The Pros and Cons of Continuous Glucose Monitoring (CGM)

You’ve most likely seen me carrying a small gadget on my higher arm in loads of the photographs on this web site. That’s my CGM, a instrument 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?

CGM stands for steady glucose monitor. This gadget makes it attainable for me to see my glucose readings in (nearly) real-time and to trace historic glucose knowledge.

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 cells)
• An connected transmitter, which sends the readings to a receiving gadget (that is the half you see on my arm)
• A receiver or smartphone that shows the readings and glucose pattern knowledge

There are presently a number of CGM programs out there for private use in america:

• Abbott FreeStyle Libre 2
• Abbott FreeStyle Libre 3
• Ascensia Diabetes Care Eversense E3 (a completely implantable choice)
• Dexcom G6
• Dexcom G7
• Medtronic Guardian Join

Most CGM gadgets present glucose readings each 5 minutes, whereas the FreeStyle Libre “flash” monitoring programs present readings upon scanning of the gadget.

My expertise with CGM

I acquired my first Medtronic CGM in December 2012 and wore it on daily basis 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 programs. Since I’ve solely worn Medtronic and Dexcom gadgets to this point, I’ll provide you with my opinions primarily based on these so you’ll be able to determine if a CGM may enable you handle your diabetes higher.

The benefits of steady glucose monitoring

Information

If you happen to do finger-stick blood sugar checks and know your physique effectively, you most likely assume you will 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 unsuitable.

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 through the night time after I often don’t test.

CGM is an important instrument for offering such a ongoing info that may present developments and patterns, versus the snapshots which might be supplied by conventional monitoring.

Hastily, I might see how sure meals and actions affected my glucose ranges over the subsequent a number of hours. That info is golden!

Plus, with the ability to spot low sugars earlier than they hit (due to 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 stated lows.

Administration

So, what to do with all this new info? 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 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 know-how with an algorithm that routinely adjusts insulin dosing to assist glucose keep inside goal vary, in an innovation generally known as hybrid-closed loop (HCL) know-how.

Present HCL gadgets available on the market embrace:

• Medtronic MiniMed 770G
• Medtronic MiniMed 780G
• Tandem Management-IQ with Dexcom G6
• Insulet Omnipod 5

After all, simply slapping on a CGM gained’t handle your diabetes. However cautious interpretation and use of the info may help immensely.

For example, 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 not 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 attainable for me to optimize my coaching and has made it simpler for me to remain in a spread of 90-144 mg/dL (5.0-8.0 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 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 occasions a day as a result of I not must — the knowledge is correct there on the display screen in entrance of me.

Utilizing this gadget has enabled me to go for a stroll or a hardcore gymnasium session with out fearing lows and to succeed in each my health and diabetes well being objectives extra effectively.

The disadvantages of steady glucose monitoring

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 is approach off.

The explanation behind that is that the know-how isn’t excellent but (though it’s continually 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 plain points, it can be outright harmful in the event you rely solely on the sensor readings and fully 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 onerous 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 once you’re within the midst of a superb gymnasium session.

Though some CGM gadgets are actually extremely correct and authorised by the U.S. Meals and Drug Administration (FDA) for making remedy selections, it’s all the time smart 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 several other of the gadgets 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 stated, it’s price noting that the know-how has improved tremendously over time. In response to a 2023 research, CGMs have been proven to be 96.5 % correct in a real-world hospital setting.

Overreliance

That is truly the principle motive why I initially stopped carrying my CGM and why I nonetheless take breaks every so often.

This will likely not apply to everybody, however I tend to depend on the readings and proposals a bit too closely. For instance, if the studying stated 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.

I’ve gotten loads higher at utilizing the CGM as a knowledge level and never essentially as the whole reality, which has made it a much better companion in administration.

Inconvenience

Having the CGM sensor connected to my physique on a regular basis might be extraordinarily annoying. It’s not very huge and other people don’t actually discover it, however it will possibly go away 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 way in which when figuring out, so I often put on it on my higher arm. I discover that I get fairly good readings with that placement. (The one situation is that it may be somewhat onerous 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 folks. I don’t thoughts — I see it as a possibility to coach and advocate.

But when it bothers you, there are many different areas to put 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. Seek advice from the directions that include your CGM.

On a associated subject, many individuals marvel if CGMs damage. In my expertise, there may be solely a slight pinching sensation upon inserting the sensor, and this momentary discomfort is effectively definitely worth the knowledge the gadget offers.

Plus, for the gadgets presently available on the market, the sensors solely should be modified each seven to 10 days (except for the implantable Eversense E3, which generally must be modified by a healthcare supplier each 90 days).

Associated: Here’s a publish outlining my finest CGM ideas during which I discuss extra about tips on how to placed on the sensor (with a video) and tips on how to make it keep on.

Worth

Relying in your medical health insurance protection, CGM gadgets and their related provides might be costly.

Remaining ideas

Would I like to recommend a CGM to anybody with diabetes utilizing insulin? The reply is a powerful sure, not less than till you perceive your physique and your diabetes higher.

The CGM gives you 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, you’ll be able to simply cease utilizing it.

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, but it surely’s not an alternative to my very own pondering and expertise.

It’s an ideal instrument to have in my diabetes toolbox, however it will possibly’t stand alone.