Minimed Guardian

The Dexcom 7 trial was awesome.

Despite some of its shortcomings, the accuracy of information gleaned from the Dexcom 7 was invaluable.  Within 2 days we were able to set a much lower target BG for Cadence's bedtime as we noticed that she doesn't drop significantly in the middle of the night.  This does usually require a small breastfeed at about 3 am and a correction dose (.5U) of humalog for those carbs but she is sleeping from 9pm to anywhere between 6:30 and 8:30 in the morning.  I'm up and gone for work before 6am so I miss the sleep-in (bummer!).  This tweak alone takes out Cadence's high nighttime BG's.  Last night, she slept soundly and hovered at 5.6-8.0 mmol/L for the whole night.  This has been so nice to see.

Some huge pluses for the Dexcom:  

 - small insertion needle

 - no dangley bits on the sensor, everything is affixed securely.

 - seven days of wear (sooo nice)

 - good software program

 - menu's are simple

Some downsides:

 - It's been said before, that damn sync cable and choice of only the Onetouch Ultra.  

 - awkward receiver size

 - not able to scroll backward on the receiver to see past data (love this about the minimed)

 - no 24 hour trend screen

There are some other hassles but those are the majority.  Overall we were extremely satisfied with the Dexcom 7 system.

When we tried the minimed paradigm 522 pump/CGM earlier this month I always felt like we didn't give it a fair opportunity to show us what it could do.  Admittedly the sensor wasn't secured as well as it could be with the tegaderm.  The clamshell/sensor interface was right at the top of the diaper, we calibrated during times of not so stable sugars, etc.  We are now testing the Minimed Guardian system, which is the stand alone CGMS for minimed.  It's essentially a 522 without the pump in it.  The CGMS has quite a few more features than the 522 does.

The sensor insertion went MUCH better this time than our last go-round.  Using some of the mistakes that we made last time, Cadence did fine with it.  The sensor went in easy, we covered everything securely with tegaderm, and she was playing happily within minutes of the event.  The startup and calibration went off without a hitch and the data through the day yesterday was very accurate.  A nice change from our experience with the 522.

The Guardian has "predictive alarm" capability which already has come in handy.  Cadence and I were out with Spokes, the family airedale terrier for a walk yesterday.  About 3/4 through the walk I heard an alarm from the Guardian, checked it and it said "predicted low alert", so i did a blood sugar check and sure enough she was dropping quickly but still in an ok range.  So, I gave her some fruit bar to chew on and we marched back to the house.  As we approached the house I heard another alarm and the Guardian said LOW.  I got everyone into the house and checked Cadence's blood sugar, it read 3.4.  That's getting a bit dangerous so I quickly grabbed some banana and soy milk and we had some snacks.  In checking the "Real-Time" BG reading, the Guardian showed her as 4.5 with 2 arrows dropping (very quick).  So, that's the 15-20 minute delay that exists.  The BG reading is not accurate but the trend is, we knew it was going to be lower.  

So, this predictive alarm is fantastic...except at night.  We were up a bunch last night to turn off the predicted low alarm as Cadence was 0.1 mmol/L under our threshold but holding steady.  This isn't a knock against the feature, it's doing exactly what it's supposed to do, but we will now turn it off at bedtime and set her low threshold a tad higher.  After I turned that off, the night went perfectly.

So, we'll spend the next 6 days or so testing the Guardian before we make our final decision on which device we will use and will keep things updated here.

On a side note, we had a meeting at the Diabetes Clinic yesterday and our nurse asked me "how are you doing?"  It wasn't a casual, looking for a canned answer, kind of question.  She was referring to how I was dealing with the experience of my role with Cadence in the hospital.  I was the one who held her down while the ER docs drilled into her shin to get fluid into her, looked in her eyes and saw the fleeting life, fear, pain, and panic.  I held her down when the phlebotomist came into draw venous blood as she would soil herself in panic.  It haunted me for months, and still does I now realize.  I guess I sort of repressed it a bit through alcohol and focusing on other things.  I feel like I'm on the other side of those habits though.  Her question really brought back some difficult feelings and flashbacks, but also a significant question:  

Would I trade the experience of being there for her through those moments vs. not knowing the panic that she went through?  Would it be better if I didn't see it?

It didn't take me more than a millisecond to decide: Not a chance...I feel lucky that I was the one to be there to try and comfort her, I hope she in some way remembers that I was there.  So, yes I struggle but I wouldn't trade it either.

b.