Diabetes

Diabetes

Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the body’s inability to produce enough insulin and/or effectively utilize the insulin. Diabetes is a serious, life-long condition and the sixth leading cause of death in the United States. Diabetes is a disorder of metabolism (the body's way of digesting food and converting it into energy). There are three forms of diabetes. Type 1 diabetes is an autoimmune disease that accounts for five- to 10-percent of all diagnosed cases of diabetes. Type 2 diabetes may account for 90- to 95-percent of all diagnosed cases. The third type of diabetes occurs in pregnancy and is referred to as gestational diabetes. Left untreated, gestational diabetes can cause health issues for pregnant women and their babies. People with diabetes can take preventive steps to control this disease and decrease the risk of further complications.

Recently Answered

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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    Generally speaking, most CGM system manuals and user guides are simply awful. They tend to suffer from being written by engineers and legal departments, not by diabetics who have actually used them. On the bright side, none of these manuals is intended as light bedtime reading.

    Manufacturers’ manuals are more like dictionaries—reference guide books to look up the spelling of a rarely used or obscure word. However, you can generally find PDF versions of the user’s manuals and quick start guides on the web. It is a great way to get a feel for the various devices you are considering.
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    ALynn Grieger, Nutrition & Dietetics, answered
    People with diabetes face many daunting obstacles, but in my over 20 years of working as a certified diabetes educators, I think the biggest struggle is figuring out how to fit diabetes management into your life, so that diabetes doesn't take over your life. Learning how to combine regular blood glucose testing, exercise, healthy eating, medications, regular eye exams, and daily foot care can seem overhwelming and seemingly impossible. Taking a proactive approach, where diabetes self-care becomes a part of your life without taking over your life, is key for both a happy and fulfilling life, as well as a healthy life.
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    All CGM systems have software. Some include it as part of the package, others make you buy it. Some are desktop based. Some are web-based. Big differences come into play when you look at data filtering options.

    • Can you look just at Sundays for the last three months?
    • Can you just look at lows? 
    • Can you display your day from 6 a.m. instead of from midnight? 
    • How is the sensor data displayed?
    • Do you get nice smooth lines, or plots of crazy dots, squares, and triangles?

    Do you use a Mac? Mac users are generally screwed when it comes to medical device software. If you use a Mac you’ll probably want a web-based software, just make sure there is a way for you to get your data to the web from your system.

    Also, consider download type. Cable, infrared, RF, or Blue Tooth. What are your options? What will be easiest for you? What will work best with your computer system?
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    Transmitters range in size and shape from a pack chewing gum to a flattened thimble. Some are smooth and sleek, and others have sharp edges.

    It’s not how big it is, it’s how you use it, right? The transmitter is only part of the story when it comes to how much of your skin a CGM site will take up. The transmitter needs a way to connect to the sensor, and a way to stay stuck to your skin. Solutions can range from complicated plastic foundations to sticky-pads. Sometimes smaller transmitters actually take up greater area of skin landscape.
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    You should know the following about transmitter range before buying a CGM monitor:

    How far apart can the transmitter and monitor be before your system suffers separation anxiety?

    If they get too far apart, will the transmitter store the “lost” data? Bear in mind that telemetry range data is calculated based on naked people in empty warehouses.

    You’ll almost never get the kind of range the makers brag about.
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    Transmitters either use those “button” batteries, rechargeable batteries, or are a sealed battery/transmitter package guaranteed to last a certain time period. This last style requires you to buy a new one when it runs out of juice, generally every year. And of course, if the maker decides to stop manufacturing the sealed transmitters in the future, you will be forced to upgrade and your monitor will become an expensive paperweight.
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    Some sensors are a little rocky on their first day, but seem to get better and better as their run goes on. Some sensors are hyper-responsive to small changes and perform well throughout the range; a bit more like driving a vehicle with a tight suspension instead of a Lexus. It depends on whether you want to feel every bump or if you want a smooth average ride. But, that said, I’ve even worn multiple devices simultaneously and have gotten remarkably similar readings out of each device.
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    AStacy Wiegman, PharmD, Pharmacy, answered
    The continuous glucose monitors currently available are generally not as accurate and reliable as standard blood glucose meters. Continuous glucose monitors work via a tiny sensor, inserted under the skin for up to a week, which checks glucose levels in tissue fluids. They provide glucose readings every one to five minutes and are equipped with alarms to alert wearers if blood glucose is becoming too low or too high. This minute-by-minute monitoring can allow for much better blood sugar control. But you and your doctor should not make changes in your diabetes treatment based on readings from continuous glucose monitors alone. Instead, those readings should be confirmed with a standard glucose meter before making treatment changes.
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    You should know the following about sensor wear limits for your CGM monitor:

    How many days is the sensor approved for wear?

    How long do people actually wear them in the field?

    How easy or difficult is it to “re-boot” the sensor to stretch the wear length?

    If you choose to re-boot will you be running again right away or do you have to wait through a fresh start-up period?
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    AWilliam Lee Dubois, Endocrinology Diabetes & Metabolism, answered
    You should know the following about calibration for your CGM monitor:

    • Does the CGM have a built-in meter for calibration? If so, can you use an outside meter?
    • If not, will your insurance company cover the strips for it? (Don’t assume that just because they’ll help you out with the CGM and sensors that they’ll cover the strips for it.) 
    • Can you enter as many fingersticks as you want, or will the system only accept them at certain times? 
    • If you can use an outside meter does the menu start where the CGM thinks you are to limit your “scroll time,” or does it always start at 100, forcing you to scroll up or down each time you calibrate? 
    • If your system is built into an insulin pump that talks to a fingerstick meter do you have the option of not using a fingerstick reading to calibrate? (In other words, are you forced to use every fingerstick as a calibration stick?)     

    You should know the following about the timing of calibration for your CGM monitor:

    • How often do you need to calibrate?
    • Will the system give you advance warning reminders of upcoming calibrations? 
    • If so, can you choose how much warning time you want, or do you have to use a factory default? 
    • Do you have to calibrate at a specific time or only by a specific time?      

    You should know the following about calibration limits for your CGM monitor:
    • What is the range of fingersticks the system will accept for calibration?
    • Will the system shut you down if you are above range when a calibration is required?