What is the first step in controlling our blood sugar? Knowing our blood sugar!
Most of us who take insulin test at least 4x a day (fasting, before meals, and before bed). If that is the case, each of those self-monitoring glucose (SMBG) readings are used to manage ~6hrs worth of glucose levels and treatment. But how many fluctuations are happening within those 6hrs that we don’t know about? And how is that affecting us long term (complications?)?
Studies have shown that frequency of SMBG is directly related to control (the more SMBGs in a day, the better the persons glucose control). However, even with more frequent testing it is impossible to consistently predict how diet, illness, exercise, and stress will affect blood glucose levels, and though frequent SMBGs can allow us to diagnose and treat hypo and hyperglycemia, it does not prevent it from happening. CGM therapy allows for critical treatment adjustments to be made based on directional data (trend arrows) and glucose readings provided every 5 minutes (288 readings/day
Additionally, the CGM provides a trendline with values from the previous 1, 3, 6, 12, and 24 hours (multiple days/weeks can be downloaded for review by your clinician as well). Alerts are available to inform the user if a glucose level is above or below a previously set threshold (threshold alerts), approaching those thresholds (predictive alerts), or rising or falling at a rapid rate of change (rate of change alerts). These settings can all be individualized by the user and clinician and allow the user to be proactive regarding their blood glucose instead of reacting to bad blood sugars after they happen
For example; Sally tests her blood glucose level using SMBG. The reading is 98mg/dl (perfect, right?). One hour later, Sally starts to feel sweaty, shaky, and hungry. She checks another SMBG which reads 58mg/dl. Her SMBG is low so she eats 15g of carbs to bring it up to normal levels. How would this have been different with a CGM? The CGM may have shown Sally’s glucose of 98mg/dl with a trend arrow pointing straight down alerting Sally that her glucose level was dropping (rate of change alert). She could have then proactively eaten a few carbs to keep her glucose stable, completely avoiding the low. Additionally, the CGM would have alarmed her when her glucose was approaching or reached her previously set threshold of 80mg/dl (threshold and predictive alerts). These available features allow for more informed treatment decisions, more time in range, lower HbA1c levels, less hypoglycemia, and a more proactive approach to glucose control. It is especially useful in people who suffer from hypoglycemia unawareness (cannot feel lows).
How does it work? The CGM consists of 3 parts; A sensor, a transmitter, and a receiver. The sensor is placed by the user with an inserter and sits just under the skin (like an infusion set for a pump user). It is changed every 3-7 days depending on the type of CGM. Most transmitters are reusable and sit above the skin as an extension of the sensor. The sensor uses oxidative enzymes to read interstitial glucose levels which are converted to blood glucose levels. The information is then transferred to a receiver device, cell phone, or insulin pump to be viewed by the user. Recently released, the Minimed 670G insulin pump and CGM pairing allows the pump to adjust its basal rate based on the reading provided by the Medtronic CGM (more on this to come).
Real-time CGM data can be shared with loved ones alerting them to hypo or hyperglycemia of the user. A nervous parent, for instance, can be alerted when their child’s glucose drops below 80mg/dl in the middle of the night giving them the ability to sleep without fear that their child is experiencing a hypo episode in the next room (I don’t think my mom slept through the night until I left the house). Additionally, the downloadable data provides crucial information to clinicians allowing for more knowledgeable treatment changes. Overall, in addition to providing increased glucose control, CGM therapy provides increased knowledge, peace of mind for users and loved ones, and in my opinion a much better quality of life!
For more detailed information on CGMs check out the article I coauthored with my colleagues on CGM therapy and prospective developments.
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