The Execs and Cons of Steady Glucose Monitoring (CGM)

You have got most likely seen me carrying a small machine on my higher arm in lots of the images on this web site. That’s my CGM, an instrumental device in my day by day diabetes administration. It’s a superb piece of kit and I completely find it irresistible (more often than not).

CGM stands for Steady Glucose Monitoring. This machine makes it potential for me to see my blood glucose readings in (nearly) real-time and observe historic knowledge. The piece of kit you see on my arm is a small sensor with an connected transmitter. The CGM then permits me to see my blood sugar ranges and the way I’m trending on my telephone or on the receiver that comes with the CGM.

The Execs and Cons of Steady Glucose Monitoring (CGM)

There are at present three CGM programs obtainable for private use within the US:

  • Medtronic Enlite
  • Dexcom 
  • The implantable Eversense
  • (there may be additionally the Freestyle Libre, however within the US it’s not authorized to ship steady knowledge so it’s a fingerstick alternative, not an actual CGM).

I bought 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, however since I’ve solely worn the Medtronic and the Dexcom, I’ll provide you with my opinion on these so you possibly can resolve if it’s one thing that may enable you handle your diabetes higher.


The benefits of steady glucose monitoring

Data – In the event you do handbook blood sugar measurements and know your physique effectively, you most likely assume you’ve a reasonably good thought of what your sugars are as much as between measurements. Properly, you might be most probably unsuitable. I bought a giant shock once I began seeing how my blood sugar truly different all through the day, to not point out throughout the night time once I often don’t take a look at. And that’s why CGM is such an superior device for that between measurements info.

Hastily, I might see how sure meals and actions affected my sugars over the subsequent a number of hours. That info is golden! Additionally, having the ability to catch low sugars earlier than they really occur has considerably decreased my variety of lows, to not point out decreased my consumption of glucose tablets and juice.

Administration – What to do with all this new info? Properly, it has not solely helped me restrict hypo occasions, I additionally managed to scale back my A1C degree to round 6%. I’ve at all times been fairly effectively regulated, however have by no means been this steady earlier than.

After all, simply slapping on a CGM gained’t handle your diabetes, however the perception from it may possibly.

I realized that if I sleep to any later than 8 am earlier than taking my morning insulin, I’ll be battling excessive sugars not less than till midday. I’ve realized what sort of actions will make my sugars drop FAST (that may be strolling), my true insulin sensitivities all through the day, and that I at all times want a minimal of ½ unit of energetic insulin on board earlier than a exercise.

It took time and did embody a couple of missteps, however that’s life and that’s studying. The knowledge made it potential for me to optimize my coaching, and make it simpler for me to remain in a 90-144 mg/dL (~5-8 mmol/l) vary when exercising.


Confidence and safety – My CGM has enabled me to grasp my diabetes higher. It has given me extra confidence in the way in which I handle my diabetes and has helped me obtain tangible outcomes.

It’s additionally comforting to understand how my sugars are trending. I’ll even enterprise out generally with out bringing all my diabetes gear (!). I additionally stopped testing 10-12 occasions a day as a result of I didn’t must — the data was proper there on the display screen in entrance of me.

It enabled me to go for a stroll or a hardcore health club session with out fearing lows and to achieve each my health and diabetes well being targets extra effectively.

The Execs and Cons of Steady Glucose Monitoring (CGM)


The disadvantages of steady glucose monitoring

Accuracy – Anyone who has ever worn a CGM is aware of the frustration of manually testing your blood sugar and seeing that the sensor is manner off. The explanation behind that is that the know-how simply isn’t excellent but and the sensor measures your BG primarily based on the interstitial fluid and never the bloodstream.

Except for the plain issues, it may also be outright harmful should you rely solely on the sensor readings, and ignore what your physique is telling you. For instance, if the CGM warnings are going off telling you that you’re at 250 mg/dL (~14 mmol/L), it may be onerous to not react.

I’ve additionally needed to cease exercises as a result of the sensor inaccurately instructed me that my BG was low or about to get low. Annoying!

Over-reliance – That is truly the principle cause why I initially stopped carrying my CGM and why I take breaks occasionally.

I can generally tend to depend on the readings and proposals a bit too closely. For instance, if the studying stated that my BG was dropping shortly, I’d belief it over how I truly really feel, and I believe that’s a giant no-no in relation to diabetes administration.

I’ve gotten quite a bit higher at utilizing the CGM as a knowledge level and never the whole fact, which has made it a much better “accomplice”.


It’s connected to your physique – Having the CGM sensor connected to my physique on a regular basis could be extraordinarily annoying. It not very large and other people don’t actually discover it, but it surely does depart considerably unattractive suntan marks and I scar simply.

If I put on it on my abdomen it tends to get in the way in which when understanding, so I often put on it on my higher arm. I discover that I get fairly good readings with that placement, the one concern is that it may be a bit of 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 people who find themselves curious. I don’t thoughts, I see it as a chance to coach and advocate. But when it could trouble you, then there are many different areas to put the sensor the place it’s not seen.

I wrote a put up about my finest CGM suggestions the place I speak extra about how one can placed on the sensor (with a video) and how one can make it keep on.

The Execs and Cons of Steady Glucose Monitoring (CGM)


Which CGM to decide on

As talked about, I’ve solely tried the Medtronic and Dexcom CGMs.

I favor the form of the Enlite transmitter because it’s flatter and doesn’t stick out as a lot because the Dexcom. Being flatter means, for me, that it wouldn’t get got rid of or snagged on issues. When you’ve got a Medtronic pump, it’s nearly a no brainer to get the Enlite, because it’s built-in with the pump. That implies that you see your blood sugar readings straight on the pump.

And you probably have one of many two latest variations of the Medtronic pumps (530/670), they arrive with the brand new “synthetic pancreas” options the place the pump will cease delivering insulin when your blood sugar is low or trending low.

Nevertheless, should you’re on pen remedy (MDI) like I’m, the upside to the Enlite begins to decrease. I favor the Dexcom as a result of it sends the readings on to my telephone, and it’s now so correct that the FDA has authorized that you would be able to dose your insulin primarily based in your CGM readings (I nonetheless take a look at although — guess I’ve belief points).

What I do want that the Dexcom individuals would enhance are the alarms (excessive and low) that may’t be turned off. I perceive that it’s a security characteristic, however generally I’m in a gathering the place I can’t have it go off and generally I simply wish to sleep and proper within the morning.


My advice

Would I like to recommend CGM to any insulin-dependent diabetic? The reply is a BIG FAT YES, not less than 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 when you really feel such as you now not want it, you possibly can 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 fantastic device, but it surely’s not an alternative choice to my very own considering and expertise. It’s a fantastic device to have in my toolbox however it may possibly’t stand alone.

Instructed subsequent put up: 5 CGM Ideas for the Energetic Diabetic

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