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Advantages and disadvantages of continuous glucose monitoring (CGM)

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You may have seen me wearing a small device on my upper arm in many of the photos on this website. That’s my Continuous Glucose Monitor (CGM), a tool that helps me manage my diabetes every day.

It’s a great piece of equipment and (for the most part) I really like it.

Christel with Dexcom CGM on her arm

Key Point:

  • CGM provides real-time and historical blood sugar data, increasing awareness of how food and activity affect blood sugar levels. These devices can help reduce the incidence of hypoglycemia, improve A1c levels, and make diabetes management more reliable and safe.
  • CGM greatly reduces the need for traditional finger monitoring, allowing more freedom in daily activities. This will give you peace of mind during exercise and other activities.
  • Problems with the CGM sensor can result in inaccurate readings, which can affect diabetes management decisions, and the sensor can also cause inconvenience or discomfort. Additionally, over-reliance on devices can impair an individual’s judgment.
  • Despite the potential drawbacks, CGM is highly recommended for diabetic patients taking insulin as it provides valuable insight into blood sugar trends and overall diabetes management.
  • Which CGM system you use depends on a variety of factors, including compatibility with your insulin pump, smartphone integration and data accessibility, and your lifestyle needs. These factors should be weighed based on your specific diabetes management requirements.

table of contents

What is CGM?

CGM devices allow you to see your blood sugar readings in (near) real time and track historical blood sugar data.

Most CGMs include three main components:

  • A small sensor inserted just under the skin (where it reads blood sugar levels in interstitial fluid, or the fluid between body cells)
  • Attached transmitter (this is the part on my arm). Send the measurements to the receiving device.
  • Receiver or smartphone that displays readings and blood glucose trend data

There are currently several CGM systems available for personal use in the United States.

My experience with CGM

I got my first Medtronic CGM in December 2012 and wore it every day for 18 months before taking a break. I then ordered my first His Dexcom system in August 2016 and it has been my go-to ever since.

All CGM systems have advantages and disadvantages. I’ve only ever worn Medtronic and Dexcom devices, so I’ll give my opinion based on those so you can decide if CGM can help you manage your diabetes better.

Advantages of CGM

data

If you measure your blood sugar with your finger and know your body well, you’d probably think you have a pretty good understanding of blood sugar levels between measurements. However, there’s a good chance you’re wrong.

I was in for a big surprise when I started seeing how much my blood sugar levels actually changed throughout the day, let alone during the night, when I don’t usually check them.

CGM is an important tool that provides this type of continuous information showing trends and patterns over a 24-hour period, as opposed to snapshots at specific times of the day provided by traditional monitoring.

Suddenly, you can see how certain foods and activities affect your blood sugar levels over a period of several hours. That information is golden!

Additionally, because I can now catch hypoglycemia before it happens (thanks to the alerts I set when my blood sugar starts to drop or reaches a certain point), it really reduces the frequency of hypoglycemia.

It also means fewer glucose tablets or juices to take to deal with low blood sugar levels, as fewer interventions are needed to bring blood sugar levels back into the target range.

management

So what do I do with all this new information? In my case, not only did it help me reduce the incidence of hypoglycemia (low blood sugar), but it also helped me improve my A1c level (a measure of blood sugar control over the past 2-3 months). ) to approximately 6.0%.

My blood sugar levels have always been well regulated, but never before have they been this stable.

Additionally, some of today’s CGM devices can be integrated with insulin pumps, allowing both glucose and insulin levels to be monitored simultaneously.

Additionally, certain devices combine CGM and insulin pump technology with an innovation known as hybrid closed-loop (HCL) technology to ensure that blood sugar levels remain within the target range (optimal levels determined by your healthcare provider). It is combined with an algorithm that automatically adjusts insulin doses. .

HCL devices currently on the market include:

Of course, diabetes can’t be managed by simply hitting the CGM. However, careful interpretation and use of data can be very helpful.

For example, I’ve found that if I go to bed after 8 a.m. before my morning insulin dose, I’ll be battling high blood sugar levels in the morning until at least noon.

I also learned what activities lower my blood sugar faster (in my case, walking), my actual insulin sensitivity level throughout the day, and that I need at least 0.5 units of active insulin at all times. . Onboard (IOB) before training.

It took time and some mistakes to gain this knowledge, but that’s life and learning. This information allowed me to optimize my training and made it easier to maintain my desired range of 90-144 mg/dL (5.0-8.0 mmol/L) during exercise.

Trust and peace of mind

CGM has helped me understand more about my diabetes. It has given me confidence in how to manage my condition and helped me achieve visible results.

It’s also reassuring to know the trends in your blood sugar levels. Sometimes you go on an adventure without taking all your diabetes gear with you. Also, he stopped watching 10-12 times a day. Because there is no longer a need for that. Information is always displayed on the screen in front of you.

With this device, you can now go for a walk or a serious gym session without fear of low pressure, helping you reach both your fitness and diabetic health goals more efficiently.

Christel does bicep curls with a Dexcom CGM on her upper arm at the gym.Christel does bicep curls with a Dexcom CGM on her upper arm at the gym.

Disadvantages of CGM

Accuracy

Anyone who has ever worn a CGM knows how frustrating it can be to perform a traditional finger prick check and find that the sensor reading is off.

The reason behind this is that the technology is not yet perfect (although it is improving all the time) and the sensor measures blood glucose levels in interstitial fluid rather than blood. (In general a few minutes delay between interstitial glucose level and blood sugar level)

Aside from the obvious problems, relying solely on sensor readings and completely ignoring your body’s signals can be downright dangerous. For example, if your CGM alarm sounds indicating a concentration of 250 mg/dL (13.9 mmol/L), it can be difficult not to react immediately.

I’ve also had to stop a workout because the sensor falsely told me my blood sugar was low or about to drop. It’s always an annoying scenario in the middle of a good session at the gym.

Some CGM devices are now so accurate that they have been approved by the U.S. Food and Drug Administration (FDA). to determine treatmentit’s always wise to check with a traditional finger stick before taking action for any unexpected readings or readings that don’t match your body sensations.

(Also, some devices on the market, such as Medtronic Guardian and Ascensia Eversense E3, require approximately 2 devices Finger prick check one day For calibration. )

That being said, it’s worth noting that technology has improved significantly over the years. A 2023 study showed that CGM is: 96.5% accuracy in a real-world hospital setting.

excessive dependence

This is actually the main reason I stopped wearing CGM in the first place, and why I still take breaks from time to time.

This may not be true for everyone, but I tend to rely too much on reading and recommendations. For example, if it says my blood sugar is dropping rapidly, I’ll trust that completely over how I actually feel. When it comes to diabetes management, I think this is something you should never do. In this scenario, it is wise to tactile the CGM information.

I’ve become much better at using CGM as a data point, not necessarily the whole truth, and I’ve become a better partner in management.

inconvenience

Having a CGM sensor on your body all the time can be very annoying. They aren’t that big so you don’t really notice them, but sunburns don’t look good and I tend to get them easily.

I usually wear it on my upper arm because it tends to get in the way when I exercise if I wear it on my stomach. I found that this arrangement gave pretty good measurements. (There’s one problem, though: It’s a little difficult to take off a sweaty sports bra without tearing the sensor.)

Wearing this on my upper arm has led to some great interactions and conversations with curious people. I don’t care. I see this as an opportunity to educate and advocate.

However, if that bothers you, there are many other places you can place sensors out of sight. Common locations recommended by manufacturers for sensor placement include the upper arm, abdomen, lower back, thigh, and buttocks, depending on the specific device you are using.

There is an adhesive that helps the CGM adhere to your body. See the instructions that come with your CGM and talk to your diabetes care provider about the approach that works for you.

On a related topic, many people wonder if CGM can be harmful. In my experience, there is only a slight tightening sensation when inserting the sensor, and this momentary discomfort is well worth the data the device provides.

Additionally, for devices currently on the market, sensors only need to be replaced every 7 to 10 days (with the exception of the implantable Eversense E3, which healthcare providers typically need to replace every 90 days) ).

Related: This is a post outlining my best CGM tips, with details on how to wear the sensor (with video) and how to keep the sensor in place.

price

Depending on your health insurance coverage, CGM devices and related supplies can be expensive. Check with your insurance company about the costs associated with CGM.

Christel checks the CGM outdoors with a weight.Christel checks the CGM outdoors with a weight.

final thoughts

Would you recommend CGM to a diabetic who uses insulin? The answer is a resounding yes, at least until you understand your body and diabetes better.

CGM provides you with knowledge about diabetes that you have never experienced before. If after a while you feel you no longer need it, talk to your diabetes care provider about other options.

For me, the key to using CGM is learning to listen better to both the CGM and my body. It’s a great device, but it doesn’t replace my own thoughts and experience.

This is a great tool to have in your diabetes toolbox, but it doesn’t work on its own.

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