This content material initially appeared on diaTribe. Republished with permission.
By Paul Heltzel
Key takeaways:
- Steady glucose monitoring (CGM) units present blood sugar traits over time.
- Take into account some tips about tips on how to elevate the problem in case your physician hasn’t but advised CGM use.
- There’s a small however manageable studying curve when beginning to use a CGM system and reporting again your outcomes to your physician’s workplace.
So that you’ve determined to commerce finger pricks and in-the-moment blood sugar readings for the power to view your blood sugar’s previous, current and forecasted future. Or maybe you’re newly identified and see steady glucose monitoring (CGM) as a good way to begin your care. Regardless, congratulations in your determination to undertake a extra knowledgeable manner of managing your diabetes.
CGM expertise makes use of readings from the interstitial fluid in your physique utilizing a tool known as a sensor, which displays blood sugar ranges by a small wire inserted underneath the pores and skin and worn for per week or two. Within the meantime, you’ll get almost real-time blood sugar readings – and you may get alerts of present or impending excessive or low blood sugar ranges in your CGM reader or smartphone.
However earlier than you get began, there are a couple of issues. If you wish to attempt CGM however your physician hasn’t talked about it, it’s possible you’ll wish to take into consideration tips on how to request a prescription. There are additionally a handful of points to consider so that you get off to a great begin. And, in fact, you’ll wish to report again your glucose outcomes along with your healthcare supplier. Under you’ll additionally discover steering on sharing info in your traits, so you may work along with your physician’s workplace to make choices about your care.
The right way to get a CGM
To start out utilizing a CGM system, you’ll sometimes want a prescription. And whereas some CGM units are now obtainable and not using a prescription, the out-of-pocket value could also be a barrier.
Moreover – and importantly – the over-the-counter units are designed to point out blood sugar traits however don’t have alerts for top and low blood sugar.
“For security, sufferers with a danger of hypoglycemia – for instance, who’re taking insulin – must be on CGMs with security alarms in-built,” stated Dr. Marilyn Tan, scientific affiliate professor of endocrinology on the Stanford College Faculty of Drugs.
Most insurance coverage insurance policies will cowl a CGM for somebody who makes use of insulin and has skilled low blood sugar, Tan stated, and a few insurance policies will cowl CGM use even for individuals who don’t take insulin. For an in depth have a look at navigating insurance coverage hurdles round CGM, see our information.
Advocate for your self
So what must you do if you wish to attempt a CGM system, however your doctor hasn’t advised it or doesn’t appear on board with the thought?
Tan stated that there are a variety of causes a healthcare supplier could not have raised the thought: “Lack of time, pondering the affected person is probably not , or that they could not qualify for insurance coverage protection, pondering the affected person doesn’t want one, or not being aware of CGMs. A affected person ought to really feel comfy citing CGM to the healthcare supplier.”
You’ll be able to discuss to your physician about the way you’d wish to get a greater image of your total diabetes administration and enhance time in vary. You too can point out that you simply’d like to make use of CGM to keep away from extreme low and high-blood sugar ranges, which if left untreated can require the help of one other particular person and could be harmful.
Analysis exhibits that CGM use advantages individuals with all varieties of diabetes, and might result in dramatic enchancment even in individuals with diabetes with excessive A1C ranges.
What to anticipate as a first-time CGM consumer
You’ll must study to insert a sensor, which is often very straightforward. CGMs now include a one-time injection system that makes the method fast and almost painless. In comparison with just some earlier generations of CGM, most individuals, together with kids, can do the insertion with one hand.
The insertion occurs so rapidly it’s possible you’ll not even understand the sensor is inserted. (That stated, listed here are some suggestions for individuals who discover the method intimidating, together with some options to day-to-day CGM points.)
And when you received’t be required to make use of a finger stick to make sure the accuracy of your CGM (a course of known as calibration) with the latest technology of CGM programs, some nonetheless require calibration. Be aware that there’ll probably be a small distinction in readings between a blood glucose meter and a CGM system.
“The glucose readings on the CGM are inclined to lag [behind meters] and could be much less correct at extremes and with speedy glucose adjustments,” Tan stated.
“Sufferers regularly be aware variations in CGM and finger stick measurements; that is regular.”
What to keep away from when utilizing a CGM
Some medicines can result in CGM readings that show greater than they really are. One such drug is hydroxyurea, which is used to deal with most cancers and blood issues. Massive doses of acetaminophen (Tylenol) also can trigger issues with CGM readings. In the event you’re taking one in all these, the supplier of your CGM system can inform you if it’s a problem (this may fluctuate by mannequin), and it’s an space the place you’ll positively wish to seek the advice of along with your healthcare supplier.
You may additionally must get used to the concept your blood sugar is now being checked each couple of minutes, 24 hours a day, a number of hundred occasions a day. That’s lots of info and it’s possible you’ll wish to work along with your practitioner to decide on which alerts you wish to obtain, at numerous blood sugar ranges — and occasions through the day — so that you simply’re not overwhelmed with too many alerts.
Ideally you’ll be alerted earlier than you go too excessive or too low so you may act, based mostly in your supplier’s suggestions, earlier than the scenario turns into pressing. CGM expertise continues to enhance in predicting near-term blood glucose, and remedy could be much more finely tuned when a CGM system is used with an automated insulin supply (AID) system.
Sharing CGM information along with your healthcare supplier
Traits captured by the CGM can present a transparent, total image of your diabetes administration. This information may also be displayed in experiences which can be very particular, for instance to point out what your blood sugar ranges seem like at sure occasions through the day. The power to customise these views may help you and your physician work collectively to make changes.
There are typically three major methods to share your blood sugar traits along with your physician’s workplace.
First, you may normally share your CGM readings along with your physician’s workplace in order that they’ll see your information in an ordinary view particularly designed for a healthcare group. This will enable, relying on the options of your CGM, the power in your supplier to view information with only a small time lag.
“The data is most crucial to medical determination making,” Tan says. “Many clinics have clinic accounts the place the information could be shared through a selected share code or entry granting course of.”
Experiences are one other approach to share your information along with your supplier. Your physician or different supplier could ask you to carry sure experiences generated by the software program that comes along with your CGM to share at your visits. These might be emailed or shared by your physician’s well being portal web site as a PDF file, or printed and introduced alongside to your appointment. Amongst different views, these experiences can embody your common blood sugar over time, your time in vary, and your commonplace deviation, which is a measure of how your blood sugar readings diverse based mostly in your common studying.
One other approach to share your CGM information is through the use of a third-party on-line instrument which takes your blood sugar readings and data them, then shows them as a graph or in experiences which can be particular to that instrument. Tidepool, Nightscout and Glooko are three of those companies, which work with most varieties of CGM units.
“There are a lot of third-party choices,” Tan says, “however we advise sufferers to make use of the producer apps.” These embody, for instance, the software program that comes with Abbott’s Freestyle Libre system, or Dexcom’s Readability app.
The underside line
In the event you’re prepared to begin utilizing CGM, you’ll commerce finger sticks and a studying that measures a time limit for a show of your present blood sugar degree but in addition the speed of change and an estimation of the place your blood sugar is headed. You’ll additionally get alerts – if you’re headed too low or too excessive, for instance – ideally in time to get again in vary rapidly.
Right here’s one other profit: You’ll be able to select a CGM system that connects with an automated insulin supply (AID) system, which integrates an insulin pump to regulate dosing and helps hold your blood sugar in vary.
In the event you’re able to attempt a CGM however your physician or different healthcare supplier hasn’t raised the thought, you may focus on proactively the way you’d wish to attempt it . Most insurance coverage insurance policies will cowl CGM for individuals taking insulin and a few will cowl CGM use for individuals with diabetes who don’t take insulin. Medicare and Medicaid cowl CGM use for sort 1, sort 2 and gestational diabetes. There are additionally new over-the-counter (OTC) selections, however the price could also be a problem when paid out-of-pocket and the OTC units lack alarms.
Lastly, there are a number of choices for sharing this info along with your healthcare supplier. As in different areas of diabetes care, use the method that works greatest for you and your supplier, which may result in a extra complete understanding of your blood sugar ranges and improved diabetes care.
