I've had D since I was 10 months old. I'm now in my early 40's, surviving a few rounds with prolific retinopathy in my early 20's, and i've had protein in my urine for years, I think the ace inhibitors have been keeping that in check for quite a while now. I have 2 great children, ages 19 & 11. Unfortunately, I also passed on the D gene to both of them, they were both also D'xed at < 12 months old. My older daughter is quite busy, school, work, friends, pretty much being a normal young adult with a busy non-stop life. So, her endo and I thought a CGMS might help her maintain better control. It was shipped to her a few weeks ago.
to me, this is the realization of a dream. She had been wearing it pretty much non4e stop for a few weeks, and wanted a break, so I borrowed it from her in preperation for my endo visit. I haven't been so excited by a piece of D tech since my pump. It was amazing to see what I did after meals, overnight, with excercise, and when vegging out on the coach. I want to try and get one of thee devices, the info is incredible and it was just so great to be able to factor in IOB and tell if I needed a temp basal increase or decrease, and finally see how long it took for me to digest Pizza (5 hours, who knew?).
If for nothing else, my peace of mind. My endo, however, thinks I don't need one. Huh? Did he not see the 2 nights I plummetted down to the 60's, stayed there for hours, and then was at the 300's by 6 am? How could he say this is an unnecessary device, that finger sticks work just as well? How can I convince him that even though my Ha1c's are decent (6.5-7.7 for the past 3 years), I could do so much better, and want to work on things like lower standard deviation, contol the "swing" in my BG. Or, should I just give and and go endo shopping? I actually MISS the dex, and so does my husband, he loved coming up to bed and being able to SEE that I was OK, just maybe a little warm, not low. Opinions?

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I tried to get my PCP to sign off on a pump. She said: "No way". I am now waiting for my first endo appointment ever. But for a CGM you can get the signature of your PCP and be done with it.
I asked, he won't, he leaves D stuff to the endo, since I pump, he won't touch it. Too bad, all I really need from endo is scripts for the most part. It would be nice to find anoher endo like I had in NY though, she was really good. Wish John Walsh would come out with a book on CGMS, his insulin pumping book was excellent. I should probably skim through it again and apply the lessons with the added info CGMS can give me, if I can get one that is. If not, gonna go try and find another doc.

Thanks for the advice Helmut, you have truly incredible results on imjections, I wish I was that disaplined, but my life is typically only under my control for short periods of time, then bosses , husbands and kids undermine me : )
Discipline is one ingredient but maybe not the most important. I controlled my bg with urine strips for about 10 years. My good doctor only measured my fasting bg and I knew what to do to get a good number. Then I moved. My new doctor measures my A1C and it was in the 8s. He told me that I had to prick my fingers going forward. I vividly remember the conversation. I promised to be better and asked him to let me continue without finger pricks. He said: "You will not be able to achieve good enough control without pricking your fingers.". I caved in. The insurance paid for 100 bg strips a month and my A1C went down into the low 6s. 15 years later I had a complication scare. I realized that A1C in the low 6s was not a get-out-of-jail-free card. I went to 12 finger pricks a day and my A1C came down into the high 5s. It took a lot of effort and planning to use the 12 bg strips at times of highest uncertainty. Now that I have the dex I typically prick my fingers only twice a day to calibrate. The dex is the first tool that gives me better control with LESS effort. Not to mention the piece of mind.

Bottom line: The better your tools the easier it is to have good bg control.
Jacky -- Like many of us here, I have had a front row seat watching insulin-dependent diabetes treatments for a long time, in my case since 1984. During that time only a handful of treatment changes occurred that qualify as "game changers." These treatments have materially improved my blood glucose control and in doing so, my overall quality of life. I include in this list: home blood glucose meters, insulin pumps, insulin analogs (fast acting insulin designed by the new biotech industry starting in the late '90s), and finally the continuous glucose meter (CGM).

The Juevenile Diabetes Research Foundation studies have conclusively shown that wearing (and paying attention to) a CGM will drop your A1c, reduce or eliminate severe hypoglycemia, and reduce BG variability. For a doctor to ignore these undisputed clinical facts indicates a serious lack of judgement.

I would find a new endocrinologist immediately. I know locating a good endo is not easy but it looks like it will be well worth the effort. This serious lapse in judgment makes me wonder what else he is missing in your treatment regimen. I don't require perfection from my doctors (they are only human!) but I do expect them to get the major decisions right. And I expect them to listen well and respond appropriately.

Good luck. CGM therapy is definitely a treatment worth fighting for.
The more I picture this, it is hard to fathom your endo's opinion. Even if you don't meet the usual criteria for coverage, what's his downside and why not try? Do docs experience subtle and maybe not so subtle pressures from insurance companies?

I'm not sure what is your quickest route. It seems like if you were firm with him, he might fill out the necessary paperwork. You're not asking him to agree that you need it, you are asking him to fill out the letter of medical necessity based on your clinical factors and it is up to the insurance company to decide. Don't expect him to understand the peace of mind because his pancreas works and therefore he can't get it. I agree with Terry's sentiment that CGM is "game-changing" technology for the treatment of diabetes that increases quality of life by allowing you to catch lows and highs much, much sooner.
I don't understand your endo either! You have had diabetes for so many years and are on ACE inhibitors and really need to keep glucose levels as tight as possible. I would not take no for an answer and would find an endo that will support you in taking care of your health. Don't let him put you off. This is your body, your life, your decision. I would call up Dexcom and ask them if there are endocrinologists in your area that prescribe Dex frequently or just shop around on your own. If an endo did not prescribe the appropriate number of strips, type of insulin, pump and/or cgms I would find one who does.
Kiss your endo goodbye immediately, and find one that has thinking inline with the 21st century. Because the next thing you know, he'll be trying to find you some pork insulin and convince you that urine testing is okey-dokey.

Any doc who refuses to write a script for CGM for a patient that is eager and wants it is committing malpractice. Although I had been running A1Cs in the low-to-mid 6s (i.e., supposedly almost perfect), I never appreciated my blood sugar spikes and dawn phenomenon until I got a CGM. I'm in even better control now that I have a CGM.

Shame on your endo.
Ok, just heard from Dex Com, they are shipping my unit tonight! I sent paperwork to DEx sales rep, don't know if endo had a change of heart, or whatever, but he signed forme, and insurance approved!

I am so happy, now, since I'll have all this great info at my fingertips, maybe I can get my A1c's <6.5 with less lows and hopefully not starting with the hypo unawareness that a <6.5 Ha1c used to mean!

Should I continue to endo shop? Are there endos that are really helping their patients use this technol;ogy, or are most of you guys doing your own adjustments based on the info the CGMS is supplying. There was recently a CGMS seminar near my home, now I wish I had signed up, I really didn't think I would be able to get one though.
A DexCom trainer will contact you and assist you. I thought that using the 7+ couldn't be that difficult and skipped the training. Looking back this was not a good idea. Spend the time and listen to what the DexCom trainer has to say. You might also want to scan through Rickst29's posts. Rickst29 has posted a lot of valuable information about the 7+.
It's also great to get to know your DexCom trainer as they'll be your best resource in educating your Endo to use the info from the Dex properly. My trainer has actually been in contact with me each time after he visits my Endo to let me know what she wants to see from my downloads and to check in and see how it's going. Without him I think my Endo visits would be much more complicated and less productive. The trainer is a great resource to have on your side!
Jacky -- That's great news. Maybe your endo reconsidered as a result of looking into the recent medical literature regarding the CGM. My view of the patient/endo relationship is that the patient is the most important factor in good outcomes.

The doctor, as a professional, must be respected for his knowledge but in the end you are the one who is the expert about your metabolism. A good endo, in my mind, is one that you can bounce ideas off of and one that can give you a perspective that you might not consider on your own. I don't see it as a relationship of equals but one where the diabetic is the senior partner. This rises from the inherent fact that it's your body that is on the line.

If a doctor can respect this then s/he makes a good endo. In a recent visit with my endo ( I just changed endos this year) he asked my opinion, "Well, you've lived with diabetes for 25 years, what do you think is the cause of these unexpected BG excursions?"

Learn all you can about the Dexcom CGM, whether it be from the trainer, the user's manual, or the internet. I encourage you to use the software to look at your patterns. Managing diabetes is definitely a forest and trees thing! I'll be interested to hear what your endo says when he sees real improvement in your numbers due to the CGM. Good luck.
Terry, that is so true. I'm about to change my endo because she gave little value to my personal observations and had a "cookie cutter" approach that I felt did not fit me. Patient and endo need to be a team that has mutual respect for each other.




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