You’ve most likely seen me carrying a small gadget on my higher arm in quite a lot of the photographs 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 potential for me to see my glucose readings in (nearly) real-time and to trace historic glucose knowledge.
Most CGMs embody three most 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 development knowledge
There are at the moment a number of CGM programs accessible for private use in the US:
My expertise with CGM
I bought my first Medtronic CGM in December 2012 and wore it day-after-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 programs. Since I’ve solely worn Medtronic and Dexcom units so far, I’ll provide you with my opinions primarily based on these so you possibly can resolve if a CGM would possibly enable you to handle your diabetes higher.
Some great benefits of CGM
Information
When you do finger-stick blood sugar checks and know your physique nicely, you most likely assume you’ve a fairly good concept of what your sugars are as much as between measurements. Chances are high good, although, that you could be be incorrect.
I bought an enormous shock once I began seeing how a lot my blood sugar really different all through the day, to not point out throughout the evening once I often don’t examine.
CGM is a crucial device for offering the sort of ongoing info over a 24-hour interval that may present tendencies and patterns, versus the snapshots at sure instances throughout the day which can be offered by conventional monitoring.
Impulsively, I may see how sure meals and actions affected my glucose ranges over the following a number of hours. That info is golden!
Plus, having 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 typically I’ve low blood sugar episodes.
It additionally means I’m consuming fewer glucose tablets and fewer juice to cope with 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 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 p.c.
My blood sugar has at all times 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 routinely 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 in the marketplace embody:
After all, simply slapping on a CGM received’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 at the very least midday.
I’ve additionally realized 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 at all times want a minimal of a half unit of energetic insulin on board (IOB) earlier than a exercise.
Gaining this data took time and did embody just a few 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 best way 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 must — the data is at all times proper 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 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 know-how isn’t good but (though it’s consistently enhancing) and the sensor measures your glucose ranges within the interstitial fluid and never the blood. (There may be typically a lag of some minutes between your interstitial glucose ranges and blood glucose ranges)
Other than the plain points, it will also be outright harmful in case you 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 — at all times an annoying situation if you’re within the midst of gymnasium session.
Though some CGM units are actually extremely correct and authorised by the U.S. Meals and Drug Administration (FDA) for making therapy selections, it’s at all times smart 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 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 price noting that the know-how has improved tremendously through the years. In response to a 2023 examine, CGMs had been proven to be 96.5 p.c correct in a real-world hospital setting.
Overreliance
That is really the principle motive 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 tend to depend on the readings and proposals a bit too closely. For instance, if the studying mentioned that my glucose was dropping shortly, I might belief it absolutely over how I really really feel. I feel that’s an enormous no-no with regards to diabetes administration. On this situation, it could be prudent to verify the CGM info with a finger-stick examine.
I’ve gotten rather a lot higher at utilizing the CGM as an information level and never essentially as the whole reality, which has made it a much better associate in administration.
Inconvenience
Having the CGM sensor connected to my physique on a regular basis will be extraordinarily annoying. It’s not very massive and other people don’t actually discover it, however it could possibly 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 best way when understanding, so I often put on it on my higher arm. I discover that I get fairly good readings with that placement. (One concern, although, is that it may be a bit of 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 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 position the sensor the place it’s not seen. Typical producers’ suggestions for sensor placement embody 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. Confer with the directions that include your CGM and communicate together with your diabetes care supplier about approaches that may give you the results you want.
On a associated matter, many individuals surprise if CGMs damage. In my expertise, there may be solely a slight pinching sensation upon inserting the sensor, and this momentary discomfort is nicely definitely worth the knowledge the gadget gives.
Plus, for the units at the moment in the marketplace, the sensors solely have to be modified each 7 to 10 days (except the implantable Eversense E3, which generally must be modified by a healthcare supplier each 90 days).
Associated: Here’s a publish outlining my greatest CGM ideas by 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.
Value
Relying in your medical health insurance protection, CGM units and their related provides will 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, at the very least 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, communicate 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 unbelievable gadget, however it’s not an alternative choice to my very own pondering and expertise.
It’s an awesome device to have in my diabetes toolbox, however it could possibly’t stand alone.
