Ad hoc

As you have noticed, if you have looked around on this blog, it is mainly on insulin pump therapy - also known as Continuous Subcutaneous Insulin Infusion, or CSII. As I have told in my previous posts, this kind of continuous insulin delivery was a breakthrough for our daughter, Emilie, who has type 1 diabetes - and for our family as a whole.

But delivering insulin to the body continuously in exact amounts only partially meets the challenges of type 1 diabetes. To administer the right amount of insulin, you have to know the level of glucose in your blood. Until recently, the only way of knowing that was to stick your finger and measure the glucose concentration in the drop of blood coming out.

Enter Continuous Glucose Monitoring Systems, or GCMS.

In the beginning of April, Emilies endocrinologist at Glostrup County Hospital, Copenhagen, suggested that Emilie tried the brand new Medtronic MiniMed Paradigm Real-Time insulin pump. In addition to being an insulin pump, this device receives and displays readings from a separate continuous glucose sensor, inserted in the subcutaneous tissue. The danish distributor had offered Emilies endocrinologist some pumps for her juvenile patients to try - and a number of grown up diabetics at another clinic would have the same offer.

The shift to a MiniMed pump had been coming for some time, because that brand is the only one offered by the Copenhagen County in a new plan for a wider use of insulin pump therapy in children in the county. And now seemed to be the time to try …

At first, Emilie liked the idea very much: No more blood glucose tests, yes! And the pump was cool, and smaller.

When we told her, that she would still have to test the way she used to, perhaps a little less frequently, her motivation dropped a little, but she still wanted to try.

I hope to get the time to share our experiences with this device - but before continuing, it is important to stress, that even though the pump receives and stores the data from the sensor - and presents the data in combination with data on insulin delivery from the pump - there is no other kind of integration between the two devices. The sensor is in no way controlling or even making suggestions about insulin delivery.

If you use the Bolus Wizard feature of the pump, you even need to manually enter the value from the sensor if you want to use that data as input for the wizard.

That said, what are the pros and cons of the continuous blood glucose sensor?

First of all, it provides access to data, that we until now have been able to only guess about: The trend in blood glucose values after meals, during the night, at different times during the day. Even with 6, 8, or more blood glucose tests each day, there are things going on between these tests, that we have had no idea about.

Second, the blood glucose alarm already has proven to be useful. It is possible to define custom alarm thresholds, so that if the blood glucose rises above or falls below a given value, the pump will sound an alarm.

So, the potential benefits are obvious - but does it work?

Hopefully, I will return to that question soon … In the meantime, you could drop by another blog on a similar issue - one that is much more detailed, than I will have the time to be: LifeAfterDx–The Guardian Chronicles. In this blog, Wil from New Mexico, United States, shares his experiences with an earlier version of the same technology: The Medtronic MiniMed Guardian RT, that uses the same sensor technology, but displays the glucose readings in a separate device.