You’ve in all probability seen me carrying a small gadget on my higher arm in lots of the images on this web site. That’s my steady glucose monitor (CGM), a device that’s instrumental in my each day diabetes administration.
It’s a superb piece of kit, and I completely find it irresistible (more often than not).
What’s CGM?
A CGM gadget makes it doable for me to see my glucose readings in (virtually) real-time and to trace historic glucose information.
Most CGMs embrace three foremost parts:
- A small sensor that’s inserted just below the pores and skin (the place it reads glucose ranges in interstitial fluid, or the fluid between physique cells)
- An connected transmitter (that is the half you see on my arm), which sends the readings to a receiving gadget
- A receiver or smartphone that shows the readings and glucose development information
There are presently a number of CGM methods out there for private use in the US:
My expertise with CGM
I obtained my first Medtronic CGM in December 2012 and wore it day by day for 18 months earlier than taking a break. I then ordered my first Dexcom system in August 2016, and that has been my go-to since.
There are execs and cons to all CGM methods. Since I’ve solely worn Medtronic and Dexcom units up to now, I’ll provide you with my opinions based mostly on these so you’ll be able to resolve if a CGM would possibly show you how to handle your diabetes higher.
The benefits of CGM
Information
Should you do finger-stick blood sugar checks and know your physique properly, you in all probability assume you might have a fairly good thought of what your sugars are as much as between measurements. Chances are high good, although, that you could be be improper.
I obtained a giant shock after I began seeing how a lot my blood sugar really assorted all through the day, to not point out throughout the night time after I normally don’t test.
CGM is a crucial device for offering this kind of ongoing data over a 24-hour interval that may present traits and patterns, versus the snapshots at sure instances throughout the day which can be supplied by conventional monitoring.
Rapidly, I may see how sure meals and actions affected my glucose ranges over the following a number of hours. That data is golden!
Plus, having the ability to spot low sugars earlier than they hit (because of the alerts I set for when my sugar ranges begin dropping or get to a sure level) has actually lower down on how usually I’ve low blood sugar episodes.
It additionally means I’m consuming fewer glucose tablets and fewer juice to take care of mentioned lows, as a result of I’m catching them earlier when much less intervention is required to get my blood sugar again to focus on vary.
Administration
So, what to do with all this new data? In my case, it has not solely helped me restrict episodes of hypoglycemia (low blood sugar), however I’ve additionally managed to scale back my A1c stage (a measure of glucose management over the earlier 2 to three months) to round 6.0 %.
My blood sugar has all the time been fairly well-regulated however has by no means been this secure earlier than.
What’s extra, some present CGM units can combine with an insulin pump, permitting you to observe each glucose and insulin ranges on the similar time.
And sure units mix CGM and insulin pump know-how with an algorithm that mechanically adjusts insulin dosing to assist glucose keep inside goal vary (the optimum stage as decided by an individual’s healthcare supplier), in an innovation generally known as hybrid-closed loop (HCL) know-how.
Present HCL units available on the market embrace:
After all, simply slapping on a CGM gained’t handle your diabetes. However cautious interpretation and use of the info may help immensely.
As an illustration, I’ve realized that if I sleep any later than 8 a.m. earlier than taking my morning insulin, I’ll be battling excessive morning blood sugar ranges till no less than midday.
I’ve additionally realized what sort of actions will make my sugars drop quick (in my case, that will be strolling), my true ranges of insulin sensitivity all through the day, and that I all the time want a minimal of a half unit of lively insulin on board (IOB) earlier than a exercise.
Gaining this information took time and did embrace a couple of missteps, however that’s life and that’s studying. The knowledge has made it doable for me to optimize my coaching and has made it simpler for me to remain in my desired vary of 90 to 144 mg/dL (5.0 to eight.0 mmol/L) when exercising.
Confidence and safety
My CGM has enabled me to grasp my diabetes higher. It has given me extra confidence in the best way I handle my situation and has helped me obtain tangible outcomes.
It’s additionally comforting to know the way my sugar ranges are trending. I’ll even enterprise out typically with out bringing all my diabetes gear. I additionally stopped monitoring 10 to 12 instances a day as a result of I not have to — the data is all the time proper there on the display in entrance of me.
Utilizing this gadget has enabled me to go for a stroll or a hardcore health club session with out fearing lows and to succeed in each my health and diabetes well being targets extra effectively.
The disadvantages of CGM
Accuracy
Anyone who has ever worn a CGM is aware of the frustration of doing a conventional finger-stick test and seeing that the sensor studying is off.
The explanation behind that is that the know-how isn’t good but (though it’s consistently bettering) and the sensor measures your glucose ranges within the interstitial fluid and never the blood. (There’s typically a lag of some minutes between your interstitial glucose ranges and blood glucose ranges)
Apart from the apparent points, it can be outright harmful for those who rely solely on the sensor readings and utterly ignore what your physique is telling you. For instance, if the CGM alarms are going off telling you that you’re at 250 mg/dL (13.9 mmol/L), it may be laborious to not instantly react.
I’ve additionally needed to cease exercises as a result of the sensor incorrectly instructed me that my blood glucose was low or about to get low — all the time an annoying situation if you’re within the midst of a very good health club session.
Though some CGM units at the moment are extremely correct and authorized by the U.S. Meals and Drug Administration (FDA) for making remedy selections, it’s all the time sensible to verify any sudden readings or readings that don’t match what your physique is feeling with a conventional finger-stick earlier than taking motion.
(And several other of the units available on the market, together with the Medtronic Guardian and the Ascensia Eversense E3, require roughly two finger-stick checks a day for calibration.)
That mentioned, it’s price noting that the know-how has improved tremendously through the years. In line with a 2023 examine, CGMs had been proven to be 96.5 % correct in a real-world hospital setting.
Overreliance
That is really the primary cause why I initially stopped carrying my CGM and why I nonetheless take breaks from time to time.
This will likely not apply to everybody, however I generally tend to depend on the readings and suggestions a bit too closely. For instance, if the studying mentioned that my glucose was dropping rapidly, I’d belief it totally over how I really really feel. I believe that’s a giant no-no with regards to diabetes administration. On this situation, it might be prudent to verify the CGM data with a finger-stick test.
I’ve gotten lots higher at utilizing the CGM as a knowledge level and never essentially as the whole reality, which has made it a much better accomplice in administration.
Inconvenience
Having the CGM sensor connected to my physique on a regular basis may be extraordinarily annoying. It’s not very huge and other people don’t actually discover it, however it will possibly depart considerably unattractive suntan marks, and I additionally are likely to scar simply.
If I put on it on my abdomen, it tends to get in the best way when figuring out, so I normally put on it on my higher arm. I discover that I get fairly good readings with that placement. (One challenge, although, is that it may be slightly laborious to get a sweaty sports activities bra off with out ripping on the sensor.)
Carrying it on my higher arm has led to some fairly cool interactions and conversations with curious individuals. I don’t thoughts — I see it as a chance to teach and advocate.
But when it bothers you, there are many different areas to position the sensor the place it’s not seen. Typical producers’ suggestions for sensor placement embrace the higher arm, abdomen, decrease again, thigh, and buttocks, relying on the particular gadget you’re utilizing.
There are adhesives that may assist strengthen the CGM’s adherence to your physique. Seek advice from the directions that include your CGM and converse along with your diabetes care supplier about approaches that may give you the results you want.
On a associated subject, many individuals surprise if CGMs damage. In my expertise, there’s solely a slight pinching sensation upon inserting the sensor, and this momentary discomfort is properly definitely worth the information the gadget supplies.
Plus, for the units presently available on the market, the sensors solely have to be modified each 7 to 10 days (excluding the implantable Eversense E3, which generally must be modified by a healthcare supplier each 90 days).
Associated: Here’s a put up outlining my finest CGM suggestions during which I discuss extra about find out how to placed on the sensor (with a video) and find out how to make it keep on.
Value
Relying in your medical insurance protection, CGM units and their related provides may be costly. Test along with your insurance coverage supplier to find out what prices are related to CGM for you.
Remaining ideas
Would I like to recommend a CGM to anybody with diabetes utilizing insulin? The reply is a powerful sure, no less than till you perceive your physique and your diabetes higher.
The CGM provides you with data about your diabetes that you’ve by no means had earlier than, and if after a when you really feel such as you not want it, converse along with your diabetes care supplier about different choices.
The important thing for me when utilizing my CGM is to get higher at listening to each the CGM and my physique. It’s a improbable gadget, nevertheless it’s not an alternative choice to my very own considering and expertise.
It’s an awesome device to have in my diabetes toolbox, however it will possibly’t stand alone.
