Linking Diabetics Coast 2 Coast
CGMS Chat with Dr. Bruce Buckingham of Stanford University
(16:59):Welcome to CGMS chat with Dr. Bruce Buckingham of Stanford University , Dr. Bruce Buckingham !
Dr. Bruce Buckingham says to (16:59):
Hello everyone!
Jan3037 says to (16:59):
Hi, everybody.
Ellen4302 says to (16:59):
It's so nice of you to chat with us Dr. B. Thank you for making yourself available for us
bethdou says to (17:00):
Hi! Thanks for being here to chat, Dr. B.
Dr. Bruce Buckingham says to (17:00):
My Pleasure!
stacygroh says to (17:00):
Yes, Thank you for taking time out of your busy schedule to help us.
havana16 says to (17:00):
yes thank you
Gina says to (17:00):
I AM MODERATING THE CHAT TONIGHT... AND ALL QUESTIONS WILL BE FILTERED
Jan3037 says to (17:00):
We are all very appreciative. I understand you have information about all three cgms systems!
Gina says to (17:01):
you wont see questions up till i press the button
Gina says to (17:01):
everyone have it?
elvisbirth says to (17:01):
Yes
Gina says to (17:01):
understand it i mean?
Gina says to (17:01):
ok
stacygroh says to (17:01):
Yes
tmtdude says to JIMBOB48 (17:01):
yup
Teri says to (17:01):
thanks for letting us know Gina
Gina says to (17:01):
here we go
Dr. Bruce Buckingham says to (17:01):
We have been studying sensors in children for 8 years and we have looked at the minimed, the dexcom and the navigator
Gina says to (17:01):
type in as you would
Gina says to (17:01):
moderate chat on
*** (17:01):Moderator activated moderated-chat function.
Dr. Bruce Buckingham says to (17:01):
we studied children down to age 3 wearing the sensor
bethdou says to (17:02):
My husband was in one of your sessions at FFL and told me you had spoken about CGM data and seizures. Can you speak to those findings?
KarenG says to (17:03):
Thank you!
Dr. Bruce Buckingham says to (17:03):
we studied children and young adults who had seizures at night while wearing a CGMS, it was 2 1/2 - 4 hours of hypo less than 60 before a seizure
Dr. Bruce Buckingham says to (17:03):
i think this indicates we have a lot of time to respond to alarms, and the 18 minute delay in the sensor is not critical in preventing hypoglycemic seizures
Dr. Bruce Buckingham says to (17:04):
there is a skin real estate issue especially if they are also on a pump. but the sensors worked well
JIMBOB48 says to (17:04):
i was excited to hear that you work with children. as an adult that has struggled all my life withe not really knowing where i was i think it is important to establish good control very early
Ellen4302 says to (17:05):
These seizures were induced?
Dr. Bruce Buckingham says to (17:05):
the seizures were spontaneous
Jan3037 says to (17:05):
So the seizures do not occur immediately with the low blood sugar? That is comforting.
Dr. Bruce Buckingham says to (17:05):
correct
*** (17:05):
Teri says to (17:05):
We are fairly new to diabetes (Dec our 22 yr old daughter was dxed) is there a rule of thumb of when a seizures would happen? Is there anything "wrong" with having lower numbers? Daughter likes to have numbers lower rather than higher.
Dr. Bruce Buckingham says to (17:06):
#'s above 70 are reasonable and we aim for 70-160 for a target
marcy says to (17:06):
That's very interesting about the timing. I used to have seizures when I was a child/teenager--but never now.
richard157 says to (17:07):
After how long on the CGMS did the seizures significantly decrease in number?
Teri says to (17:07):
her 1st A1C was 16.9 and then 4 months later she was able to drop her A1C to 5.8 was that too fast to drop that much? She shocked all the Dr's in our small town on how fast she adapted
stacygroh says to (17:08):
I am worried about the skin real estate issue, plus where to "hide" both my pump and the CGMS. I wear my pump now usually in my bra. Do most people wear both clipped on to their pants?
Dr. Bruce Buckingham says to (17:08):
of the children with seizures 3 of them were using the retrospective CGMS, one was wearing the real time and they have not had any additional seizures. seizures are fairly rare in our practice and i got these cases from around the world, one from Australia
Dr. Bruce Buckingham says to (17:08):
one from Finland, and 2 from California
bethdou says to (17:08):
Did you find any major differences in the various systems in terms of accuracy?
Dr. Bruce Buckingham says to (17:09):
this is a very difficult question to answer - because the sensor technology is changing every 6 -12 months
Jan3037 says to (17:10):
E. has been as low as 20, no seizures or loss of unconsciousness. Perhaps meter deviation.... I would like to know when the Navigator and/or the Dexcom will also be approved by insurance for children to use?
Dr. Bruce Buckingham says to (17:10):
there was a study comparing the minimed, the dexcom and the navigator and the navigator did better in the hypo range, but since then the dexcom technology has improved but there is no data
Dr. Bruce Buckingham says to (17:10):
on the current dexcom sensor
havana16 says to (17:11):
is this CGMS outside or inside the skin like a pump?
Ellen4302 says to (17:11):
What is important to know when starting on a CGMS for the first time?
Dr. Bruce Buckingham says to (17:11):
1. it will not be as accurate as your meter
Dr. Bruce Buckingham says to (17:11):
2. there will be lag time of 18 minutes
richard157 says to (17:11):
It is my impression that the sensors are more unreliable with the Minimed.
Jan3037 says to (17:11):
Insurance has approved Minimed sensor which we are on summer break from. We are extremely unhappy about the size of the introducer needle. Do you know when Minimed will reduce the guage of their needle?
Dr. Bruce Buckingham says to (17:11):
3. there will be higher glucose values after a meal
Dr. Bruce Buckingham says to (17:12):
and 4. you will be able to see what happens overnight
Dr. Bruce Buckingham says to (17:12):
it takes awhile to learn how to use this info
marcy says to (17:12):
What are some tips you could give us about helping to get accurate numbers on systems?
Dr. Bruce Buckingham says to (17:12):
if you are on a pump you should always use the "insulin on board" for correction doses
Dr. Bruce Buckingham says to (17:13):
always calibrate when your trend has been flat for 20 minutes
Dr. Bruce Buckingham says to (17:13):
don't calibrate with rapid glucose changes
Jan3037 says to (17:13):
I used to give .20 correction immediately for every up arrow.
Lloyd says to (17:13):
Did you have very many cases where the sensors gave you what seemed like random numbers, clearly incorrect?
Dr. Bruce Buckingham says to (17:14):
if there is a sensor that is failing or the insertion site is going bad or sometimes if you lay on the sensor when you are sleeping, it can cause a dip in the glucose
values
shikiar says to (17:14):
what do you think about the omnipod vs medtronics meter w/ cgms for an active 11 year old
dktopham says to (17:15):
do all the sensors tend to read low at night?
Dr. Bruce Buckingham says to (17:15):
a meter can give you high glucose readings if the finger isn't clean. all things require good technique.
dktopham says to (17:15):
could it have anything to do with slowing of heart rate and less interstitial fluid at night?
stacygroh says to (17:15):
Why higher glucose values after a meal?
Dr. Bruce Buckingham says to (17:15):
sensors not necessarily read low at night
Jan3037 says to (17:16):
Minimed sensor values were not completely accurate, though still helpful. It was usually 25 to 30 points higher than her true blood sugar if low. And it could lag way behind the highs. If spiking high as in an aggressive growth spurt sensor was useless.
karkad says to (17:16):
I don't know much information yet about the continuous glucose monitoring system, but do you recommend that certain ages only use it?
Teri says to (17:17):
may I ask...How strong is the "tape" for the sensor? Now that she finally does have it and it's summer.....will it stay on for water skiing or wake boarding? I worry that it will fall off and then we will be lost
Dr. Bruce Buckingham says to (17:18):
because you don't normally test every 5 minutes for 2 hours after a meal and peaks after breakfast are very common
debiminlo says to (17:18):
We've been using the Guardian (with MM522 pump) for about 4 months, and have been pleasantly surprised by its accuracy. My daughter's A1C dropped from 8.1 to 7.0 in the first two months, we think as a result of the CGM. My husband would like to know how
karkad says to (17:18):
my son is 13, he was diagnosed a year ago, and i find that I cannot go to sleep without knowing his glucose levels are too high or low, so has this system given comfort to save a child from a high or low?
DiabeticDiva says to Teri (17:18):
Use Tagaderm (site cover) over it when tubing or doing water stuff! I live in Florida and have that problem, the sticky clear site covers work great for security that things won't fall off!
Ellen4302 says to (17:18):
Do you have concerns knowing that people are making therapeutic dosing decisions based on the the CGMS even though the devices are not approve for that purpose? Also, do you have concerns about the Navigator polymer residue that is left in the patient?
Dr. Bruce Buckingham says to (17:19):
that you can overtape the sensor with optsite or tegaderm and wear the sensor under the bathing suit, they are waterproof but you don't want to lose it
marcy says to (17:19):
That's true. I found myself trying new things to lower after meal bG after wearing the sensor for a while
debiminlo says to (17:19):
you feel about "intermittent" use of the sensors- we're quickly running through our supply, and no financial relief in sight. I don't want to go without it!
Dr. Bruce Buckingham says to (17:20):
in our study, patients who were testing 5-8 times a day decreased their testing to 4 times a day, but still tested before giving insulin
Dr. Bruce Buckingham says to (17:20):
The navigator polymer residue is very very small, and i have not seen any reaction in the skin, once the navigator is removed on a consistent basis
Dr. Bruce Buckingham says to (17:21):
it has been approved by the FDA
bethdou says to (17:21):
Tagging on to Ellen4302's question - a friend's child has twice had the Dex sensor wire remain in her tush after removing the site. She is reluctant to have her continue using the Dexcom. Is this a common occurrence?
marcy says to (17:21):
Do you find the 2 calibrations per day best to help keep sensors most accurate?
Ellen4302 says to (17:22):
Bethdou - I saw one report of it at FDA MAUDE website for reporting adverse events. I hope your friend reports it.
Dr. Bruce Buckingham says to (17:22):
i have heard of one other occurrence, the navigator is not approved for the bottom, it was only approved for the abdomen, and that was the response from Dexcom
Dr. Bruce Buckingham says to (17:22):
the dexcom not the navigator
dktopham says to (17:22):
do you think the next generation of rapid acting insulins like the 2nd generation novolog and the new one from biodel make a closed loop system possibly practical?
Dr. Bruce Buckingham says to (17:23):
more rapid acting insulins will definitely make a difference, especially if they have a shorter duration of action
Jack Purvis says to (17:24):
When you say 'clean' do you mean alcohol swabbed clean or just soap and water?
Dr. Bruce Buckingham says to (17:24):
i would use alcohol swab clean
Ellen4302 says to (17:24):
What is the harm in using the arm for blood glucose to calibrate the Navigator, as opposed to the fingertip?
shikiar says to (17:25):
your opinion on omnipod vs medtronics meter w/CGMS for active 11 year old
Dr. Bruce Buckingham says to (17:25):
the forearm can have a 10-15 minute lag when compared to the finger stick
Dr. Bruce Buckingham says to (17:26):
the omnipod is waterproof
Dr. Bruce Buckingham says to (17:26):
the medtronic pump with CGMS provides CGMS data which is not present with the Omnipod system
marktype1 says to (17:26):
hello dr buckingham.my name is mark year 34 type1
stacygroh says to (17:27):
Is there any technology where the CGMS "talks" to the pump and automatically administers insulin?
Dr. Bruce Buckingham says to (17:27):
i think a pump is a personal choice and all the pumps deliver the insulin very well
Dr. Bruce Buckingham says to (17:27):
currently there is no closed loop system
Dr. Bruce Buckingham says to (17:28):
closed loop studies are being done in a research center the first system will shut the pump off to prevent a low glucose
MelissaBL says to (17:28):
Are you an advocate for closed loop systems?
Dr. Bruce Buckingham says to (17:29):
YES
marcy says to (17:29):
Would you prescribe a CGM for every T1 child?
bethdou says to (17:29):
Is there a potential time frame for a closed loop system yet, or is it still too early in the trials?
Ellen4302 says to (17:29):
Dr. Buckingham, I believe you mentioned at CWD FFL that there was a study that using the CGMS actually decreased friction between parents and teens or children. Can you tell us where we can read that study?
MelissaBL says to (17:29):
It's my concern that a closed loop system might not ever be able to take into account all of the patient decisions such as intent and activity that go into the judgment calls we make about dosages and diet.
Dr. Bruce Buckingham says to (17:29):
too early to really predict - the earliest is 2011 and could be later due to the FDA and how comfortable the FDA is with the system
Lloyd says to (17:30):
I see my pump basal changes in 30 minutes, on my Navigator. Is this anything like typical?
karend1 says to (17:30):
let's see how comfy the FDA is with having diabetes for just one day :-P
Dr. Bruce Buckingham says to (17:31):
it is normal to take 30-60 minutes to see a change in the basal rate
Dr. Bruce Buckingham says to (17:31):
no guess
nissen says to (17:31):
What are some of the criteria to consider for a child using the CGMS?
Liz W. says to (17:32):
how far out do you think that integrating the minilink sensor and a pump site is?
Dr. Bruce Buckingham says to (17:32):
the major things are is the child going to be using the information,
Jan3037 says to (17:32):
If you integrate the minilink sensor with the pump site, you would have to change the sensor every three days. Don't like that idea. Unless sensor/pump needle is small gauge I would not want it.
Dr. Bruce Buckingham says to (17:32):
do they want the information
Dr. Bruce Buckingham says to (17:32):
and do they know how to use the information
Dr. Bruce Buckingham says to (17:32):
or is it for the parent to have alarms at night
Dr. Bruce Buckingham says to (17:33):
and to be able to review patterns during the day
dktopham says to (17:33):
i've been using a dexcom for about a year. I'm probably breaking a few rules wearing on my hips, back of my arms upper thigh. Is it known that certain sites are not reliable?
karend1 says to (17:33):
I have had diabetes for 41 years and I have trouble using the info I receive from my CGMS correctly
Dr. Bruce Buckingham says to (17:34):
it is my impression that the subcutaneous space provides similar readings throughout the body, but the dexcom is only approved for use on the abdomen
Jan3037 says to (17:34):
Adults monitor her basal patterns and make corrections in our house. But she can act on the low alarms, and go to the nurse for the high alarms if at school.
Ellen4302 says to (17:34):
Is the sensor lag the same between different brands of sensors or does one have more lag than another?
Dr. Bruce Buckingham says to (17:35):
it has not been well studied between the current sensors, in published studies there have been similar lag times in older sensors
Lloyd says to (17:35):
The Navigator is approved for the Abdomen also
bethdou says to (17:35):
Is navigator still only approved for 18+?
Dr. Bruce Buckingham says to (17:35):
yes
Sven Hoek says to (17:36):
Pregnant and on MDI...should I switch to pump w/CGMS or to Animas Ping?
Dr. Bruce Buckingham says to (17:36):
i would work with your physician in making these changes, i do not take care of pregnancy
Dr. Bruce Buckingham says to (17:37):
the nurses working with me had great success with a pump and CGMS during their pregnancies
dktopham says to (17:37):
what is the insertion needle size for the available systems?
sugarchallenged says to (17:37):
big
sugarchallenged says to (17:37):
haha
Dr. Bruce Buckingham says to (17:37):
they probably range from 5-13mm in length
Jan3037 says to (17:37):
Ping does not have cgms. How would the ping help with keeping blood sugars as low as endos require during pregnancy?
dktopham says to (17:38):
sorry i should of asked guage
Gina says to (17:38):
ATTENTION IF I MISSED YOUR QUESTION PLEASE RESUBMIT
debiminlo says to (17:38):
when did you start your studies
Dr. Bruce Buckingham says to (17:39):
about 2000
bethdou says to (17:39):
Which system is used more frequently in your practice?
Dr. Bruce Buckingham says to (17:40):
we have been doing studies, it is often what is provided by the study. we use all three.
dktopham says to (17:41):
of the 3 cgms available what are the insertion guages of the needles?
Mary C. says to (17:41):
There aren't any CGMS systems approved for under 18, are there?
Dr. Bruce Buckingham says to (17:41):
the minimed is approved to age 8
Jan3037 says to (17:42):
How would you rate the reliability/ease of use of each of the three systems? Have read Navigator most accurate. Is the Dexcom equivalent to the MM?
bethdou says to (17:42):
Is one closed loop study ahead of another in terms of when it might come to market? If so, is it the one with glucagon on board or the one without?
Dr. Bruce Buckingham says to (17:43):
for some subjects one system works better than other, we have people who have had trouble on one and then worked on the other
Dr. Bruce Buckingham says to (17:43):
there has not been any good published data
Jan3037 says to (17:43):
Paradigm Minilink is FDA approved for children 7 and up.
Dr. Bruce Buckingham says to (17:43):
in our JDRF trial we did not compare the systems
Dr. Bruce Buckingham says to (17:43):
just looked on the overall effect of CGMS
Ellen4302 says to (17:43):
Although not approved, do you find the accuracy of the Navigator to go beyond the 5 days - I know you can restart it but you need another 10 hour warm up period before seeing results
Dr. Bruce Buckingham says to (17:44):
we do not have accuracy data beyond 5 days
DiabeticDiva says to (17:44):
If you had to choose a system for your hypothetical diabetic child, which system would you choose?
Dr. Bruce Buckingham says to (17:44):
the dexcom is not approved for children, nor is the navigator at this time, that would leave the MM
JIMBOB48 says to (17:45):
could the eighteen minutes be an issue for a middle aged brittle type 1 diabetic who has hypo unawareness
Dr. Bruce Buckingham says to (17:45):
the 18 min lag could be an issue during the day, it could affect performance when driving if you go low
Jack Purvis says to (17:46):
in terms of accuracy what is the margin of error that you find with the results with the Minimed CGMS?
Dr. Bruce Buckingham says to (17:46):
people with hypoglycemic unawareness have been some of the people to receive the best benefit from CGMS
Dr. Bruce Buckingham says to (17:46):
we've seen the MM running around 10-16% MARD
JIMBOB48 says to (17:47):
but if i understand it correctly it will help prevent seizures
Dr. Bruce Buckingham says to (17:47):
yes
TJ Irvin says to (17:47):
Do you know of any studies involving CGMS and very young children (i.e. 3 years old)?
Jack Purvis says to (17:47):
is that the range across all results (i.e. from below 60 to above 200)?
Dr. Bruce Buckingham says to (17:47):
we studied a few children who were able to wear the system for 6-12 months
marktype1 says to (17:48):
sorry if i am off topic,but i saw a watch cgms made in germany for sale on the internet for 850 dollars,does anyone know of such a thing?if i had one of those my life would change dramatically,i have low blood sugar unawareness.it seemed to just go away.
marktype1 says to (17:48):
ive had type 1 for 34 years now
Dr. Bruce Buckingham says to (17:48):
the accuracy data, i would refer to the published papers which show that all
Dr. Bruce Buckingham says to (17:49):
CGMS are less accurate in the hypoglycemic range
TJ Irvin says to (17:49):
Do you forsee the FDA approving CGMS for children younger than 7 any time soon?
Dr. Bruce Buckingham says to (17:49):
yes
Dr. Bruce Buckingham says to (17:49):
but i am not the FDA
DiabeticDiva says to (17:49):
lol
Ellen4302 says to (17:49):
I know many of us are extremely enthusiastic about the CGMS -would you be so kind as to share some of the disadvantages?
Dr. Bruce Buckingham says to (17:50):
seeing a lot of glucose data that you previously weren't aware of
karend1 says to (17:50):
good question Ellen as I have used the CGMS and I am not quite a fan
Dr. Bruce Buckingham says to (17:50):
having your diabetes exposed to others, such as your parent or doctor, feeling naked
Dr. Bruce Buckingham says to (17:50):
tape allergies
Dr. Bruce Buckingham says to (17:50):
wearing more devices
TJ Irvin says to (17:51):
False alarms, bad sensors (ie my daughter was reading 49 and 289 every other reading) BG showed her to be 250
Jack Purvis says to (17:51):
are the papers available electronically? and do you have links to them?
Jack Purvis says to (17:51):
TJ Irvin ... which device was it where your daughter experienced bad sensors?
Dr. Bruce Buckingham says to (17:51):
they are available and perhaps through public med
Gina says to (17:52):
do you know if Abbott aviator will be out this year
Dr. Bruce Buckingham says to (17:52):
i do not
Jan3037 says to (17:52):
Great readings in the mid-ranges, but off in the lows and highs, which is where you really need accuracy. Though trends still so useful. Size of that needle is not made for children, yet MM is the only device insurance will cover.
Ellen4302 says to (17:52):
Pubmed: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed
Dr. Bruce Buckingham says to (17:53):
THANK YOU!!
Jack Purvis says to Ellen4302 (17:53):
Thanks!
TJ Irvin says to (17:53):
Could you direct me to a resource that would help with what to do with the CGMS data? (ie something that would expand on the info you gave at CWD this past week) I have the Dexcom system for my 3 year old daughter.
Ellen4302 says to (17:54):
Thank you:D
Gina says to Jack Purvis (17:54):
6 minutes left get your questions in
Dr. Bruce Buckingham says to (17:54):
there will be a web site explaining the devices and providing training and case examples that should be come available on the JDRF website it is not up yet and it will be up in 6-8 weeks
Ellen4302 says to (17:54):
Dr. Buckingham, when the AP or closed loop system becomes standard of care, do you think it would be wise for companies to be compelled to provide two systems per patient? In the event of failure, patients will no longer know how to manage on their own
Ellen4302 says to (17:55):
Years ago Disetronic provided two pumps - it was GREAT to have a backup
Dr. Bruce Buckingham says to (17:55):
redundancy is always good
bethdou says to (17:56):
How do you see CGM (and potentially, AP systems) changing the way diabetes is treated?
Jan3037 says to (17:56):
Closed loop system, what if there is a malfunction? Scares me.
Dr. Bruce Buckingham says to (17:56):
yes
Dr. Bruce Buckingham says to (17:56):
and that's true with any system
Dr. Bruce Buckingham says to (17:56):
a big concern
marktype1 says to (17:57):
would there be any other way to get a blood glucose reading without blood ie skin or sweat or?
Dr. Bruce Buckingham says to (17:57):
none of those systems have been approaching commercial availability
Jan3037 says to (17:57):
Life or death concern. Do not know if I would want to abdicate all control to the AP. Would like comfortable, small, easy to use open loop systems.
skyler says to (17:57):
hello! um.. Dr. B. i was recently diagnosed as type 1 in November of last year. i am in good control of my sugars but i was wandering if it would be a good idea for me to switch to a pump this early??
Dr. Bruce Buckingham says to (17:57):
but many have been proposed using light or flourescent
Ellen4302 says to (17:58):
Are you a proponent of using glucagon in the closed loop, or pramlintide, or just insulin, or all three?? Also, are you enthused about any other CGMs on the horizon that have not yet cleared or been approved by FDA?
marktype1 says to (17:58):
thanx
Dr. Bruce Buckingham says to (17:58):
i think glucagon may be very helpful for preventing a hypo crash
Gina says to (17:58):
Ok everyone, Dr. Buckingham has to go.
Dr. Bruce Buckingham says to (17:58):
that pramlintide may
Gina says to (17:59):
hes going to finish up now
marktype1 says to (17:59):
bye thanx
Dr. Bruce Buckingham says to (17:59):
make meal coverage with a closed loop system easier
DiabeticDiva says to (17:59):
Thanks Dr. Buckingham!
*** (17:59):Moderator disabled moderated-chat function, you can free chat now.
TJ Irvin says to (17:59):
Thank you.
Jack Purvis says to Dr. Bruce Buckingham (17:59):
just wanted to say hello! I was your patient back at CH of LA
Dr. Bruce Buckingham says to (17:59):
and i think other systems would be great to have particularly in providing redundancy in the closed loop
Gina says to (17:59):
i turned off moderate chat
bethdou says to (18:00):
Thank you, Dr. B!
Dr. Bruce Buckingham says to (18:00):
Good to see you Jack!
Dr. Bruce Buckingham says to (18:00):
i recognized your name
karend1 says to (18:00):
ty for sharing your time and knowledge with us
Dr. Bruce Buckingham says to (18:00):
THANK YOU EVERYONE!!
Jan3037 says to (18:00):
Thanks for your time, Dr. Buckingham.
Gina says to (18:00):
thank you dr. B
Jack Purvis says to Dr. Bruce Buckingham (18:00):
Thanks for your time.
Gina says to (18:00):
it was great chatting with you
Jack Purvis says to Dr. Bruce Buckingham (18:00):
you probably remember my dad as well ;-)
Jack Purvis says to Dr. Bruce Buckingham (18:00):
my mom says hello
Ellen4302 says to (18:00):
Thank you Dr. Buckingham - continued success - most of all thank you for your efforts in improving the quality of life for persons with diabetes.
Dr. Bruce Buckingham says to (18:01):
say hello to your mom and dad, Jack!
Jack Purvis says to Dr. Bruce Buckingham (18:01):
will do thanks
Jack Purvis says to (18:01):
will do thanks
Gina says to (18:01):
Dr. Buckingham, I have started an online petition to help people that want to get covered for CGMS systems
Gina says to (18:02):
it would be great if you could sign it
Gina says to (18:02):
here is the link
Gina says to (18:02):
http://www.ipetitions.com/petition/CGMSdenial/index.html
Ellen4302 says to (18:03):
I signed. Thanks for your efforts too Gina!
Gina says to (18:03):
thanks ellen
Gina says to (18:04):
appreciate it
Jack Purvis says to (18:04):
Gina I signed as well thanks for all of your work
bethdou says to (18:04):
Me three...thanks, Gina. What else can we do, do you think?
Gina says to (18:04):
spread the word
Gina says to (18:04):
make people sign the petition
karend1 says to (18:04):
i did
Gina says to (18:04):
send it to everyone you know
Gina says to (18:05):
friends
Gina says to (18:05):
family
Gina says to (18:05):
enemies lol
karend1 says to (18:05):
i did that too
Gina says to (18:05):
go to chat rooms
Jon says to (18:05):
and write to your congressman and the president every chance you get
Gina says to (18:05):
message boards
karend1 says to (18:05):
hmmm will try enemies next
Gina says to (18:05):
lol
Gina says to (18:05):
the transcript will be up tomorrow
bethdou says to (18:05):
Well, I 'd better get busy then! LOL
Gina says to (18:05):
yes!
Gina says to (18:05):
did you sign beth?
bethdou says to (18:06):
Yep, I did. Will make sure everyone I know does too. :)
Gina says to (18:06):
http://www.ipetitions.com/petition/CGMSdenial/index.html
Gina says to (18:06):
IF YOU WANT TO HELP NEW YORKERS GO HERE
Gina says to (18:06):
www.diabetestalkfest.com/blog
karend1 says to (18:06):
bye for now
Gina says to (18:06):
if we get new york to mandate CGM as a medical necessity
Gina says to (18:07):
other states will follow
Renee352 says to (18:07):
Gina, I'm signing now and will send it to all of the above. My insurance company just denied me!:'(
Gina says to (18:07):
sorry Renee
Gina says to (18:07):
we are all in the same boat!
Jon says (18:07):
has anybody actually been approved?
Gina says to (18:07):
i am in the appeal process
Gina says to (18:07):
its so annoying
Jon says (18:08):
my sons doctor won't even write the prescription because he says it is a lot of paperwork and they will just deny it
Renee352 says to (18:08):
My doctor would rather i wait as well.
bethdou says to (18:08):
I know a few who have been approved, but most all of them had to fight like mad to get there.
Gina says to (18:08):
why renee
Gina says to (18:08):
you have to fight
Gina says to (18:08):
they want you to give up
bethdou says to (18:08):
I talked my doc into the paperwork but we paid out of pocket.
Gina says to (18:09):
how much do you pay
Gina says to (18:09):
which one
Renee352 says to (18:09):
Yeah. I'm not as strong as you.
Gina says to (18:09):
you are renee
bethdou says to (18:09):
Dex seven; $240 per box of sensors. I think it was $350 for the startup. She doesn't wear it 24/7; we are having issues with the tape. I am going to put in for the Nav and fight for it.
Gina says to (18:10):
oh you are on dex
bethdou says to (18:11):
Yeah. We have really good runs with it, and then really bad ones with it where it's WAAAAAAAY off. Put one on her to go to FFL, and it wouldn't even calibrate the first time; after about 6 hours it just fell off (even with skin tac and IV 3000 over it).
Gina says to (18:11):
ugh
Gina says to (18:12):
i tried out the MM
Gina says to (18:12):
it worked wellfor me
bethdou says to (18:12):
But they turned down coverage for it?
Gina says to (18:12):
yea
Gina says to (18:12):
i wore it for a week
Dr. Bruce Buckingham says to (16:59):
Hello everyone!
Jan3037 says to (16:59):
Hi, everybody.
Ellen4302 says to (16:59):
It's so nice of you to chat with us Dr. B. Thank you for making yourself available for us
bethdou says to (17:00):
Hi! Thanks for being here to chat, Dr. B.
Dr. Bruce Buckingham says to (17:00):
My Pleasure!
stacygroh says to (17:00):
Yes, Thank you for taking time out of your busy schedule to help us.
havana16 says to (17:00):
yes thank you
Gina says to (17:00):
I AM MODERATING THE CHAT TONIGHT... AND ALL QUESTIONS WILL BE FILTERED
Jan3037 says to (17:00):
We are all very appreciative. I understand you have information about all three cgms systems!
Gina says to (17:01):
you wont see questions up till i press the button
Gina says to (17:01):
everyone have it?
elvisbirth says to (17:01):
Yes
Gina says to (17:01):
understand it i mean?
Gina says to (17:01):
ok
stacygroh says to (17:01):
Yes
tmtdude says to JIMBOB48 (17:01):
yup
Teri says to (17:01):
thanks for letting us know Gina
Gina says to (17:01):
here we go
Dr. Bruce Buckingham says to (17:01):
We have been studying sensors in children for 8 years and we have looked at the minimed, the dexcom and the navigator
Gina says to (17:01):
type in as you would
Gina says to (17:01):
moderate chat on
*** (17:01):Moderator activated moderated-chat function.
Dr. Bruce Buckingham says to (17:01):
we studied children down to age 3 wearing the sensor
bethdou says to (17:02):
My husband was in one of your sessions at FFL and told me you had spoken about CGM data and seizures. Can you speak to those findings?
KarenG says to (17:03):
Thank you!
Dr. Bruce Buckingham says to (17:03):
we studied children and young adults who had seizures at night while wearing a CGMS, it was 2 1/2 - 4 hours of hypo less than 60 before a seizure
Dr. Bruce Buckingham says to (17:03):
i think this indicates we have a lot of time to respond to alarms, and the 18 minute delay in the sensor is not critical in preventing hypoglycemic seizures
Dr. Bruce Buckingham says to (17:04):
there is a skin real estate issue especially if they are also on a pump. but the sensors worked well
JIMBOB48 says to (17:04):
i was excited to hear that you work with children. as an adult that has struggled all my life withe not really knowing where i was i think it is important to establish good control very early
Ellen4302 says to (17:05):
These seizures were induced?
Dr. Bruce Buckingham says to (17:05):
the seizures were spontaneous
Jan3037 says to (17:05):
So the seizures do not occur immediately with the low blood sugar? That is comforting.
Dr. Bruce Buckingham says to (17:05):
correct
*** (17:05):
Teri says to (17:05):
We are fairly new to diabetes (Dec our 22 yr old daughter was dxed) is there a rule of thumb of when a seizures would happen? Is there anything "wrong" with having lower numbers? Daughter likes to have numbers lower rather than higher.
Dr. Bruce Buckingham says to (17:06):
#'s above 70 are reasonable and we aim for 70-160 for a target
marcy says to (17:06):
That's very interesting about the timing. I used to have seizures when I was a child/teenager--but never now.
richard157 says to (17:07):
After how long on the CGMS did the seizures significantly decrease in number?
Teri says to (17:07):
her 1st A1C was 16.9 and then 4 months later she was able to drop her A1C to 5.8 was that too fast to drop that much? She shocked all the Dr's in our small town on how fast she adapted
stacygroh says to (17:08):
I am worried about the skin real estate issue, plus where to "hide" both my pump and the CGMS. I wear my pump now usually in my bra. Do most people wear both clipped on to their pants?
Dr. Bruce Buckingham says to (17:08):
of the children with seizures 3 of them were using the retrospective CGMS, one was wearing the real time and they have not had any additional seizures. seizures are fairly rare in our practice and i got these cases from around the world, one from Australia
Dr. Bruce Buckingham says to (17:08):
one from Finland, and 2 from California
bethdou says to (17:08):
Did you find any major differences in the various systems in terms of accuracy?
Dr. Bruce Buckingham says to (17:09):
this is a very difficult question to answer - because the sensor technology is changing every 6 -12 months
Jan3037 says to (17:10):
E. has been as low as 20, no seizures or loss of unconsciousness. Perhaps meter deviation.... I would like to know when the Navigator and/or the Dexcom will also be approved by insurance for children to use?
Dr. Bruce Buckingham says to (17:10):
there was a study comparing the minimed, the dexcom and the navigator and the navigator did better in the hypo range, but since then the dexcom technology has improved but there is no data
Dr. Bruce Buckingham says to (17:10):
on the current dexcom sensor
havana16 says to (17:11):
is this CGMS outside or inside the skin like a pump?
Ellen4302 says to (17:11):
What is important to know when starting on a CGMS for the first time?
Dr. Bruce Buckingham says to (17:11):
1. it will not be as accurate as your meter
Dr. Bruce Buckingham says to (17:11):
2. there will be lag time of 18 minutes
richard157 says to (17:11):
It is my impression that the sensors are more unreliable with the Minimed.
Jan3037 says to (17:11):
Insurance has approved Minimed sensor which we are on summer break from. We are extremely unhappy about the size of the introducer needle. Do you know when Minimed will reduce the guage of their needle?
Dr. Bruce Buckingham says to (17:11):
3. there will be higher glucose values after a meal
Dr. Bruce Buckingham says to (17:12):
and 4. you will be able to see what happens overnight
Dr. Bruce Buckingham says to (17:12):
it takes awhile to learn how to use this info
marcy says to (17:12):
What are some tips you could give us about helping to get accurate numbers on systems?
Dr. Bruce Buckingham says to (17:12):
if you are on a pump you should always use the "insulin on board" for correction doses
Dr. Bruce Buckingham says to (17:13):
always calibrate when your trend has been flat for 20 minutes
Dr. Bruce Buckingham says to (17:13):
don't calibrate with rapid glucose changes
Jan3037 says to (17:13):
I used to give .20 correction immediately for every up arrow.
Lloyd says to (17:13):
Did you have very many cases where the sensors gave you what seemed like random numbers, clearly incorrect?
Dr. Bruce Buckingham says to (17:14):
if there is a sensor that is failing or the insertion site is going bad or sometimes if you lay on the sensor when you are sleeping, it can cause a dip in the glucose
values
shikiar says to (17:14):
what do you think about the omnipod vs medtronics meter w/ cgms for an active 11 year old
dktopham says to (17:15):
do all the sensors tend to read low at night?
Dr. Bruce Buckingham says to (17:15):
a meter can give you high glucose readings if the finger isn't clean. all things require good technique.
dktopham says to (17:15):
could it have anything to do with slowing of heart rate and less interstitial fluid at night?
stacygroh says to (17:15):
Why higher glucose values after a meal?
Dr. Bruce Buckingham says to (17:15):
sensors not necessarily read low at night
Jan3037 says to (17:16):
Minimed sensor values were not completely accurate, though still helpful. It was usually 25 to 30 points higher than her true blood sugar if low. And it could lag way behind the highs. If spiking high as in an aggressive growth spurt sensor was useless.
karkad says to (17:16):
I don't know much information yet about the continuous glucose monitoring system, but do you recommend that certain ages only use it?
Teri says to (17:17):
may I ask...How strong is the "tape" for the sensor? Now that she finally does have it and it's summer.....will it stay on for water skiing or wake boarding? I worry that it will fall off and then we will be lost
Dr. Bruce Buckingham says to (17:18):
because you don't normally test every 5 minutes for 2 hours after a meal and peaks after breakfast are very common
debiminlo says to (17:18):
We've been using the Guardian (with MM522 pump) for about 4 months, and have been pleasantly surprised by its accuracy. My daughter's A1C dropped from 8.1 to 7.0 in the first two months, we think as a result of the CGM. My husband would like to know how
karkad says to (17:18):
my son is 13, he was diagnosed a year ago, and i find that I cannot go to sleep without knowing his glucose levels are too high or low, so has this system given comfort to save a child from a high or low?
DiabeticDiva says to Teri (17:18):
Use Tagaderm (site cover) over it when tubing or doing water stuff! I live in Florida and have that problem, the sticky clear site covers work great for security that things won't fall off!
Ellen4302 says to (17:18):
Do you have concerns knowing that people are making therapeutic dosing decisions based on the the CGMS even though the devices are not approve for that purpose? Also, do you have concerns about the Navigator polymer residue that is left in the patient?
Dr. Bruce Buckingham says to (17:19):
that you can overtape the sensor with optsite or tegaderm and wear the sensor under the bathing suit, they are waterproof but you don't want to lose it
marcy says to (17:19):
That's true. I found myself trying new things to lower after meal bG after wearing the sensor for a while
debiminlo says to (17:19):
you feel about "intermittent" use of the sensors- we're quickly running through our supply, and no financial relief in sight. I don't want to go without it!
Dr. Bruce Buckingham says to (17:20):
in our study, patients who were testing 5-8 times a day decreased their testing to 4 times a day, but still tested before giving insulin
Dr. Bruce Buckingham says to (17:20):
The navigator polymer residue is very very small, and i have not seen any reaction in the skin, once the navigator is removed on a consistent basis
Dr. Bruce Buckingham says to (17:21):
it has been approved by the FDA
bethdou says to (17:21):
Tagging on to Ellen4302's question - a friend's child has twice had the Dex sensor wire remain in her tush after removing the site. She is reluctant to have her continue using the Dexcom. Is this a common occurrence?
marcy says to (17:21):
Do you find the 2 calibrations per day best to help keep sensors most accurate?
Ellen4302 says to (17:22):
Bethdou - I saw one report of it at FDA MAUDE website for reporting adverse events. I hope your friend reports it.
Dr. Bruce Buckingham says to (17:22):
i have heard of one other occurrence, the navigator is not approved for the bottom, it was only approved for the abdomen, and that was the response from Dexcom
Dr. Bruce Buckingham says to (17:22):
the dexcom not the navigator
dktopham says to (17:22):
do you think the next generation of rapid acting insulins like the 2nd generation novolog and the new one from biodel make a closed loop system possibly practical?
Dr. Bruce Buckingham says to (17:23):
more rapid acting insulins will definitely make a difference, especially if they have a shorter duration of action
Jack Purvis says to (17:24):
When you say 'clean' do you mean alcohol swabbed clean or just soap and water?
Dr. Bruce Buckingham says to (17:24):
i would use alcohol swab clean
Ellen4302 says to (17:24):
What is the harm in using the arm for blood glucose to calibrate the Navigator, as opposed to the fingertip?
shikiar says to (17:25):
your opinion on omnipod vs medtronics meter w/CGMS for active 11 year old
Dr. Bruce Buckingham says to (17:25):
the forearm can have a 10-15 minute lag when compared to the finger stick
Dr. Bruce Buckingham says to (17:26):
the omnipod is waterproof
Dr. Bruce Buckingham says to (17:26):
the medtronic pump with CGMS provides CGMS data which is not present with the Omnipod system
marktype1 says to (17:26):
hello dr buckingham.my name is mark year 34 type1
stacygroh says to (17:27):
Is there any technology where the CGMS "talks" to the pump and automatically administers insulin?
Dr. Bruce Buckingham says to (17:27):
i think a pump is a personal choice and all the pumps deliver the insulin very well
Dr. Bruce Buckingham says to (17:27):
currently there is no closed loop system
Dr. Bruce Buckingham says to (17:28):
closed loop studies are being done in a research center the first system will shut the pump off to prevent a low glucose
MelissaBL says to (17:28):
Are you an advocate for closed loop systems?
Dr. Bruce Buckingham says to (17:29):
YES
marcy says to (17:29):
Would you prescribe a CGM for every T1 child?
bethdou says to (17:29):
Is there a potential time frame for a closed loop system yet, or is it still too early in the trials?
Ellen4302 says to (17:29):
Dr. Buckingham, I believe you mentioned at CWD FFL that there was a study that using the CGMS actually decreased friction between parents and teens or children. Can you tell us where we can read that study?
MelissaBL says to (17:29):
It's my concern that a closed loop system might not ever be able to take into account all of the patient decisions such as intent and activity that go into the judgment calls we make about dosages and diet.
Dr. Bruce Buckingham says to (17:29):
too early to really predict - the earliest is 2011 and could be later due to the FDA and how comfortable the FDA is with the system
Lloyd says to (17:30):
I see my pump basal changes in 30 minutes, on my Navigator. Is this anything like typical?
karend1 says to (17:30):
let's see how comfy the FDA is with having diabetes for just one day :-P
Dr. Bruce Buckingham says to (17:31):
it is normal to take 30-60 minutes to see a change in the basal rate
Dr. Bruce Buckingham says to (17:31):
no guess
nissen says to (17:31):
What are some of the criteria to consider for a child using the CGMS?
Liz W. says to (17:32):
how far out do you think that integrating the minilink sensor and a pump site is?
Dr. Bruce Buckingham says to (17:32):
the major things are is the child going to be using the information,
Jan3037 says to (17:32):
If you integrate the minilink sensor with the pump site, you would have to change the sensor every three days. Don't like that idea. Unless sensor/pump needle is small gauge I would not want it.
Dr. Bruce Buckingham says to (17:32):
do they want the information
Dr. Bruce Buckingham says to (17:32):
and do they know how to use the information
Dr. Bruce Buckingham says to (17:32):
or is it for the parent to have alarms at night
Dr. Bruce Buckingham says to (17:33):
and to be able to review patterns during the day
dktopham says to (17:33):
i've been using a dexcom for about a year. I'm probably breaking a few rules wearing on my hips, back of my arms upper thigh. Is it known that certain sites are not reliable?
karend1 says to (17:33):
I have had diabetes for 41 years and I have trouble using the info I receive from my CGMS correctly
Dr. Bruce Buckingham says to (17:34):
it is my impression that the subcutaneous space provides similar readings throughout the body, but the dexcom is only approved for use on the abdomen
Jan3037 says to (17:34):
Adults monitor her basal patterns and make corrections in our house. But she can act on the low alarms, and go to the nurse for the high alarms if at school.
Ellen4302 says to (17:34):
Is the sensor lag the same between different brands of sensors or does one have more lag than another?
Dr. Bruce Buckingham says to (17:35):
it has not been well studied between the current sensors, in published studies there have been similar lag times in older sensors
Lloyd says to (17:35):
The Navigator is approved for the Abdomen also
bethdou says to (17:35):
Is navigator still only approved for 18+?
Dr. Bruce Buckingham says to (17:35):
yes
Sven Hoek says to (17:36):
Pregnant and on MDI...should I switch to pump w/CGMS or to Animas Ping?
Dr. Bruce Buckingham says to (17:36):
i would work with your physician in making these changes, i do not take care of pregnancy
Dr. Bruce Buckingham says to (17:37):
the nurses working with me had great success with a pump and CGMS during their pregnancies
dktopham says to (17:37):
what is the insertion needle size for the available systems?
sugarchallenged says to (17:37):
big
sugarchallenged says to (17:37):
haha
Dr. Bruce Buckingham says to (17:37):
they probably range from 5-13mm in length
Jan3037 says to (17:37):
Ping does not have cgms. How would the ping help with keeping blood sugars as low as endos require during pregnancy?
dktopham says to (17:38):
sorry i should of asked guage
Gina says to (17:38):
ATTENTION IF I MISSED YOUR QUESTION PLEASE RESUBMIT
debiminlo says to (17:38):
when did you start your studies
Dr. Bruce Buckingham says to (17:39):
about 2000
bethdou says to (17:39):
Which system is used more frequently in your practice?
Dr. Bruce Buckingham says to (17:40):
we have been doing studies, it is often what is provided by the study. we use all three.
dktopham says to (17:41):
of the 3 cgms available what are the insertion guages of the needles?
Mary C. says to (17:41):
There aren't any CGMS systems approved for under 18, are there?
Dr. Bruce Buckingham says to (17:41):
the minimed is approved to age 8
Jan3037 says to (17:42):
How would you rate the reliability/ease of use of each of the three systems? Have read Navigator most accurate. Is the Dexcom equivalent to the MM?
bethdou says to (17:42):
Is one closed loop study ahead of another in terms of when it might come to market? If so, is it the one with glucagon on board or the one without?
Dr. Bruce Buckingham says to (17:43):
for some subjects one system works better than other, we have people who have had trouble on one and then worked on the other
Dr. Bruce Buckingham says to (17:43):
there has not been any good published data
Jan3037 says to (17:43):
Paradigm Minilink is FDA approved for children 7 and up.
Dr. Bruce Buckingham says to (17:43):
in our JDRF trial we did not compare the systems
Dr. Bruce Buckingham says to (17:43):
just looked on the overall effect of CGMS
Ellen4302 says to (17:43):
Although not approved, do you find the accuracy of the Navigator to go beyond the 5 days - I know you can restart it but you need another 10 hour warm up period before seeing results
Dr. Bruce Buckingham says to (17:44):
we do not have accuracy data beyond 5 days
DiabeticDiva says to (17:44):
If you had to choose a system for your hypothetical diabetic child, which system would you choose?
Dr. Bruce Buckingham says to (17:44):
the dexcom is not approved for children, nor is the navigator at this time, that would leave the MM
JIMBOB48 says to (17:45):
could the eighteen minutes be an issue for a middle aged brittle type 1 diabetic who has hypo unawareness
Dr. Bruce Buckingham says to (17:45):
the 18 min lag could be an issue during the day, it could affect performance when driving if you go low
Jack Purvis says to (17:46):
in terms of accuracy what is the margin of error that you find with the results with the Minimed CGMS?
Dr. Bruce Buckingham says to (17:46):
people with hypoglycemic unawareness have been some of the people to receive the best benefit from CGMS
Dr. Bruce Buckingham says to (17:46):
we've seen the MM running around 10-16% MARD
JIMBOB48 says to (17:47):
but if i understand it correctly it will help prevent seizures
Dr. Bruce Buckingham says to (17:47):
yes
TJ Irvin says to (17:47):
Do you know of any studies involving CGMS and very young children (i.e. 3 years old)?
Jack Purvis says to (17:47):
is that the range across all results (i.e. from below 60 to above 200)?
Dr. Bruce Buckingham says to (17:47):
we studied a few children who were able to wear the system for 6-12 months
marktype1 says to (17:48):
sorry if i am off topic,but i saw a watch cgms made in germany for sale on the internet for 850 dollars,does anyone know of such a thing?if i had one of those my life would change dramatically,i have low blood sugar unawareness.it seemed to just go away.
marktype1 says to (17:48):
ive had type 1 for 34 years now
Dr. Bruce Buckingham says to (17:48):
the accuracy data, i would refer to the published papers which show that all
Dr. Bruce Buckingham says to (17:49):
CGMS are less accurate in the hypoglycemic range
TJ Irvin says to (17:49):
Do you forsee the FDA approving CGMS for children younger than 7 any time soon?
Dr. Bruce Buckingham says to (17:49):
yes
Dr. Bruce Buckingham says to (17:49):
but i am not the FDA
DiabeticDiva says to (17:49):
lol
Ellen4302 says to (17:49):
I know many of us are extremely enthusiastic about the CGMS -would you be so kind as to share some of the disadvantages?
Dr. Bruce Buckingham says to (17:50):
seeing a lot of glucose data that you previously weren't aware of
karend1 says to (17:50):
good question Ellen as I have used the CGMS and I am not quite a fan
Dr. Bruce Buckingham says to (17:50):
having your diabetes exposed to others, such as your parent or doctor, feeling naked
Dr. Bruce Buckingham says to (17:50):
tape allergies
Dr. Bruce Buckingham says to (17:50):
wearing more devices
TJ Irvin says to (17:51):
False alarms, bad sensors (ie my daughter was reading 49 and 289 every other reading) BG showed her to be 250
Jack Purvis says to (17:51):
are the papers available electronically? and do you have links to them?
Jack Purvis says to (17:51):
TJ Irvin ... which device was it where your daughter experienced bad sensors?
Dr. Bruce Buckingham says to (17:51):
they are available and perhaps through public med
Gina says to (17:52):
do you know if Abbott aviator will be out this year
Dr. Bruce Buckingham says to (17:52):
i do not
Jan3037 says to (17:52):
Great readings in the mid-ranges, but off in the lows and highs, which is where you really need accuracy. Though trends still so useful. Size of that needle is not made for children, yet MM is the only device insurance will cover.
Ellen4302 says to (17:52):
Pubmed: http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed
Dr. Bruce Buckingham says to (17:53):
THANK YOU!!
Jack Purvis says to Ellen4302 (17:53):
Thanks!
TJ Irvin says to (17:53):
Could you direct me to a resource that would help with what to do with the CGMS data? (ie something that would expand on the info you gave at CWD this past week) I have the Dexcom system for my 3 year old daughter.
Ellen4302 says to (17:54):
Thank you:D
Gina says to Jack Purvis (17:54):
6 minutes left get your questions in
Dr. Bruce Buckingham says to (17:54):
there will be a web site explaining the devices and providing training and case examples that should be come available on the JDRF website it is not up yet and it will be up in 6-8 weeks
Ellen4302 says to (17:54):
Dr. Buckingham, when the AP or closed loop system becomes standard of care, do you think it would be wise for companies to be compelled to provide two systems per patient? In the event of failure, patients will no longer know how to manage on their own
Ellen4302 says to (17:55):
Years ago Disetronic provided two pumps - it was GREAT to have a backup
Dr. Bruce Buckingham says to (17:55):
redundancy is always good
bethdou says to (17:56):
How do you see CGM (and potentially, AP systems) changing the way diabetes is treated?
Jan3037 says to (17:56):
Closed loop system, what if there is a malfunction? Scares me.
Dr. Bruce Buckingham says to (17:56):
yes
Dr. Bruce Buckingham says to (17:56):
and that's true with any system
Dr. Bruce Buckingham says to (17:56):
a big concern
marktype1 says to (17:57):
would there be any other way to get a blood glucose reading without blood ie skin or sweat or?
Dr. Bruce Buckingham says to (17:57):
none of those systems have been approaching commercial availability
Jan3037 says to (17:57):
Life or death concern. Do not know if I would want to abdicate all control to the AP. Would like comfortable, small, easy to use open loop systems.
skyler says to (17:57):
hello! um.. Dr. B. i was recently diagnosed as type 1 in November of last year. i am in good control of my sugars but i was wandering if it would be a good idea for me to switch to a pump this early??
Dr. Bruce Buckingham says to (17:57):
but many have been proposed using light or flourescent
Ellen4302 says to (17:58):
Are you a proponent of using glucagon in the closed loop, or pramlintide, or just insulin, or all three?? Also, are you enthused about any other CGMs on the horizon that have not yet cleared or been approved by FDA?
marktype1 says to (17:58):
thanx
Dr. Bruce Buckingham says to (17:58):
i think glucagon may be very helpful for preventing a hypo crash
Gina says to (17:58):
Ok everyone, Dr. Buckingham has to go.
Dr. Bruce Buckingham says to (17:58):
that pramlintide may
Gina says to (17:59):
hes going to finish up now
marktype1 says to (17:59):
bye thanx
Dr. Bruce Buckingham says to (17:59):
make meal coverage with a closed loop system easier
DiabeticDiva says to (17:59):
Thanks Dr. Buckingham!
*** (17:59):Moderator disabled moderated-chat function, you can free chat now.
TJ Irvin says to (17:59):
Thank you.
Jack Purvis says to Dr. Bruce Buckingham (17:59):
just wanted to say hello! I was your patient back at CH of LA
Dr. Bruce Buckingham says to (17:59):
and i think other systems would be great to have particularly in providing redundancy in the closed loop
Gina says to (17:59):
i turned off moderate chat
bethdou says to (18:00):
Thank you, Dr. B!
Dr. Bruce Buckingham says to (18:00):
Good to see you Jack!
Dr. Bruce Buckingham says to (18:00):
i recognized your name
karend1 says to (18:00):
ty for sharing your time and knowledge with us
Dr. Bruce Buckingham says to (18:00):
THANK YOU EVERYONE!!
Jan3037 says to (18:00):
Thanks for your time, Dr. Buckingham.
Gina says to (18:00):
thank you dr. B
Jack Purvis says to Dr. Bruce Buckingham (18:00):
Thanks for your time.
Gina says to (18:00):
it was great chatting with you
Jack Purvis says to Dr. Bruce Buckingham (18:00):
you probably remember my dad as well ;-)
Jack Purvis says to Dr. Bruce Buckingham (18:00):
my mom says hello
Ellen4302 says to (18:00):
Thank you Dr. Buckingham - continued success - most of all thank you for your efforts in improving the quality of life for persons with diabetes.
Dr. Bruce Buckingham says to (18:01):
say hello to your mom and dad, Jack!
Jack Purvis says to Dr. Bruce Buckingham (18:01):
will do thanks
Jack Purvis says to (18:01):
will do thanks
Gina says to (18:01):
Dr. Buckingham, I have started an online petition to help people that want to get covered for CGMS systems
Gina says to (18:02):
it would be great if you could sign it
Gina says to (18:02):
here is the link
Gina says to (18:02):
http://www.ipetitions.com/petition/CGMSdenial/index.html
Ellen4302 says to (18:03):
I signed. Thanks for your efforts too Gina!
Gina says to (18:03):
thanks ellen
Gina says to (18:04):
appreciate it
Jack Purvis says to (18:04):
Gina I signed as well thanks for all of your work
bethdou says to (18:04):
Me three...thanks, Gina. What else can we do, do you think?
Gina says to (18:04):
spread the word
Gina says to (18:04):
make people sign the petition
karend1 says to (18:04):
i did
Gina says to (18:04):
send it to everyone you know
Gina says to (18:05):
friends
Gina says to (18:05):
family
Gina says to (18:05):
enemies lol
karend1 says to (18:05):
i did that too
Gina says to (18:05):
go to chat rooms
Jon says to (18:05):
and write to your congressman and the president every chance you get
Gina says to (18:05):
message boards
karend1 says to (18:05):
hmmm will try enemies next
Gina says to (18:05):
lol
Gina says to (18:05):
the transcript will be up tomorrow
bethdou says to (18:05):
Well, I 'd better get busy then! LOL
Gina says to (18:05):
yes!
Gina says to (18:05):
did you sign beth?
bethdou says to (18:06):
Yep, I did. Will make sure everyone I know does too. :)
Gina says to (18:06):
http://www.ipetitions.com/petition/CGMSdenial/index.html
Gina says to (18:06):
IF YOU WANT TO HELP NEW YORKERS GO HERE
Gina says to (18:06):
www.diabetestalkfest.com/blog
karend1 says to (18:06):
bye for now
Gina says to (18:06):
if we get new york to mandate CGM as a medical necessity
Gina says to (18:07):
other states will follow
Renee352 says to (18:07):
Gina, I'm signing now and will send it to all of the above. My insurance company just denied me!:'(
Gina says to (18:07):
sorry Renee
Gina says to (18:07):
we are all in the same boat!
Jon says (18:07):
has anybody actually been approved?
Gina says to (18:07):
i am in the appeal process
Gina says to (18:07):
its so annoying
Jon says (18:08):
my sons doctor won't even write the prescription because he says it is a lot of paperwork and they will just deny it
Renee352 says to (18:08):
My doctor would rather i wait as well.
bethdou says to (18:08):
I know a few who have been approved, but most all of them had to fight like mad to get there.
Gina says to (18:08):
why renee
Gina says to (18:08):
you have to fight
Gina says to (18:08):
they want you to give up
bethdou says to (18:08):
I talked my doc into the paperwork but we paid out of pocket.
Gina says to (18:09):
how much do you pay
Gina says to (18:09):
which one
Renee352 says to (18:09):
Yeah. I'm not as strong as you.
Gina says to (18:09):
you are renee
bethdou says to (18:09):
Dex seven; $240 per box of sensors. I think it was $350 for the startup. She doesn't wear it 24/7; we are having issues with the tape. I am going to put in for the Nav and fight for it.
Gina says to (18:10):
oh you are on dex
bethdou says to (18:11):
Yeah. We have really good runs with it, and then really bad ones with it where it's WAAAAAAAY off. Put one on her to go to FFL, and it wouldn't even calibrate the first time; after about 6 hours it just fell off (even with skin tac and IV 3000 over it).
Gina says to (18:11):
ugh
Gina says to (18:12):
i tried out the MM
Gina says to (18:12):
it worked wellfor me
bethdou says to (18:12):
But they turned down coverage for it?
Gina says to (18:12):
yea
Gina says to (18:12):
i wore it for a week
Replies to This Discussion
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Permalink Reply by Gary R. Taylor on -
I have worn the Dexcom Seven for over a year and am very pleased with it. Blue Shield of California is reimbursing about 80 %, however I still have to explain in detail, because not all claims reviewers are familiar with the "opt out" proceedures for people covered by medicare such as myself.
I was diagnosed with Type I in 1950. I will be 70 on August 23. I recommend having a good healthcare team, exercise regularly, and have a positive attitude.
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