcher

Posted on Tue Jul 17 17:02:18 GMT 2012

I have a medtronic pump and have been pumping for 9 years. A few months ago I started with the CGM, since starting the CGM my blood sugars have been much better and have not had as many low's either plus my A1C went down, not that it was real high to begin with. Thanks to my Dr's they have taught me how to adjust my basal for high activity exercises. Would love to learn more about the CGM and what it can do for me.

Becky Moore

Posted on Tue Jul 17 17:16:09 GMT 2012

I have type II DM and my Dr. is all about the insulin pump and CGM. I have had other physicians who were not in favor of it and even the endocrinologist ? the use of insulin. I've been diabetic for 14 years and it is not like I've never taken oral hypoglycemics. Anyway Medtronic has excellent products and support and now that I'm using the CGM I have much better control and I know better how activities, foods and meds effect my glucose. I'm performing FSBS testing more as well! Hopefully the book will help to educate physicians and nurses about Insulin pumps and CGM.

Karen Ingram

Posted on Tue Jul 17 17:29:54 GMT 2012

My 15 year old Type 1 diabetic son has been on the pump for four months now and loves it. He loves not having to carry around needles and pens. One tip we have to share is to change your site more frequently if you are out it hot weather a lot.

Evan Keese

Posted on Tue Jul 17 17:31:30 GMT 2012

I think the biggest thing Is knowing your body and how things are going to affect you. Also you have to exercise, it's easy not to but nothing easy is good for you

Beth Holen

Posted on Tue Jul 17 17:32:57 GMT 2012

My tip is to listen to everything that Dr. Kaufman has to say! :) She has been my kids' doctor since one year into diagnosis for one and since diagnosis for the other one! So for about 16 years! It has not been easy and my kids are handling it differently from each other and the almost 20 year old is actually having to be in the world of adult endocrinologists and is finding the care, in our experience, a lot less hands on. So keep your kiddos with their pediatric endo for as long as you can if you are having success because once they get out to an adult endo there is usually no going back. Keep fighting the fight everyone!!

Kim Cutberth

Posted on Tue Jul 17 17:48:44 GMT 2012

Hope to get a copy of this book!! I have been pumping for 1.5 years now as a Type 1 diagnosed 8 years ago. As a working, busy 36 year old I need all the help and tips I can get to beat this disease!!!

Donna M. Theobald

Posted on Tue Jul 17 17:52:17 GMT 2012

I'm only on the insulin pump 2 months now & could use more info on it. I'm handiacpped and 69 years old. Have highs & lows.

Chris Starnes

Posted on Tue Jul 17 18:59:12 GMT 2012

I have been a Type 1 diabetic for 42 years now. I have been on the insulin pump for 14 years and this is the first Medtonic with CGM that I have used. I am getting used to the system but trusting it all the time is a problem sometimes, I hope a book like this will give me some insite on the situation.

Jennifer Palmer

Posted on Tue Jul 17 19:20:20 GMT 2012

My son is 4 and has been on the pump for a year. We love it!!

Terry Troy

Posted on Tue Jul 17 19:42:17 GMT 2012

When my daughter seems to be having a hard time with the daily monitoring of her diabetes, my husband will offer to walk a day with her in her shoes. He'll check his number whenever she does and take the same amount of saline solution as she does insulin when she gives herself a shot. Next week, she'll be getting her pump. We're looking forward to what we believe will be a positive change in her routine.

Michelle Stevens

Posted on Tue Jul 17 19:52:25 GMT 2012

I've been Type 1 for 19 years, using the pump for about 12. The ability to have multiple basal rates throughout the day is beautiful thing. Temporary basal rates are my number one tool for exercising. I find that I need to cut back 50% an hour before working out in the afternoon or evenings. Trying to lose weight around diabetes (dealing with changes in BG and insulin needs) can be tough. I have a soft spot for fellow pancreas pals. If you would like an accountability coach email me at michellemarielc@gmail.com Have a sweet day!

patrice

Posted on Tue Jul 17 20:12:07 GMT 2012

I am very excited about this book and anxious to read it. My daughter was diagnosed at age 3. These teen years are tough!

Karrie

Posted on Tue Jul 17 20:13:03 GMT 2012

Great tips everyone! Thanks for sharing your personal experiences and what has worked for you.

Karrie

Posted on Tue Jul 17 20:17:16 GMT 2012

Donna – I’ve forwarded your comment on to the appropriate team here at Medtronic and someone will reach out to you soon with some information.

Jayne Evans

Posted on Tue Jul 17 21:09:21 GMT 2012

Type 2 Diabetic still using Insulin pens with mixed results. Would love to have one of these books both for myself and my granddaughter who has HI. Thanks so much.

mike

Posted on Tue Jul 17 22:00:30 GMT 2012

My wife needs to learn how to better manage her BG.

Helen Johnson

Posted on Tue Jul 17 23:48:19 GMT 2012

I have had T1 diabetes for 41 years and been on a insulin pump for about 30 years. I got a cgm a couple of years ago. It was the best thing I have ever done. If you get low blood sugars, I strongly suggest getting a cgm that will alert you if your BS is dropping.

Sara susner

Posted on Wed Jul 18 00:04:08 GMT 2012

My 6 year old was dx'd at 4 and started the pump a month afterwards. We have tried the CGM a handful of times but with little training on it we were too overwhelmed. Honeymoon phase is long over with and his sugars are out of control. We want to stabilize him and with more knowledge of the CGM I'm sure we would try it again. Knowledge is power. Read and educate yourself as much as you can.

HarLynne

Posted on Wed Jul 18 01:40:07 GMT 2012

I have been Type I for over 42 years and a pumper for 22 years. I also use the CGM off and on. My number one tip is to find a team of healthcare practitioners that will allow you to be in charge but, and this is just as important (!), that YOU will listen to. After all, they are up to date on the latest, evidence based, medicine and WE are the ones who know what it is like to walk in our shoes. It HAS to be a partnership!

Ellison McCall

Posted on Wed Jul 18 02:02:47 GMT 2012

I have use the Revel MiniMed pump for close to a year now and love it. The CGM not so much. I have a hard time trusting what it is telling me.I have it set to notify me of any sugars above 200 and below 70. It alarms and says my sugar is 231, I check with my meter,it is 131. This is really annoying at night when it happens while i am sleeping. I feel signs of low blood sugar coming on, check sensor its says sugar is 110, meter says 60. This has occur many times. Maybe this book can show me if I am doing something wrong.

David Downs

Posted on Wed Jul 18 02:21:22 GMT 2012

I've been pumping since '98 and using a CGM for about a year. I'd love to get Dr. Kaufman's insight on how to tighten my control and get my A1c back in mid-6's.

Deb

Posted on Wed Jul 18 03:14:36 GMT 2012

I have been a type 1 diabetic for 30 years, pumping for 12. I have a cgm but find it painful. I compete in tri's and 1/2 marathons and always wear it for my events - so useful. However, I tend not to wear it for day to day use because it's uncomfortable. Perhaps this book has some tips on making it less painful. Very interested to read this, knowledge is power...and I'm still learning great things about my pump even after all these years. How can I get my hands on this book??

Mike Lanphere

Posted on Wed Jul 18 03:25:50 GMT 2012

I have been a type 1 since 1984 and been on a pump since 2001.Just got a monitor last year and like it.The problem I have with it is when you sweat it comes out.The biggest thing I have learned is get educated and have a good educator.I am covered by the VA and have the Best diabetes educator that the VA has.She has helped me thru alot and taught me alot too.

Maria Pavalko

Posted on Wed Jul 18 07:47:19 GMT 2012

I was just approved for an upgraded pump and a cgm today. Would love to have this book as I am so nervous about the cgm ....thank you!

Ellison McCall

Posted on Wed Jul 18 11:49:49 GMT 2012

I have use the Revel MiniMed pump for close to a year now and love it. The CGM not so much. I have a hard time trusting what it is telling me.I have it set to notify me of any sugars above 200 and below 70. It alarms and says my sugar is 231, I check with my meter,it is 131. This is really annoying at night when it happens while i am sleeping. I feel signs of low blood sugar coming on, check sensor its says sugar is 110, meter says 60. This has occur many times. Maybe this book can show me if I am doing something wrong.

Roger Barnett

Posted on Wed Jul 18 21:37:02 GMT 2012

Hi, My name is Roger and I am a "PERSON" with diabetes. My pancreas runs on Triple A batteries. I have a Medtronic Revel Mini Med Pump. I do not have a CGM. Since my introduction to the "pump" in August 2011, my A1c's have remained steady at 6.1 or better. I was diagnosed as a "PERSON" with diabetes at age 55 on Sept.19, 2005 . Although I am classified as a "Person" with Type 2 diabetes, I have always been on insulin. My electronic pancreas is the greatest tool that I have ever had in my efforts to fight this disease. It has allowed me to bring my bs under control. "I'm Lovin' It"

Anders Lange Andersen

Posted on Wed Jul 18 22:53:32 GMT 2012

Hi.
I was diagnosed with diabetes 17 years ago and have just started pumping 3 months ago. Pumps have been dificult to get due to the fact that I am living in Denmark. In Denmark private health insurance isn't normal, due to the fact, that public healthcare are VERY good. The hospitals has finally realized that pumps and CGM is the best way to treat diabetes, it saves cost, as patients a capable of controlling blood glucoses better, and that way avoid complication caused by bad blood glucose control. The normal way to get started using a pump is to wear a CGM for a week and after that a pump only. The public healthcare has now started a study to determine if the continues use of a CGM device provides any benefits in the treatment. For now we a 3 patients in the souther part of Denmark (Denmark is a small country with only 5 million people), and the group of test persons are growing. I like the CGM treatment as it gives me better control of my blood glucose levels, its not perfect but gives a good picture of the basal and bolus rates. If I am successfull with the CGM device it might clear the path of other patients to be aproved for a CGM treatment.
As I find the CGM treatment very helpfull I am determined to do the best I can to improve result, and that way help other patients to get the CGM device as well.
I have studiet a lot about this treatment lately, but documentation is hard to find, one example could be the 500 rule... We does it come from? Another one is the 100 rule...
Being able to undestand the treatment is crucial for a good outcome of the treatment, thats the reason why I would like to receive one book to be able to improve further and improve my undestanding of the treatment.
Undestanding is my advice to other patients, the more you undestand of the disease and the treatment, the better you will be able to handle it...
Good luck to all of you.

Ray Olendzenski

Posted on Thu Jul 19 19:43:37 GMT 2012

I have been a type 1 diabetic since 4/5/1993. I was n the military and had all the signs and symptoms but had o idea what diabetes was. I went on sick call on 4/5 and had a blood suger of 1193 had I ran the 5 miles that day Dr's said I would have killed myself.

My post is to all the diabetic educators who help us learn about our condition, If it wasn't for my diabetic educator I am sure I would have no clue as to what to do with y future. She suggested I go into nursing and help other diabetics which is what I did.

My advice listen to your Certified diabetic educators they can help in so many ways.

Thank you again to Jo Timmons and every CDE out in the diabetic community

Ray O

Kenda WIlliams

Posted on Fri Jul 20 00:44:20 GMT 2012

I have had Type 1 DM since may 1965. I have seen many changes in the world of diabetes management. I am a retired nurse. I was one of the first Certified Diabetes Educators. Diabetes has never kept me from doing anything I wanted to do. I did my learning and growing as a person with diabetes with the help of my committed family. Now people with the diagnosis of diabetes, people have wonderful teams of educators to help them find the best path to take and achieve the best diabetes management possible.

Jennie

Posted on Sun Jul 22 04:48:43 GMT 2012

To get your CGM to work for you the best thing is to remember to calibrate before meals and insulin. That's when your blood sugar is most stable and the sensor can be the most accurate. You have to do it at least twice a day but I do it before every meal. Occasionally I'll get the random wrong numbers but for the most part I get a good idea of which direction my sugars are heading. Keep trying and you will see some good results. Even having just one time where the sensor alert wakes you up and lets you know you are about have a hypo episode is worth wearing the sensor:)

Brenda Burger

Posted on Thu Aug 23 15:35:06 GMT 2012

I am a new pumper recently rediagnosed with LADA (Type 1 diabetes) is an autoimmune disease that cannot be prevented and often appears slowly late in life. As it reared its ugly head, I was in the best position in my IT career. Slowly I had more and more functional difficulties until I had to go on disability. My endo has now moved me to a Medtronics pump and CGM which has literally changed my life for the better. Here is where I hope the book can help, due to severe Gastroparesis and abdominal adhesions I am having some issues deciphering the data. Perhaps this will be another lucky day for me and I will win a book. (fingers crossed, thank you)

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