The Pros and Cons of Continuous Glucose Monitoring (CGM)

You’ve most likely seen me carrying a small machine on my higher arm in loads of the images on this web site. That’s my CGM, a device that’s instrumental in my every day diabetes administration. 

It’s an excellent piece of kit, and I completely like it (more often than not).

Key Factors:

• CGMs present real-time and historic glucose knowledge, bettering consciousness of how meals and actions have an effect on glucose ranges. These gadgets assist cut back episodes of hypoglycemia, enhance A1c ranges, and enhance confidence and safety in diabetes administration.
• CGM use considerably reduces the necessity for conventional finger-stick monitoring, offering better freedom in every day actions. This could present peace of thoughts throughout train and different actions. 
• Points with CGM sensors can generally result in inaccurate readings, probably affecting diabetes administration choices, and the sensors can sometimes trigger inconvenience or discomfort. Moreover, overreliance on the machine can cut back private judgment. 
• Regardless of the potential drawbacks, CGMs are extremely really helpful for individuals with diabetes who take insulin, as they provide worthwhile insights into glucose tendencies and total diabetes administration.
• Which CGM system to make use of will depend on a wide range of elements, together with compatibility with insulin pumps, smartphone integration and knowledge accessibility, and life-style wants. You must weigh these elements based mostly in your particular diabetes administration necessities.

What’s CGM?

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

Most CGMs embrace three most important elements: 

• 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 hooked up transmitter, which sends the readings to a receiving machine (that is the half you see on my arm)
• 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 USA:

• Abbott FreeStyle Libre 2
• Abbott FreeStyle Libre 3
• Ascensia Diabetes Care Eversense E3 (a totally implantable possibility)
• 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 machine.

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 programs. Since I’ve solely worn Medtronic and Dexcom gadgets to this point, I’ll provide you with my opinions based mostly on these so you may determine if a CGM may enable you handle your diabetes higher.

Some great benefits of steady glucose monitoring

Knowledge

When you do finger-stick blood sugar checks and know your physique properly, you most likely assume you’ve got a reasonably good concept of what your sugars are as much as between measurements. Likelihood is good, although, that you could be be improper.

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 normally don’t verify. 

CGM is a crucial device for offering this sort of ongoing data that may present tendencies and patterns, versus the snapshots which are offered by conventional monitoring.

Hastily, 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 reduce 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 stated lows.

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 at all times 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 mechanically adjusts insulin dosing to assist glucose keep inside goal vary, in an innovation referred to as hybrid-closed loop (HCL) know-how. 

Present HCL gadgets in the marketplace embrace:

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

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

As an example, 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 not less than 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 embrace just a few missteps, however that’s life and that’s studying. The data has made it potential for me to optimize my coaching and has made it simpler for me to remain in a variety 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 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 generally 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 correct there on the display screen in entrance of me.

Utilizing this machine 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 standard finger-stick verify and seeing that the sensor is means off. 

The rationale behind that is that the know-how isn’t good but (though it’s always bettering) and the sensor measures your glucose ranges within the interstitial fluid and never the blood. (There may be usually a lag of some minutes between your interstitial glucose ranges and blood glucose ranges)

Other than the plain points, it may also 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 — at all times an annoying situation if you’re within the midst of a very good gymnasium session.

Though some CGM gadgets are actually extremely correct and authorised by the U.S. Meals and Drug Administration (FDA) for making therapy choices, it’s at all times smart to verify any sudden readings or readings that don’t match what your physique is feeling with a standard 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 stated, it’s value noting that the know-how has improved tremendously through the years. In accordance with a 2023 research, CGMs have been proven to be 96.5 % correct in a real-world hospital setting.

Overreliance

That is truly the primary cause why I initially stopped carrying my CGM and why I nonetheless take breaks every now and then.

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 feel that’s an enormous no-no on the subject of diabetes administration.

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

Inconvenience

Having the CGM sensor hooked up 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 may possibly go away 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 figuring out, so I normally 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 a bit of 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 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 machine you’re utilizing. Check with the directions that include your CGM.

On a associated matter, 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 properly well worth the knowledge the machine offers. 

Plus, for the gadgets at the moment in the marketplace, the sensors solely must be modified each seven to 10 days (excluding the implantable Eversense E3, which usually must be modified by a healthcare supplier each 90 days).

Associated: Here’s a submit outlining my greatest CGM suggestions during which I speak extra about the way to placed on the sensor (with a video) and the way to make it keep on.

Worth

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

Last ideas

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

The CGM provides you with information 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 may 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 unbelievable machine, but it surely’s not an alternative choice to my very own pondering and expertise. 

It’s an incredible device to have in my diabetes toolbox, however it may possibly’t stand alone.