A new way to keep track of your sugar levels! Everything about Continuous Glucose Monitoring (CGM)

If you are living with diabetes, it goes without saying how important it is to control your blood sugar levels. Testing your blood sugar several times a day with your finger can be a hassle at times. But now a new technology has emerged as a great solution to this. That is the `Continuous Glucose Monitoring` or `CGM` method. Let's talk about it in detail today.

What is CGM (Continuous Glucose Monitoring)? Simply put...

Simply put, a CGM is a small device that continuously monitors your body's glucose (sugar) levels, meaning 24 hours a day. It's a type of wearable technology. As long as you wear the device, it measures the glucose levels in the fluid under your skin called the interstitial fluid and gives you data. Many people use the acronym CGM for this.

This `CGM` device is mainly useful for people with diabetes. Because managing diabetes means controlling blood sugar levels. So `CGM` gives you real-time information about how your glucose levels are changing. This is very important, because there are many factors that affect our blood sugar levels, some of which we cannot even imagine in advance.

There are several types of CGM devices on the market, and the technology is evolving rapidly. Some CGM devices are designed to be connected to insulin pumps and automated insulin delivery systems. If you'd like to learn more about CGM, talk to your doctor.

What is `Interstitial Fluid`?

Now you might be wondering what this ``interstitial fluid`` is. Think about it, this is the fluid that surrounds the cells in our body. This fluid is made up of substances that leak from our blood vessels. Glucose, or sugar, comes into this fluid from the blood this way.

The sensor in a CGM is not attached directly to a blood vessel, but to the interstitial fluid under the skin. So it measures the amount of glucose there.

Glucose first enters the blood and then diffuses into the interstitial fluid. Therefore, there may be a slight lag between the glucose level in your blood and the glucose level in the interstitial fluid. This means that the glucose readings from the CGM sensor may be a few minutes later than the glucose readings from a fingerstick.

How does a `CGM` device work?

There are several types of `CGM` devices on the market. They all work in the same way. The main differences lie in the features and appearance of the device.

But every `CGM` has three basic parts:

1. Sensor: This is the small part that measures the glucose level in your interstitial fluid at that moment. You insert this sensor under your skin with a device called an applicator. It uses a needle to puncture the skin. Then, when the needle is removed, the sensor remains under your skin. This sensor usually lasts for about 7 to 15 days, depending on the brand. Some CGM systems are implantable, which last for months. It looks like a small piece of tape about 18 millimeters long, and a doctor inserts it under the skin of your upper arm.

2. Transmitter: Every CGM system has a transmitter. This is what wirelessly sends the glucose data measured by the sensor to a device (e.g., smartphone app, receiver, insulin pump) that you can view. Some CGMs have a reusable transmitter that you can connect to a new sensor. Other CGMs have a transmitter that comes with the sensor and is removable (a disposable sensor).

3. Smartphone app, receiver or insulin pump: This technology shows your current glucose level, as well as a graph of your previous glucose levels. It also shows you whether your glucose levels are rising, falling, and how fast they are changing. Many CGMs have a smartphone app to view your data. For those who don't have a smartphone, some CGMs come with a small handheld receiver. Some CGMs can also send this glucose information to a compatible insulin pump.

Here are the steps in which a CGM typically works:

• You insert a small `sensor` under the skin, often in the abdomen or arm. This is done quickly and easily with an `applicator`. The `sensor` is held in place by an adhesive tape.
• Next, you connect the CGM transmitter to the sensor, or sometimes both the sensor and transmitter come pre-connected. Some transmitters need to be charged before connecting to the sensor. If you want, you can use additional tape to keep the transmitter and sensor firmly attached to your skin.
• Depending on the type of CGM, there is a "warm-up" period before the sensor starts sending data. This can typically be anywhere from 30 minutes to two hours.
• Most CGMs will automatically start sending glucose data after this "warm-up" period. Some require you to "calibrate" (adjust settings) by taking a fingerstick sample of blood and checking your glucose level before sending data.
• You can then monitor your current glucose levels using your smartphone app, receiver, or insulin pump as long as the sensor is connected. You can also set an alarm to notify you if your glucose levels go out of range. These ranges vary from person to person.
• When the sensor expires (or stops working), you will have to go through these steps again from the beginning.

You can download your CGM data (trends and history) to a computer at any time. Some CGM systems send data continuously. You can also share this information with your doctor.

Is it easy to use `CGM`?

CGM devices are somewhat complex little machines. It takes a while to understand their technical aspects at first.

For example, you will need to learn these things:

• How to properly insert the `Sensor`.
• If necessary, how to calibrate the device by taking blood from a finger and checking the glucose level.
• How to set the device's alarm.
• How to transfer data to a computer (for long-term analysis) or to your phone.
• How to make changes to your treatment plan based on the data collected.

It takes time and patience to understand how a CGM device works. But you don't have to do it alone. Once you decide to get a CGM and get a prescription for it, a qualified professional will teach you how to use it safely. Your doctor may recommend that you take a diabetes education class or talk to a Certified Diabetes Care and Education Specialist (CDCES).

Do I still need to take blood from my finger to check my sugar when using a `CGM`?

Using a CGM should significantly reduce the number of times you need to test your blood sugar with a fingerstick. However, it is still important to keep a fingerstick meter and supplies handy. If your CGM suddenly stops working or falls out, you can still monitor your glucose levels with a fingerstick meter until you can get a new sensor.

Also, fingerstick testing can help confirm the results of a CGM. Because, like all technology, CGMs can be inaccurate. If your CGM reading seems suspicious, it's always a good idea to get a blood test from your fingerstick to confirm . For example, if your CGM shows that your blood sugar is rising or falling but you don't feel it, it's a good idea to get a blood test from your fingerstick. Also, if you're not feeling well but your CGM shows that your glucose levels are in the normal range, a fingerstick test can give you the best possible result.

Some CGM devices require calibration (adjustment of settings) and fingerstick testing.

Can people without diabetes use `CGM`?

CGMs are primarily designed for people with diabetes. However, doctors may also recommend CGMs for other conditions that affect glucose levels. For example:

• Prediabetes.
• Obesity.
• Some `Glycogen storage diseases` are characterized by frequent low blood sugar episodes.
• Insulinoma is a rare type of tumor that produces too much insulin, causing severe low blood sugar levels.

If you think a CGM could benefit your health, talk to your doctor.

What are the benefits of using CGM for diabetes management?

Using a CGM device can make diabetes management easier. Several studies have shown that people with Type 1 and Type 2 diabetes have fewer low blood sugar episodes and lower A1C levels when they use CGM.

A `CGM` device provides these benefits:

• It gives you a bigger picture of how diabetes affects you: A CGM measures your glucose levels every few minutes. The data gives you a complete picture of how your glucose levels are changing over time. This information can help you and your doctor better understand how things like food, exercise, stress, and illness affect your glucose levels.
• Leads to more personalized care: CGM doesn't tell the whole story about how diabetes is affecting you. It only tells you when your glucose is high or low, not why. But you and your doctor can download data from your CGM device and look for patterns and trends. That way, you can work together to personalize your care based on what you learn.
• Alerts you to highs and lows: Many CGM devices send you an alert if your glucose levels go too high or too low. With this information, you can make changes quickly. You can treat or prevent high blood sugars or low blood sugars before they become serious problems.
• Reduces the number of times you need to take fingerstick blood tests: With `CGM`, you can significantly reduce the number of times you need to take fingerstick blood tests per day.

Is a `CGM` essential for diabetes management?

You can check your blood glucose levels regularly by taking a fingerstick and using a glucose meter. That's what most people do.

However, a fingerstick test only measures the glucose level in your blood at that moment . It's like reading one page of a book. The more fingersticks you test, the more information you get, which can give you clues about what's happening to your blood sugar levels.

The vast majority of diabetes specialists recommend using CGM for diabetes management, as it provides significantly more information about blood sugar trends than fingerstick testing.

What are the limitations of `CGM`?

CGMs are very useful devices, but they also have some limitations. Like all technology, CGM systems can have problems, malfunction, or even stop working. The person who teaches you about CGM will teach you about these potential problems and how to find solutions to them.

Some medications and supplements can also affect the accuracy of some CGM sensors. For example:

• Acetaminophen (e.g. Tylenol® or Panadol®)
• Hydroxyurea (a medicine for sickle cell anemia)
• Vitamin C (`Vitamin C` - Ascorbic Acid)

These medications and supplements can make your CGM readings appear higher or lower than they actually are. It's important to ask the manufacturer of your CGM about what can affect the accuracy of your device.

What are the disadvantages of using `CGM`?

Here are some of the things you may see as disadvantages when using `CGM`:

• Price: CGM devices and supplies can be more expensive than fingerstick blood tests. This price will vary depending on your health care insurance plan.
• Information overload: While the vast amount of information provided by CGMs can be very helpful, it can also be overwhelming. For some, this can lead to increased diabetes distress or burnout. It can also lead to disordered eating.
• Alarm fatigue: Depending on your settings, your CGM may alarm you several times a day. This can be stressful and cause fatigue. It can also disrupt your sleep.
• Always have to wear it: Every CGM is an additional device that you wear on your body. This can take some getting used to. If you want, there are many ways to hide these so they are invisible.
• Problems caused by adhesives: Some people may have allergic reactions to the skin adhesives used in CGM devices.

If you're facing this challenge, consider meeting with a CDCES. They can teach you tips and tricks to help you use a CGM more easily.

When should I contact my doctor?

If you have any questions about how to safely use a CGM device, contact your diabetes healthcare provider.

Blood sugar levels that are too high or too low can be dangerous if left untreated for a long time. In severe cases, this can lead to seizures, coma, or even death. You can prevent these complications by keeping your blood sugar levels in a healthy range. If you have any symptoms that worry you, talk to your doctor.

Can I get a CGM without a doctor?

Currently, there is a CGM that is available over the counter (OTC). This means that you don't need a doctor or a prescription to get it. Other CGM manufacturers are in the process of developing similar OTC CGMs.

However, OTC CGMs may not be suitable for people who are managing their diabetes with insulin or who have significantly low blood sugar levels. Before using OTC CGMs, make sure you fully understand their capabilities and limitations.

Summary and things to remember

Managing diabetes is like shooting at a moving target – it’s hard to do from the start. When you just take a blood sample from your finger, it’s like you’re blindfolded until the second you shoot the arrow. But with a CGM, it’s like you’re watching the target move – its direction, how fast it’s going, and whether it’s moving – before you shoot it.

CGM is a very powerful tool to have in your diabetes management toolbox.

If you'd like to learn more about using a CGM, talk to your doctor. They can help you decide which method is best for you.

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