This content material initially appeared on diaTribe. Republished with permission.
By Paul Heltzel
Key takeaways:
- Steady glucose monitoring (CGM) gadgets present blood sugar traits over time.
- Contemplate some tips about learn how to elevate the problem in case your physician hasn’t but advised CGM use.
- There’s a small however manageable studying curve when beginning to use a CGM machine and reporting again your outcomes to your physician’s workplace.
So that you’ve determined to commerce finger pricks and in-the-moment blood sugar readings for the power to view your blood sugar’s previous, current and forecasted future. Or maybe you’re newly identified and see steady glucose monitoring (CGM) as a good way to begin your care. Regardless, congratulations in your determination to undertake a extra knowledgeable approach of managing your diabetes.
CGM expertise makes use of readings from the interstitial fluid in your physique utilizing a tool known as a sensor, which displays blood sugar ranges via a small wire inserted beneath the pores and skin and worn for per week or two. Within the meantime, you’ll get practically real-time blood sugar readings – and you will get alerts of present or impending excessive or low blood sugar ranges in your CGM reader or smartphone.
However earlier than you get began, there are just a few issues. If you wish to attempt CGM however your physician hasn’t talked about it, it’s possible you’ll need to take into consideration learn how to request a prescription. There are additionally a handful of points to consider so that you get off to an excellent begin. And, in fact, you’ll need to report again your glucose outcomes along with your healthcare supplier. Beneath you’ll additionally discover steering on sharing info in your traits, so you’ll be able to work along with your physician’s workplace to make choices about your care.
How you can get a CGM
To start out utilizing a CGM machine, you’ll usually want a prescription. And whereas some CGM gadgets are now obtainable with no prescription, the out-of-pocket price could also be a barrier.
Moreover – and importantly – the over-the-counter gadgets are designed to indicate blood sugar traits however don’t have alerts for prime and low blood sugar.
“For security, sufferers with a threat of hypoglycemia – for instance, who’re taking insulin – ought to be on CGMs with security alarms inbuilt,” mentioned Dr. Marilyn Tan, scientific affiliate professor of endocrinology on the Stanford College College of Medication.
Most insurance coverage insurance policies will cowl a CGM for somebody who makes use of insulin and has skilled low blood sugar, Tan mentioned, and a few insurance policies will cowl CGM use even for individuals who don’t take insulin. For an in depth take a look at navigating insurance coverage hurdles round CGM, see our information.
Advocate for your self
So what must you do if you wish to attempt a CGM system, however your doctor hasn’t advised it or doesn’t appear on board with the concept?
Tan mentioned that there are a variety of causes a healthcare supplier might not have raised the concept: “Lack of time, considering the affected person is probably not , or that they might not qualify for insurance coverage protection, considering the affected person doesn’t want one, or not being aware of CGMs. A affected person ought to really feel snug mentioning CGM to the healthcare supplier.”
You possibly can discuss to your physician about the way you’d wish to get a greater image of your total diabetes administration and enhance time in vary. You can even point out that you simply’d like to make use of CGM to keep away from extreme low and high-blood sugar ranges, which if left untreated can require the help of one other particular person and will be harmful.
Analysis exhibits that CGM use advantages individuals with all kinds of diabetes, and may result in dramatic enchancment even in individuals with diabetes with excessive A1C ranges.
What to anticipate as a first-time CGM consumer
You’ll must study to insert a sensor, which is often very straightforward. CGMs now include a one-time injection machine that makes the method fast and practically painless. In comparison with only a few earlier generations of CGM, most individuals, together with youngsters, can do the insertion with one hand.
The insertion occurs so rapidly it’s possible you’ll not even understand the sensor is inserted. (That mentioned, listed here are some ideas for many who discover the method intimidating, together with some options to day-to-day CGM points.)
And when you gained’t be required to make use of a finger stick to make sure the accuracy of your CGM (a course of known as calibration) with the newest era of CGM techniques, some nonetheless require calibration. Observe that there’ll probably be a small distinction in readings between a blood glucose meter and a CGM machine.
“The glucose readings on the CGM are likely to lag [behind meters] and will be much less correct at extremes and with fast glucose modifications,” Tan mentioned.
“Sufferers steadily word variations in CGM and finger stick measurements; that is regular.”
What to keep away from when utilizing a CGM
Some medicines can result in CGM readings that show larger than they really are. One such drug is hydroxyurea, which is used to deal with most cancers and blood issues. Massive doses of acetaminophen (Tylenol) also can trigger issues with CGM readings. If you happen to’re taking one in all these, the supplier of your CGM system can inform you if it’s a problem (this will fluctuate by mannequin), and it’s an space the place you’ll undoubtedly need to seek the advice of along with your healthcare supplier.
You may additionally must get used to the concept that your blood sugar is now being checked each couple of minutes, 24 hours a day, a number of hundred instances a day. That’s numerous info and it’s possible you’ll need to work along with your practitioner to decide on which alerts you need to obtain, at varied blood sugar ranges — and instances through the day — so that you simply’re not overwhelmed with too many alerts.
Ideally you’ll be alerted earlier than you go too excessive or too low so you’ll be able to act, primarily based in your supplier’s suggestions, earlier than the state of affairs turns into pressing. CGM expertise continues to enhance in predicting near-term blood glucose, and therapy will be much more finely tuned when a CGM machine is used with an automated insulin supply (AID) system.
Sharing CGM knowledge along with your healthcare supplier
Tendencies captured by the CGM can present a transparent, total image of your diabetes administration. This knowledge will also be displayed in studies which can be very particular, for instance to indicate what your blood sugar ranges appear like at sure instances through the day. The flexibility to customise these views may also help you and your physician work collectively to make changes.
There are usually three important methods to share your blood sugar traits along with your physician’s workplace.
First, you’ll be able to normally share your CGM readings along with your physician’s workplace in order that they’ll see your knowledge in a regular view particularly designed for a healthcare group. This will likely permit, relying on the options of your CGM, the power in your supplier to view knowledge with only a small time lag.
“The knowledge is most crucial to medical determination making,” Tan says. “Many clinics have clinic accounts the place the info will be shared through a particular share code or entry granting course of.”
Experiences are one other technique to share your knowledge along with your supplier. Your physician or different supplier might ask you to carry sure studies generated by the software program that comes along with your CGM to share at your visits. These might be emailed or shared via your physician’s well being portal website as a PDF file, or printed and introduced alongside to your appointment. Amongst different views, these studies can embrace your common blood sugar over time, your time in vary, and your normal deviation, which is a measure of how your blood sugar readings different primarily based in your common studying.
One other technique to share your CGM knowledge is through the use of a third-party on-line instrument which takes your blood sugar readings and information them, then shows them as a graph or in studies which can be particular to that instrument. Tidepool, Nightscout and Glooko are three of those companies, which work with most kinds of CGM gadgets.
“There are a lot of third-party choices,” Tan says, “however we advise sufferers to make use of the producer apps.” These embrace, for instance, the software program that comes with Abbott’s Freestyle Libre system, or Dexcom’s Readability app.
The underside line
If you happen to’re prepared to begin utilizing CGM, you’ll commerce finger sticks and a studying that measures a cut-off date for a show of your present blood sugar degree but in addition the speed of change and an estimation of the place your blood sugar is headed. You’ll additionally get alerts – once you’re headed too low or too excessive, for instance – ideally in time to get again in vary rapidly.
Right here’s one other profit: You possibly can select a CGM machine that connects with an automated insulin supply (AID) system, which integrates an insulin pump to regulate dosing and helps maintain your blood sugar in vary.
If you happen to’re able to attempt a CGM however your physician or different healthcare supplier hasn’t raised the concept, you’ll be able to talk about proactively the way you’d wish to attempt it . Most insurance coverage insurance policies will cowl CGM for individuals taking insulin and a few will cowl CGM use for individuals with diabetes who don’t take insulin. Medicare and Medicaid cowl CGM use for kind 1, kind 2 and gestational diabetes. There are additionally new over-the-counter (OTC) decisions, however the price could also be a problem when paid out-of-pocket and the OTC gadgets lack alarms.
Lastly, there are a number of choices for sharing this info along with your healthcare supplier. As in different areas of diabetes care, use the strategy that works finest for you and your supplier, which may result in a extra complete understanding of your blood sugar ranges and improved diabetes care.
