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RE: [IPk] Continuous glucose monitoring: a point to consider



This could end up like the genetic testing question on life insurance.

If you have ever used CGMS, did the result reveal....

Julian

> -----Original Message-----
> From: Abigail King [mailto:email @ redacted]
> Sent: 01 December 2001 21:10
> To: email @ redacted
> Subject: [IPk] Continuous glucose monitoring: a point to consider
> 
> 
> I was speaking to one of the partners in the practice I now 
> work in, who has
> recently attended a conference re DM. Apparently ?Dr?Prof 
> Kerr was there. It
> seems that long acting analogues( glargine) are really going 
> to be pushed.
> This is partly due to work with the CGMS which has revealed 
> the full extent
> of nocturnal hypoglycaemia, even in those with really good 
> control and full
> daytime hypo awareness. Glargine apparently seems very 
> effective in solving
> this problem.
> 
> Apparently one man with IDDM was in a very responsible job 
> involving night
> work. CGMS revealed unsuspected nocturnal hypos and he was 
> advised to take
> time off work (?? or not given the choice to continue) until 
> the problem
> ressolved. Fortunately glargine ressolved it. I was lead to 
> believe that the
> person involved was on a pump before( had A1c of 7% and daytime hypo
> awareness). This may have been a miscommunication although he 
> could have
> been one of those people who don't benefit as much from pumps 
> ( I still find
> this a little hard to comprehend as even analogues have 
> slight variability
> and surely can't be tuned as finely as pumps)
> 
> Anyway, my main point is the implication for someone in whom 
> CGMS reveals
> unsuspected and asymptomatic hypos , regarding fitness to 
> drive and jobs.
> 
> I would be very wary of trying it for this reason, and even 
> before I heard
> of the above I would be cautious due to fitness to drive ie possible
> asymptomatic daytime hypos, although I think I have good awareness
> 
> It seems that with many modern innovations there may be a 
> price to pay and a
> reason to proceed with caution ( could genetic testing and 
> effect on life
> insurance be an analogy?)
> 
> Of course, the  good thing is the guy's problems were solved 
> so he has less
> chance of loosing his daytime awareness, while retaining his 
> good control,
> fitnss to drive and ability to do his job safely. Plus reduced the ?
> miniscule chance of a severe nocturnal episode resulting in 
> him not waking
> up without some assistance ( ie glucagen)
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