Borrowing a CGM, Evaluating a Cleo 90 Infusion Set

Tomorrow my DE is going to lend me a CGM – a Continuous Glucose Monitor. This is a device that reads your blood glucose continuously via a sensor placed under the skin.

I’m being lent a Medtronic Guardian. That’s the stand-alone version of Medtronic CGMs. We don’t yet have the Dexcom or Navigator in Australia yet. As you may know from prior posts, the Dexcom 7+ is my first choice.

I’m looking forward to the experience… well.. kinda. I had a little look at the sensor needle (which I’ve already been given and have put in the fridge). Have you seen that mother? It’s gigantic! For a needle-phobic to have insulin requiring diabetes is bad enough, and with an insulin pump, for me, that became whole lot easier, but to be willing to go through more torture inserting the sensor – maybe I’m really nuts?

With my insulin pump (Animas 2020) one needle every 3 days inserts the cannula that needs to be under my skin for the next 3 days to deliver insulin. I use Inset II infusion sets, which have an automatic injector, making the procedure less painful for me.

I’ve never done an insulin infusion site manually (without an automatic injector). I’ve always used the Inset IIs. So, I ordered some Cleo 90 infusion sets. These are semi-automatic (baby steps). There is an injector but you actually have to push to get the thing into your skin. So, I tried one yesterday and it wasn’t all that bad, once I figured out how to do it. Worked first try! Needles always sting me – on rare occasions the Inset IIs don’t, but I wanted to have the experience of other infusion sets as well.

I must say, I do prefer the Inset IIs, but I was compelled to try the Cleo 90s just for the hell of it. Delivery of insulin remains unchanged with the Cleo 90, but it wouldn’t be my first choice of infusion sets purely because of the way it gets inserted. That half-manual insertion still relies on more skill than the completely automatic inserters. I have a few more infusion devices to try in the next few weeks, including some that require completely manual insertion. Not sure I’ll be game enough. Then again, insulin injections freaked me out before I started, but now, it’s second nature if something goes awry with the insulin pump (a very rare occurrence for me).

The CGM sensor that goes under the skin can be worn for longer (up to 6 days) than an insulin infusion set (up to 3 days). Some consolation!

Why borrow a CGM? Well, my daytime blood glucose is just fine. Something goes a bit haywire between 10pm and 5am and I can’t put my finger on what’s going on. I’m a night owl, so even testing until 2am, I’m not seeing a pattern and I’m not seeing when it starts and where it goes. Plus, something happens when I sleep. Could be I’m going low and then my liver is releasing glucose into my bloodstream, or I could just be going high sometimes (no rhyme or reason for it because it doesn’t happen all the time – I don’t have Dawn Phenomenon as far as I can determine). A CGM will show me trends on what my blood glucose is doing. It will also alert me when my blood glucose goes outside the boundaries I set – high or low – so I can take some further action, if I choose.

It will also show me what my blood glucose is doing after meals. For example: why am I ok 1, 2 and 3 hours after dinner, and 4 or 5 hours after dinner occasionally I’m going higher. Is it the meal bolus, my basal or gastroparesis? A bit of basal testing will help along with the CGM to give me some of the info I need.

The CGM with different types of meals and boluses will show me how my body reacts and more importantly for me, when it starts. I don’t really want to know just when I test – I want to know how soon after a meal the rise in blood glucose starts and how long it’s been there before I test 2,4 or 5 hours later.

I’m hoping the CGM will be a interesting learning experience for me, and benefit me in the long run to get my A1C lower. My A1C is acceptable now, but I do want it a bit lower (less long-term damage). I know a CGM, even a borrowed one for a couple of weeks, will help me gather the data I’m not currently seeing with fingerstick testing.

I’m not, however, looking forward to the insertion with that giant needle-introducer. Everything after that should be interesting!