This content material initially appeared on diaTribe. Republished with permission.
By Paul Heltzel
Key takeaways:
- Steady glucose monitoring (CGM) gadgets present blood sugar developments over time.
- Take into account some recommendations on the right way to elevate the difficulty in case your physician hasn’t but instructed CGM use.
- There’s a small however manageable studying curve when beginning to use a CGM gadget 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 recognized and see steady glucose monitoring (CGM) as a good way to begin your care. Regardless, congratulations in your determination to undertake a extra knowledgeable method of managing your diabetes.
CGM expertise makes use of readings from the interstitial fluid in your physique utilizing a tool referred to as a sensor, which displays blood sugar ranges via a small wire inserted beneath the pores and skin and worn for every week or two. Within the meantime, you’ll get practically real-time blood sugar readings – and you may 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 strive CGM however your physician hasn’t talked about it, you could need to take into consideration the right way to request a prescription. There are additionally a handful of points to consider so that you get off to an excellent begin. And, after all, you’ll need to report again your glucose outcomes along with your healthcare supplier. Beneath you’ll additionally discover steering on sharing data in your developments, so you’ll be able to work along with your physician’s workplace to make choices about your care.
The right way to get a CGM
To begin utilizing a CGM gadget, you’ll sometimes want a prescription. And whereas some CGM gadgets are now accessible with out a prescription, the out-of-pocket price could also be a barrier.
Moreover – and importantly – the over-the-counter gadgets are designed to point out blood sugar developments 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 in-built,” mentioned Dr. Marilyn Tan, medical affiliate professor of endocrinology on the Stanford College Faculty 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 have 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 strive a CGM system, however your doctor hasn’t instructed it or doesn’t appear on board with the thought?
Tan mentioned that there are a variety of causes a healthcare supplier could not have raised the thought: “Lack of time, pondering the affected person might not be , or that they might not qualify for insurance coverage protection, pondering the affected person doesn’t want one, or not being conversant in CGMs. A affected person ought to really feel comfy citing CGM to the healthcare supplier.”
You may speak to your physician about the way you’d wish to get a greater image of your general diabetes administration and enhance time in vary. You too can point out that you just’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 might be harmful.
Analysis exhibits that CGM use advantages folks with all kinds of diabetes, and may result in dramatic enchancment even in folks with diabetes with excessive A1C ranges.
What to anticipate as a first-time CGM consumer
You’ll have to be taught to insert a sensor, which is often very straightforward. CGMs now include a one-time injection gadget 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 shortly you could not even understand the sensor is inserted. (That mentioned, listed here are some suggestions for individuals 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 referred to as calibration) with the newest technology of CGM programs, some nonetheless require calibration. Be aware that there’ll possible be a small distinction in readings between a blood glucose meter and a CGM gadget.
“The glucose readings on the CGM are likely to lag [behind meters] and might be much less correct at extremes and with fast glucose adjustments,” Tan mentioned.
“Sufferers continuously be aware 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 increased 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) may trigger issues with CGM readings. Should you’re taking one in every of these, the supplier of your CGM system can let you know if it’s a problem (this may fluctuate by mannequin), and it’s an space the place you’ll positively need to seek the advice of along with your healthcare supplier.
You may additionally have to get used to the concept your blood sugar is now being checked each jiffy, 24 hours a day, a number of hundred instances a day. That’s loads of data and you could need to work along with your practitioner to decide on which alerts you need to obtain, at varied blood sugar ranges — and instances in the course of the day — so that you just’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 might be much more finely tuned when a CGM gadget is used with an automated insulin supply (AID) system.
Sharing CGM information along with your healthcare supplier
Tendencies captured by the CGM can present a transparent, general image of your diabetes administration. This information can be displayed in experiences which are very particular, for instance to point out what your blood sugar ranges seem like at sure instances in the course of the day. The flexibility to customise these views may help you and your physician work collectively to make changes.
There are usually three predominant methods to share your blood sugar developments along with your physician’s workplace.
First, you’ll be able to often share your CGM readings along with your physician’s workplace in order that they’ll see your information in a normal view particularly designed for a healthcare crew. This may occasionally enable, relying on the options of your CGM, the power on your supplier to view information with only a small time lag.
“The data is most important to medical determination making,” Tan says. “Many clinics have clinic accounts the place the info might be shared by way of a particular share code or entry granting course of.”
Reviews are one other approach to share your information along with your supplier. Your physician or different supplier could ask you to carry sure experiences generated by the software program that comes along with your CGM to share at your visits. These may very well be emailed or shared via your physician’s well being portal web site as a PDF file, or printed and introduced alongside to your appointment. Amongst different views, these experiences can embrace your common blood sugar over time, your time in vary, and your customary deviation, which is a measure of how your blood sugar readings diversified primarily based in your common studying.
One other approach to share your CGM information is through the use of a third-party on-line software which takes your blood sugar readings and information them, then shows them as a graph or in experiences which are particular to that software. Tidepool, Nightscout and Glooko are three of those companies, which work with most kinds of CGM gadgets.
“There are lots 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
Should you’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 stage but in addition the speed of change and an estimation of the place your blood sugar is headed. You’ll additionally get alerts – whenever you’re headed too low or too excessive, for instance – ideally in time to get again in vary shortly.
Right here’s one other profit: You may select a CGM gadget that connects with an computerized insulin supply (AID) system, which integrates an insulin pump to regulate dosing and helps preserve your blood sugar in vary.
Should you’re able to strive a CGM however your physician or different healthcare supplier hasn’t raised the thought, you’ll be able to talk about proactively the way you’d wish to strive it . Most insurance coverage insurance policies will cowl CGM for folks taking insulin and a few will cowl CGM use for folks 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 data along with your healthcare supplier. As in different areas of diabetes care, use the method that works greatest for you and your supplier, which might result in a extra complete understanding of your blood sugar ranges and improved diabetes care.
