January 22, 2010

Continuous Glucose Monitoring Chat with Gary Scheiner – 01/21/10

by



Gary Scheiner MS, CDE

 

As a Certified Diabetes Educator and Type-1 diabetic for 20 years, Gary Scheiner knows and applies the latest techniques for achieving optimal diabetes control. Click here for more on Gary Scheiner

 

 

 

(10:00):Welcome to CGM Chat with Gary Scheiner!

Gary Scheiner, CDE says to (10:02):

 

Hi everyone!

gina says to (10:02):

me too

digammo says to (10:02):

Hey Gary

landileigh says (10:02):

hey gary!

bjphilly says to (10:02):

hey Gary!

[email protected] says to (10:03):

good evening!

bjphilly says to (10:03):

hey Scott and Gina

gina says to (10:04):

Betty its great to see you

Gary Scheiner, CDE says to (10:04):

 

sstrumello, don’t I know you from somewhere?

 

 

sstrumello says to bjphilly (10:04):

Hey Betty

bjphilly says to (10:04):

thank you, same for you:)

Danny6820 says to (10:04):

Hello!

Gary Scheiner, CDE says to (10:04):

 

Betty! I should have known you would be here!

bjphilly says to (10:04):

of course

Sophia says to (10:05):

how many people here have and use a CGM?

bjphilly says to (10:05):

how’s the fam Gary?

Judy&Alli says to (10:05):

My dd has one

gina says to (10:05):

I use the Minimed CGM

PowerPumper says to (10:05):

no cgm

Gary Scheiner, CDE says to (10:06):

 

Everyone’s good. Even the teenager.

bjphilly says to (10:06):

no cgm yet

stark says to (10:06):

we have used dexcom with our daughter – didn’t like it

westinsmom says to (10:06):

my son used it for some time (MM) but we can’t afford to pay out of pocket anymore

gina says to (10:06):

Gary can you tell us the benefits of wearing CGM for the people that dont have one

Danny6820 says to (10:06):

yes please…

gina says to (10:06):

and want to know about it

Judy&Alli says to (10:06):

my dd has dexcom and loves it

bjphilly says to (10:07):

I’ve worn the dexcom

Gary Scheiner, CDE says to (10:07):

 

Benefits of CGM… that’s a lot to talk about! Preventing lows, spending less time high, improving sports performance, fine-tuning doses, etc, etc, etc!

bjphilly says to (10:07):

Hey Allison!

AMBlass says to (10:07):

Good evening, folks!

Sophia says to (10:07):

what are some of the bumps in the road people should expect with a CGM?

Gary Scheiner, CDE says to (10:08):

 

Stark, did you use the Seven Plus or the Seven? There’s a pretty big difference in terms of accuracy & reliability.

 

 

stark says to (10:08):

seven

gina says to (10:08):

gary do you recommend any one over the other? Which one do you use?

bjphilly says to (10:08):

what’s the difference Gary?

lee4031 says to (10:09):

My 12 year old hates to wewar her CGM – it is integrated with her Minimed pump, she just does not like the extra site. Currently, we make her wear it for sleep overs, but I don’t like forcing it down her throat…any ideas?

Gary Scheiner, CDE says to (10:09):

 

I use the Dexcom Seven Plus personally. With all the sports I play, the sensor holds on great and doesn’t get in the way at all. Navigator is a good accurate system too; has better on-screen graphics, but the sensor/transmitter are a bit large for me.

 

 

akoster says to (10:10):

Thats one of my big reservations about getting th CGM- the extra site

landileigh says (10:10):

i thought the Navigators were about the size of the omnipod, and it’s size is what discouraged me

westinsmom says to (10:10):

lee, that is another reason we don’t use it anymore. (I have a few in the fridge for emergencies)…it was just not appreciated by the 12 year old

gina says to (10:11):

I wore the navigator and the Minimed at the same time for a trial. I really liked the nav but it was very large

landileigh says (10:11):

what kind of patients do you recommend use the CGM?

Gary Scheiner, CDE says to (10:11):

 

Maybe your daughter would like having her blood sugar tested less if she wears the sensor. If it is working well, you should be able to cut back to 3 or 4 fingersticks daily.

digammo says to (10:12):

After 4 years, my 13-year old daughter just doesn’t understand the dangers of being high..so an extra site is a hard sell

westinsmom says to (10:12):

Gary, my son never wanted to rely on the readings and continued to check his sugar whenever he felt low

lee4031 says to (10:12):

We tried that reason with her, but she doesn’t mind testing, so it isn’t a big enough reason to convince her.

Gary Scheiner, CDE says to (10:12):

 

Landileigh, I recommend CGM to anyone with type-1 who wants better control, particularly those trying to avoid lows.

 

 

stacey says to (10:12):

My son, almost 18 wears the Navigator…. has had it for 1.5 years and loves it because I don’t have to nag him to check…:) He’s become very dependant on it.

westinsmom says to (10:12):

I should add, he usually wasn’t low when he checked

stark says to (10:13):

Does the Seven plus have a smaller sensor/transmitter than the seven? Does the sensor work better? We had a horrible time getting our 10 year old to go with the extra site & then the sensor wouldn’t last more than a day or so. It wasn’t accurate either

Gary Scheiner, CDE says to (10:14):

 

Westinsmom – CGM data is not always reliable, but it usually is… particularly if the last couple of calibrations have been close to what the sensor is showing.

gina says to (10:14):

Stark, a trick i learned is if you let the sensor soak in the skin for a whole day before turning it on the readings become really accurate

westinsmom says to (10:15):

I felt very comfortable with the cgms data. I could tell when it was working well and when it wasn’t…Westin just never got comfortable with it and he never paid attention to the alarms…I loved it at night but once I stopped using it and adjusted

stacey says to (10:15):

The only drawback to the Nav for us is that 10 hr calibration… hopefully the newer version will be out soon. We’ve found that its pretty darn accurate bwtween 80-300… over 300 he checks… and he hasnt had too many lows …

westinsmom says to (10:15):

to not having it, I don’t miss it too much.

Gary Scheiner, CDE says to (10:15):

 

Stark – the Seven Plus uses the same sensors, but the transmitter works much more efficiently. The hones to the calibrations immediately, and programming is much easier, with more customization options.

stacey says to (10:16):

Gary- do you have any clue wjhen the new Navigator will be available??

[email protected] says to (10:16):

Gary – how do you feel about using the CGM for behavior modification – What i mean by that – if you know what you are about to eat and you bolus ahead of time so you don’t have the big spike

Gary Scheiner, CDE says to (10:17):

 

All 3 CGM manufacturers/systems have their pros & cons. I have a nice set of “real” comparisons at my website: www.integrateddiabetes.com; just click in the CGMS section.

 

 

Judy&Alli says to (10:17):

Gary do you have any idea when integration will happen with Dexcom and Animas?

landileigh says (10:18):

btw, this chat will be transcribed after it is over and up by tomorrow on this website! so if you miss anything Gary has talked about or a website he posts, you can catch it there!

gina says to (10:18):

Here is the direct link to Gary’s CGM page: http://www.integrateddiabetes.com/cg_home.shtml

 

 

Gary Scheiner, CDE says to (10:18):

 

Judy – I wish I knew. They have a national sales meeting next week, and new products usually follow those meetings. Hard to say for sure though.

Gary Scheiner, CDE says to (10:18):

Gina, you are TOO quick.

gina says to (10:18):

🙂

Judy&Alli says to (10:18):

ok thanks I was hoping you would have the inside scoop;)

art says to (10:19):

I use the Dexcom Seven but can’t get insurance coverage yet. Any advice on how to get them to approve it? I also find that the Dexcom is accurate when my blood sugars are stable and do not fluctuate a lot.

PowerPumper says to (10:19):

insurance is my hurdle too

Gary Scheiner, CDE says to (10:19):

 

Looks like the updated Navigator system will have a shorter warmup time, longer alarm shut-off options, and a few other programming advances. BUT, the sensor/transmitter will be the same size.

Gary Scheiner, CDE says to (10:20):

 

Art – My website also has details about securing insurance coverage. You have to be persistent… it will often be denied at first, so you have to keep appealing until they agree.

gina says to (10:20):

to be honest i think the longer calibrations make it more accurate

Wendy12571 says to (10:20):

I don’t have insurance coverage for the seven plus either, but also bolus off of it. ops don’t tell the FDA

westinsmom says to (10:20):

any tips on Medicaid?

gina says to (10:21):

I have tips at my other website on how to help people get covered for CGM as well: http://cgm-antidenial.ning.com/

Judy&Alli says to (10:21):

Michelle in Ohio they don’t even have a billing code for cgm’s.

Gary Scheiner, CDE says to (10:21):

 

I bolus off mine sometimes too, Wendy. But if my BG is rising or falling rapidly, I’ll do a fingerstick since there can be a substantial difference at that moment in time. If the BG is stable, it will be more precise.

art says to (10:21):

Thanks, Gary. I have been told that if your physcian indicates that you have hypogycemic unawareness (which I do), you have a better chance of getting it approved upon appeal.

westinsmom says to (10:22):

when we were on MIChild (which is for low income in MI but run through blue cross) we got reimbursement, surprisingly…but I have ot even tried to with straight Medicaid

stacey says to (10:22):

Jesse bolus’s off of it too.. because he’s a teen……….. and doesnt check

Gary Scheiner, CDE says to (10:22):

 

No specific Medicaid tips because coverage and terms vary from state to state. Medicare will absolutely not cover anything at this point.

lee4031 says to (10:23):

Gary, have you seen a significant drop in A1C’s in teens and young adults from using the CGMS?

stacey says to (10:23):

I got Jesse’s covered by GHI in NY… by calling and harassing them daily for 6 days… and on the 7th day he was approved.

Gary Scheiner, CDE says to (10:23):

 

That’s true, Art. Hypo unawareness is one of those “red flags” that insurance companies don’t want to mess with. That should be stated in your doctor’s letter of medical need.

 

 

Judy&Alli says to (10:24):

Gary do you find a 20 minute lag on the dexcom when coming up from a low?

Gary Scheiner, CDE says to (10:25):

 

Lee – My practice experience, and the recent JDRF-sponsored studies, show that young people who use the system on an regular basis and view the data regularly experience improvements in control.

 

 

gina says to (10:25):

i found that i have much better blood sugars when I am on the cgm and i like that i know what is going on

PowerPumper says to (10:25):

Gary, I have sites I don’t use anymore for insulin. After 34 years they just don’t work well anymore. Will these sites work ok for a CGM sensor?

DiabeticDiva says to (10:25):

Hey all

westinsmom says to (10:25):

Lee, Westin’s a1c dropped by almost a point and stayed there for a good year without using the cgms..now it popped back up.

Gary Scheiner, CDE says to (10:26):

 

That means: wearing the sensor just about all the time (not once a month or every other week), and viewing the data hourly or more to detect and fix/prevent potential problems. Those who don’t do these things don’t improve their control.

Gary Scheiner, CDE says to (10:26):

 

Way to go Stacey! Your experience sounds almost biblical.

lee4031 says to (10:26):

Is that reallt realistic for young adults in school? At what age is that an appropriate response?

randombetic says to (10:26):

I’m currently using an Animas Ping Pump. Any thoughts on their newly announced CGM system, and what to do in the meantime?

gina says to (10:27):

Gary, I would wear it all the time but, the alarms make me crazy any tips?

Gary Scheiner, CDE says to (10:28):

 

Judy – yes, there seems to be a substantial lag with all the systems during recover from a low. I believe it is caused by shifts in blood flow when the body is in a stressed state: very little new blood flow to the skin surface.

Gary Scheiner, CDE says to (10:29):

 

Power – all you can do is try. It might work fine, as long as there is reasonable blood flow to the area. Sensors seem far less affected by site selection than infusion sets.

Gary Scheiner, CDE says to (10:31):

 

random – when Animas updates their pump to link with Dexcom, it will use the current Dexcom sensors/transmitters, so it makes sense to get started on the sensor part now. When the new pump comes out, you’ll be ready to rock & roll.

art says to (10:31):

I am a triathlete and attended the Diabetes Training Camp last year with Team Triabetes. (Awesome program!) I was amazed at how many athletes now use CGMs when training. Only problem is that sweat tends to make it more inaccurate. Any advice?

Gary Scheiner, CDE says to (10:31):

 

Gina – which system do you use? There are ways to minimize the alarms.

 

 

gina says to (10:31):

MM

randombetic says to (10:31):

thanks Gary!

gina says to (10:32):

i minimize them but, it pretty much defeats the purpose of wearing it

DForce says to (10:32):

I have been wearing my CGM consistently since April, 2007, no days off. I love it, however I find that every few months, it gets crazy and say I’m 50 when I am in the 100s or I am 300 when I am in the 100s. I am an RN, CDE, CGM trainer, very experienced

DForce says to (10:32):

Any idea why this happens? Not a calibration issue…

gina says to (10:32):

Dforce that is awesome

Gary Scheiner, CDE says to (10:33):

 

Medtronic’s sensor gets a bit more cranky than the others. You can start by raising your high threshold and lowering your low threshold, and using a long snooze time for both. But there isn’t much you can do about cal errors.

PowerPumper says to (10:33):

I’ve not pushed for one yet because my control is pretty good. I’ve a 5.9% A1C and 16 basal rate changes. I’ve done lots of basal testing and meal profiling. But I am wishing I had some hypo protection. My hypo-sensitivity is pretty low.

PowerPumper says to (10:34):

My MM rep (at a session) said to insert sensors at 90 degrees, not 60. Also to calibrate less often.

Gary Scheiner, CDE says to (10:34):

 

Art- sweat should not affect accuracy, but it can affect the stability of the sensor/transmitter, which can cause error messages. Extra tape, careful placement (buttock works well), and use of Mastisol might help.

stacey says to (10:34):

Jesse’a A1C hovered around 6,8-7.1 for the first year of use… never really dropped.. BUT – we;ve just about eliminated the lows and highs… He had 78% of his readings betwn 80-175. His A1C last month was 6.5…..I’m pretty sure that puberty has ended

stark says to (10:34):

Dexcom’s sensor’s expire within a few months time. Can you still use them after the expiration date? Are they still accurate?

sstrumello says to (10:35):

Gary, have you thought about writing a CGMS book?!?!

gina says to (10:35):

that would be amazing!! WRite a book Gary!

stacey says to (10:35):

yeah !!

art says to (10:35):

Thanks, Gary! Great advice. Also did not know you could insert Dexcom sensor in back or buttocks!

Gary Scheiner, CDE says to (10:35):

 

DForce – I think you just have to expect an occasional problem. What the companies call “user error” I call “crappy sensor”.

Wendy12571 says to (10:36):

stark, i have been know to use expired sensors.

gina says to (10:36):

Art, I find that the arm is really accurate. Well, for me anyway

gina says to (10:36):

Gary LOL

gina says to (10:36):

Wendy, bad girl lol

Gary Scheiner, CDE says to (10:37):

 

Powerpumper – you could probably maintain a tight A1c but without nearly as many lows if you were using a sensor consistently and properly.

sstrumello says to (10:37):

I’m serious about a book; it would be helpful for anyone shopping for one, or trying to fine-tune one!

DForce says to (10:37):

Crappy in what way? The sensor itself has a problem?

Judy&Alli says to (10:37):

My daughter uses her arm for her sensors too. When the pad gets loose she uses sports wrap instead of tape and it works awesome!

art says to (10:38):

Gina…the arm works well for the transmitter (or the sensor)?

Gary Scheiner, CDE says to (10:38):

 

Congrats Stacey! That % in-range is my favorite statistic. THAT is what it’s all about.

gina says to (10:38):

Art, sensor

art says to (10:38):

Really! Didn’t know you could insert it there either!

sstrumello says to (10:38):

Its an almost unaddressed area in publishing

Gary Scheiner, CDE says to (10:38):

 

Stark – you should be able to use the Dexcom sensors a little after the expiration date; but if your first couple of calibrations are way off, I’d chuck it and start with a fresher one.

PowerPumper says to (10:38):

I have my lows pretty minimal. I really do understand my behavior. I’ve put a lot of work into it. But when I do go low, well, the lights might be on but nobody’s home 🙁

gina says to (10:39):

you can insert anywhere you take shots

gina says to (10:39):

powerpumper i hear you on that lol

stark says to (10:39):

Can you get free replacements for “crappy sensors” that cost a lot of money? In your experience can you get Dexcom to replace faulty ones? We were unsuccessful.

gina says to (10:40):

when i have problems with my Mininmed sensors i am able to call the hotline and get replacements

art says to (10:40):

Gina, I have only inserted it in the abdomen as they recommend. I get lots of bruises there, so it it great to know there are options. Thanks so much. ::)

Gary Scheiner, CDE says to (10:40):

 

Thanks for the vote of confidence, sstrumello. Maybe one of the sensor companies would hire me to write one.

gina says to (10:41):

Art, i use my side up in the ribs a lot too i get good readings there too

stacey says to (10:41):

jesse wears it on his left arm, in the same spot .. it drives me nuts… but at least he wears it. In the summer, he had a white rectangle on his tanned body…

landileigh says (10:41):

lol stacey! D-tans!

Gary Scheiner, CDE says to (10:42):

 

Stark – Absolutely… if your sensor poops out well short of its intended life, call the company. They will almost always replace it for you.

Gary Scheiner, CDE says to (10:42):

 

everyone — how much time do you get from your sensors? (and which system do you use?)

lee4031 says to (10:43):

We get 6 days, with a restart inbetween with our MM…

gina says to (10:43):

Stacey, that is funny happens to me all summer!

AMBlass says to (10:43):

I’m on the Minimed and I don’t wear it past 6 days. Not because the sensor is bad, but because I get infections. 🙁

Judy&Alli says to (10:43):

we use dexcom 7 plus. we get about 9 days typically:)

DForce says to (10:43):

Medtronic-6 1/2 days, although I have pulled off transmitter, popped in charger and reattached to old sensor for another 6 days!

gina says to (10:43):

Gary, I can get 7 days of use with Minimed

art says to (10:43):

I sometimes get about two weeks on my Dexcom sensors but they start to get erratic after about 12 days.

gina says to (10:43):

sometimes 9

Gary Scheiner, CDE says to (10:43):

 

Does everyone on the Medtronic know the trick for getting past 6.5 days?

AMBlass says to (10:44):

I don’t but even if I did – ouchy skin.

Gary Scheiner, CDE says to (10:44):

 

DForce just spilled the beans!

stark says to (10:44):

I guess we haven’t had much success with the this at all. . . we never got more than 1-2 days from Dexcom seven . . .uuggh!

gina says to (10:44):

Gary no ?

gina says to (10:44):

i did read Dforce that is a good idea

DForce says to (10:44):

If you train for the company, you better know the tricks!

stacey says to (10:44):

Navigator. 8-10 days… Then it usually falls off of his slimy skin… I have 100% coverage, and have a good supply ..

art says to (10:44):

Dexcom should certainly last for 7 days!

Judy&Alli says to (10:44):

1-2 days is unacceptable stark. I am sorry for you!

gina says to (10:44):

stacey you are lucky

sstrumello says to (10:44):

This seems to suggest why JDRF partnered with Dexcom, rather than Medtronic Minimed

Gary Scheiner, CDE says to (10:45):

 

After 6 days on the MM sensor, you have to remove the transmitter and charge it for 20 minutes, then plug it back in and do a fresh sensor start.

stark says to (10:45):

thanks Judy & Alli!

lee4031 says to (10:45):

After the 3rd restar, 6 days, how long does it stay accurate?

Gary Scheiner, CDE says to (10:45):

 

I like that, Allison. “Ouchy Skin”.

gina says to (10:45):

oh Speaking of the JDRF we will be having an Artificial Pancreas chat with Aaron Kowalski soon as well

Judy&Alli says to (10:46):

I hope dexcom replaces them for you stark!

gina says to (10:46):

GAry, how many more days can you get out of it then?

DForce says to (10:46):

Another tip. On day 3, enter a bg BEFORE going to “new sensor”. Then sensor will use CAL you just entered rather than having to wait a minute or 2 before entering it.

AMBlass says to (10:46):

Heh. Cute names don’t make it any painless. I don’t know how people can have something in their skin that long! Am I doing something wrong?

Gary Scheiner, CDE says to (10:46):

 

Beautifully descriptive, Stacey. What exactly does his “slimy skin” smell like? No… I don’t want to know.

PowerPumper says to (10:46):

Do you kno if this new JDRF/BD relationship will examine sensor improvement?

sstrumello says to (10:46):

Thanks Gary, Gina … I’ve got to cut out early now. I look forward to reading the transcript!

gina says to (10:47):

Scott see ya soon!

Gary Scheiner, CDE says to (10:48):

 

Yea, cute names just don’t cut it. Like infusion sets: “Sof Set”, “Silhouette”, “Tender”, “Comfort”. We need real names, like HARPOONATRON or BLUDGERMATIC.

gina says to (10:48):

LOL

PowerPumper says to (10:48):

lol

Judy&Alli says to (10:48):

lol gary

bjphilly says to (10:48):

lol

DForce says to (10:48):

I have gotten 12 days out of mine, however that was when my insurance wasn’t covering and I was desperate!

Gary Scheiner, CDE says to (10:49):

 

Most people I work with can get close to 2 “cycles” out of their sensors before the performance starts to croak.

 

 

gina says to (10:49):

wow!!!

DForce says to (10:49):

2 cycles of 6 days or 2 cycles of 3?

Judy&Alli says to (10:49):

can you go 14 days gary?

Gary Scheiner, CDE says to (10:50):

 

5-6 days w/Medtronic, 8-10 days w/Navigator, 12-14 days w/Dexcom.

 

 

Judy&Alli says to (10:51):

wow i think our record was 12 days. But she is so active they usually come out before they stop working.

DForce says to (10:51):

Do you find one brand more accurate than another? Which would you recommend to a new pt. with no preference?

Gary Scheiner, CDE says to (10:52):

 

I pay cash for my Dexcom sensors, so I put them on life support and do a few resuscitations before I rip it out.

 

 

AMBlass says to (10:52):

I definitely think I’m going to switch to DexCom once my supply of Minimed is done.

gina says to (10:52):

Gary that just made me laugh out loud

Gary Scheiner, CDE says to (10:52):

 

Usually get 15-18 days out of my dexcom sensors… also need to apply some extra tape around day 10.

 

 

art says to (10:52):

Gary…I am with you! When you have to pay out of pocket, you make them last!

PowerPumper says to (10:52):

ido cgms have to be matched to pumps — will only MM’s work with my MM722?

landileigh says (10:53):

Don’t forget everyone that you can check out Gary’s website at http://www.integrateddiabetes.com/

Gary Scheiner, CDE says to (10:53):

 

HERE’S THE RECORD FOR SENSOR LONGEVITY, at least from what I’ve seen. One of the dietitians in my office got 52 FREAKIN’ DAYS out of a single Navigator sensor. We framed the sensor and have it hanging on the wall.

🙂 says to (10:53):

I am up for a new pump…if I were to go with Medtronic, do people still recommend the Dexcom? Cons of Medtronic vs. Dexcom( aside from it being a stand alone device of course)?

gina says to (10:54):

WHAT!!!

landileigh says (10:54):

and of course the book that everyone must have “Think Like a Pancreas” written by Gary Scheiner will be linked off of this chat’s transcript

Judy&Alli says to (10:54):

52 days? OMG!!!

stacey says to (10:54):

52 days… thats scary- how did they get ot to stick so long…?

Ellen1456 says to (10:54):

Well my son can’t seem to get it not to itch after 4 days.

DForce says to (10:54):

52 days? And how was the surgery to remove it?

Gary Scheiner, CDE says to (10:54):

 

PowerPumper – CGM does NOT have to matched to a pump. I have patients on Medtronic pumps who use other types of sensors, and people on different pumps who use a Guardian system.

AMBlass says to (10:55):

Ellen, I am the same way.

PowerPumper says to (10:55):

cool, thanks

gina says to (10:55):

mine itches too

DForce says to (10:56):

Do not scratch it!! It is like poison ivy..once you scratch, you can’t stop! I find generally the itch goes away.

Gary Scheiner, CDE says to (10:56):

 

Thanks for the promo, Landileigh. FYI, my practice provides diabetes consulting via phone & internet all over the world, so if anyone is looking for some “coaching”, please let me know.

gina says to (10:56):

dforce i cant stop itching

gina says to (10:56):

LOL

Sophia says to (10:56):

I like your new website design, Gary. It looks good.

art says to (10:56):

I wish Dexcom would make the adhesive bandages flesh colored (beige or brown) instead of white. The transmitter is small but the bandage stands out like a billboard! Anyone else agree?

gina says to (10:57):

me too gary your new site looks really good! http://www.integrateddiabetes.com/

Judy&Alli says to (10:57):

i might be interested in some counseling for my 11 year old gary.

Ellen1456 says to (10:57):

Seriously, for the person who got so many days out of that Nav – what prep did they use? How many times did they have to retape it?

lee4031 says to (10:57):

Does insurance typically cover the cost?

lee4031 says to (10:57):

Of your counseling that is…

Judy&Alli says to (10:58):

good ? lee

Gary Scheiner, CDE says to (10:58):

 

Thanks Sophia. It just went up about 4 hours ago. Sorry there are still some “blank” pages.

 

 

landileigh says (10:58):

Everyone, it’s almost time for our chat to end tonight, Gary can take just a couple more questions.

gina says to (10:58):

Gary, I have been trying to get my a1c into “baby range” and it has been horrible

Gary Scheiner, CDE says to (10:59):

 

Art – at least the transmitter is no longer BlacK. fIRST time I wore it, my wife thought I had a bug on me.

 

 

gina says to (10:59):

i am about to give up how can i use my cgm to help me get there

gina says to (10:59):

any tips?

Gary Scheiner, CDE says to (10:59):

 

Lots of tape, Ellen. Lots and lots and lots of tape.

DForce says to (11:00):

Gina…just had baby #3 12 weeks ago. All normal weights, all overdue. This one was 3 weeks overdue! Doctor almost had a nervous breakdown but I refused induction/c section. There is hope..

Ellen1456 says to (11:00):

What kind of tape? Any antihistamine or barrier wipes to prepare the skin?

landileigh says (11:00):

Optiflex, I bet

landileigh says (11:00):

stuff is awesome

Gary Scheiner, CDE says to (11:00):

 

Lee – Our clients all pay us directly and then submit for reimbursement. Some get reimbursed, some don’t. But we get people the results they want, so they keep coming back!

lee4031 says to (11:00):

Thanks Gary – good to know!

art says to (11:01):

LOL! It does look like a big roach!

Gary Scheiner, CDE says to (11:01):

 

Gina – best thing you can do is set your high alert aggressively (160? 180?) and attack the high as soon as the alerts go off. If you spend very little time in the high ranges, your A1c will defintely come down.

Judy&Alli says to (11:01):

Goodnight all!! Thanks Gary!!

stacey says to (11:01):

gotta go, goodnight all (Tp)

gina says to (11:02):

Don’t forget to check out Gary’s website http://www.integrateddiabetes.com/

Gary Scheiner, CDE says to (11:02):

 

Thanks for having my on the “show”. This has been a lot of fun.

 

 

landileigh says (11:02):

Thank you everyone for coming! The Chat transcript will be up tomorrow.

DForce says to (11:02):

Try “mini bolusing”..as soon as you see bg creeping up into 130s, test and take 0.2…works for me!

art says to (11:02):

This has been great! Thanks!

Ellen1456 says to (11:02):

The new website looks good Gary.. Thanks for taking the time to chat.

Sophia says to (11:02):

Thanks Gary and thanks Gina – for all the great work you do!

AMBlass says to (11:02):

Thanks again Gary

gina says to (11:03):

Gary thank you so much for being a guest!

landileigh says (11:03):

Also, All of the links that Gary has mentioned will be listed with the chat

Ellen1456 says to (11:03):

Looking forward to reading the transcript – I arrived late.

Ellen1456 says to (11:04):

Thank you TDR!