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Stelo

M

mhtyler

Well-Known Member
Relationship to Diabetes
Type 2
Hi All, The subject is the Stelo CGM from Dexcom. First, I'll mention what brought me to it. My last A1c was 5.6. Not bad, right? Unfortunately here in the US it means my insurance company no longer considers me diabetic, and therefore they won't pony up for a CGM. So, after digesting that irony I heard about the Dexcom Stelo which doesn't require a script. I bought one...two sensors actually. GAME CHANGER. Instead of a snapshot, I could see or intuit what my liver and pancreas were doing throughout the day. I knew that when I got it, but the point I want to make is that it didn't hit home how useful that is until I tried it. The bad: Its 100 dollars a month out of pocket. I'm shelling it out though, it's just too useful. There's supposed to be a way I can use Dexcom's other app to track data long term, but haven't figured that out yet. My glucose is lower now because of this constant feedback. Is it available in the UK? Does NHS cover CGM's there? Just curious. I assume Stelo is available there or soon will be. Apparently Abbott labs is putting out a non script one as well. That's all, I just wanted to share that.
mark
 
If your a1c is 5.6 without cgm, that’s equivalent to 38 here which is well within the non diabetic range and so a cgm is overkill and I can’t imagine it is worth the expense. You don’t need to make further changes to improve your blood sugars since they’re already non diabetic range.

The NHS here only covers cgm for T1, T3C, and not many T2. If you’re T2 then to get cgm here you must be injecting insulin 2+ times a day, and have been advised to test 8+ times a day.
 
Lucyr said:
If your a1c is 5.6 without cgm, that’s equivalent to 38 here which is well within the non diabetic range and so a cgm is overkill and I can’t imagine it is worth the expense. You don’t need to make further changes to improve your blood sugars since they’re already non diabetic range.

The NHS here only covers cgm for T1, T3C, and not many T2. If you’re T2 then to get cgm here you must be injecting insulin 2+ times a day, and have been advised to test 8+ times a day.
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The requirement here is similar for insurance purposes. However, I don't consider having this overkill. For starters I want my glucose much closer to 5.0. The feedback will help me get there. I love tech, so maybe it's the geek in me.
 
I would have thought that with the information already gained from use of the sensors you would be better spending your money on good quality food and carrying on with what you have been doing to maintain where you are with your blood glucose.
There would be very little hope in the UK, many type 2s are lucky if they get a monitor and test strips on prescription so self fund those let alone a CGM.
 
Leadinglights said:
I would have thought that with the information already gained from use of the sensors you would be better spending your money on good quality food and carrying on with what you have been doing to maintain where you are with your blood glucose.
There would be very little hope in the UK, many type 2s are lucky if they get a monitor and test strips on prescription so self fund those let alone a CGM.
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Same thing here. My insurance covers an expensive monitor, and a few test strips, after that you're on your own, so I had been using the cheapest one on the market out of my own pocket from Walmart. Its not only cheap, but the test strips are quite cheap. Its about 1/5th the cost of Stelo. Now, I'm retired, so its not as though I've got a money tree out back, but this thing is just amazing.
 
mhtyler said:
For starters I want my glucose much closer to 5.0.
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Why do you want an a1c of 5.0%? That’s 31 in UK terms. Your current a1c of 5.6% / 37 is perfectly good enough, it’s already in the non diabetic range.
 
mhtyler said:
5.6 is good. 5.0 is better
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Says who? Diabetes UK says if you have diabetes then an ideal a1c is 6.5% / 48 mmol and below.
 
mhtyler said:
For starters I want my glucose much closer to 5.0. The feedback will help me get there. I love tech, so maybe it's the geek in me.
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But you can understand why insurance companies (or NICE, which makes the similar judgement in the UK) would be concerned about the cost and possible benefits?

The decision for people with Type 1 is just easier. (I think many more people with Type 2 ought to be offered CGM, and I presume that'll happen over time. But not everyone. I think I'd be OK just offering CGM to those using insulin; maybe to everyone who's currently offered test strips (which is everyone on medication which can cause hypos, I think).)

Reducing your HbA1c from 5.6% to 5.0% just isn't likely to be worth much. Maybe it'll reduce the risk of complications, but as far as I understand it that would be very speculative so an insurance company (or NICE) isn't going to recommend a CGM to help you achieve that.
 
I think what is considered to be normal level is lower in the US than in the UK. So that may be where @mhtyler is coming from.
 
Bruce Stephens said:
Is it, though? 5.6% is within the normal range so do we have good evidence that it's better to have an HbA1c of 5.0%?
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Yes, I can't quote it, but glucose at or below 5.4 leads to better health outcomes...relating to heart issues if I recall.
 
Bruce Stephens said:
Oh yes, you're right. If one believes Google AI, normal is below 5.7% whereas in the UK below 6% is. (39 and 42 I think.)
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But no country says you need to be below 5.0% (31) a1c, that’s just an arbitrary goal that @mhtyler has invented with no evidence
 
If you are able to afford it, and it supports your goals, then it feels like the right decision for you.

When I was part of a NICE group reviewing evidence for T1 in DCCT (and I believe results in UKPDS for T2 suggests similar) there are modest improvements at lower levels, but the balance of the health economics is very much shifting, and includes risks of its own. The really big wins in terms of complications risk happen higher up, even the recommendation to recommend dropping the A1c target for T1 to 6.5% from 7.5% was finely balanced and recommended with ‘personalised targets’ caveats.

Do keep an eye on your frame of mind @mhtyler

If you find using CGM helpful, then great! But keep a watch on the obsessive feelings you allude to, and how much of an impact the flow of data is having on you. If it starts becoming overwhelming or begins to feel burdensome, take a break. The benefits at 5 are marginal at best. And any stress/MH burden could negatively impact your heart risk to a greater extent!
 
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