You’ve in all probability seen me sporting a small gadget on my higher arm in lots of the photographs on this web site. That’s my steady glucose monitor (CGM), a instrument that’s instrumental in my each day diabetes administration.
It’s an excellent piece of kit, and I completely find it irresistible (more often than not).
What’s CGM?
A CGM gadget makes it potential for me to see my glucose readings in (virtually) real-time and to trace historic glucose knowledge.
Most CGMs embrace three important parts:
- A small sensor that’s inserted slightly 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 pattern knowledge
There are presently a number of CGM methods out there for private use in the US:
My expertise with CGM
I acquired my first Medtronic CGM in December 2012 and wore it each 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 professionals and cons to all CGM methods. Since I’ve solely worn Medtronic and Dexcom gadgets thus far, I’ll offer you my opinions primarily based on these so you may determine if a CGM may make it easier to handle your diabetes higher.
The benefits of CGM
Information
For those who do finger-stick blood sugar checks and know your physique nicely, you in all probability assume you have got a reasonably good concept of what your sugars are as much as between measurements. Likelihood is good, although, that you could be be flawed.
I acquired an enormous shock after I began seeing how a lot my blood sugar truly diverse all through the day, to not point out in the course of the night time after I often don’t examine.
CGM is an important instrument for offering the sort of ongoing data over a 24-hour interval that may present tendencies and patterns, versus the snapshots at sure instances in the course of the day which are supplied by conventional monitoring.
Impulsively, I might see how sure meals and actions affected my glucose ranges over the subsequent 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 reduce down on how typically 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 cut 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 steady earlier than.
What’s extra, some present CGM gadgets can combine with an insulin pump, permitting you to watch each glucose and insulin ranges on the identical time.
And sure gadgets mix CGM and insulin pump expertise 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 often known as hybrid-closed loop (HCL) expertise.
Present HCL gadgets in the marketplace embrace:
In fact, simply slapping on a CGM received’t handle your diabetes. However cautious interpretation and use of the info may also help immensely.
As an illustration, I’ve discovered 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 discovered what sort of actions will make my sugars drop quick (in my case, that might 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 potential 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 know my diabetes higher. It has given me extra confidence in the way in which I handle my situation and has helped me obtain tangible outcomes.
It’s additionally comforting to understand how 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 achieve 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 examine and seeing that the sensor studying is off.
The explanation behind that is that the expertise isn’t excellent but (though it’s consistently enhancing) 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)
Other than the apparent points, it may also be outright harmful if you happen to 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 state of affairs if you’re within the midst of a very good health club session.
Though some CGM gadgets are actually extremely correct and authorized by the U.S. Meals and Drug Administration (FDA) for making therapy choices, it’s all the time sensible to substantiate any sudden readings or readings that don’t match what your physique is feeling with a conventional finger-stick earlier than taking motion.
(And a number of other of the gadgets in the marketplace, together with the Medtronic Guardian and the Ascensia Eversense E3, require roughly two finger-stick checks a day for calibration.)
That mentioned, it’s value noting that the expertise has improved tremendously through the years. In response to a 2023 examine, CGMs had been proven to be 96.5 % correct in a real-world hospital setting.
Overreliance
That is truly the principle purpose why I initially stopped sporting my CGM and why I nonetheless take breaks occasionally.
This will 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 shortly, I’d belief it totally over how I truly really feel. I believe that’s an enormous no-no with regards to diabetes administration. On this state of affairs, it will be prudent to substantiate the CGM data with a finger-stick examine.
I’ve gotten loads higher at utilizing the CGM as a knowledge level and never essentially as the entire fact, which has made it a much better accomplice in administration.
Inconvenience
Having the CGM sensor connected to my physique on a regular basis could be extraordinarily annoying. It’s not very huge and folks don’t actually discover it, however it could depart considerably unattractive suntan marks, and I additionally are inclined to scar simply.
If I put on it on my abdomen, it tends to get in the way in which when understanding, so I often put on it on my higher arm. I discover that I get fairly good readings with that placement. (One difficulty, although, is that it may be slightly laborious to get a sweaty sports activities bra off with out ripping on the sensor.)
Sporting it on my higher arm has led to some fairly cool interactions and conversations with curious folks. I don’t thoughts — I see it as a possibility 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 precise gadget you’re utilizing.
There are adhesives that may assist strengthen the CGM’s adherence to your physique. Consult with the directions that include your CGM and converse together with your diabetes care supplier about approaches that may be just right for you.
On a associated subject, many individuals marvel if CGMs harm. In my expertise, there’s solely a slight pinching sensation upon inserting the sensor, and this momentary discomfort is nicely definitely worth the knowledge the gadget supplies.
Plus, for the gadgets presently in the marketplace, the sensors solely must be modified each 7 to 10 days (apart from the implantable Eversense E3, which usually must be modified by a healthcare supplier each 90 days).
Associated: Here’s a put up outlining my greatest CGM suggestions by which I speak extra about the best way to placed on the sensor (with a video) and the best way to make it keep on.
Value
Relying in your medical insurance protection, CGM gadgets and their related provides could be costly. Examine together 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 convincing sure, no less than till you perceive your physique and your diabetes higher.
The CGM will provide you with data about your diabetes that you’ve by no means had earlier than, and if after a whilst you really feel such as you not want it, converse together 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 implausible gadget, however it’s not an alternative choice to my very own considering and expertise.
It’s a fantastic instrument to have in my diabetes toolbox, however it could’t stand alone.
