CGM Update

Continuous glucose monitoring (CGM) has become ” state of the art” technology for improving the lives of persons with diabetes.  In these days of intensive diabetes therapy, especially in those both Type 1 and Type2 on insulin, this technology has dramatically improved safety and protection from hypoglycemia.   Hypoglycemia is a major barrier to good control. I will call this CGM forward in this article.  CGM provides information about how your blood sugar is trending, up, down or stable.  The ability to know where your blood sugar is going can help with deciding on how much insulin to take for meals and also whether your blood sugar is dropping.  Alarms can be set for all these parameters.  Mine is set for 85 low and 200 high.  The alert sounds can be loud, soft or vibration.

At my office the use of CGM has also advanced.  Both with  the Dexcom sensor and  the Abbot LIbre sensor my educators Jody and Michelle are putting sensors on persons to  analyze the excursions of their blood sugar up  and down thruout the day and night.  This has definitely changed the course  of many patient’s control and. Improved their  A1c tests.  Better control continues to be shown to  prevent microvascular complications like eye disease, kidney  disease and nerve complications of poorly  controlled diabetes.   I must say that usually inadequate treatment for meals is the most common, but it varies.  Some meals are worse than others and the printout can show it.  Often times if an adjustment is made for a certain meal or the reading gives a chance to teach about Carbohydrate Counting, dramatic changes can be seen.  Followup recordings months later will show to myself , the educator and the person with Diabetes that they are doing better and why.  We confer on each printout and decide on a course of action.

The benefits of CGM are best illustrated in persons with frequent low blood sugar who  do not feel their lows.  This is a dangerous situation to happen in the night or while driving.  Hypoglycemia and hypoglycemia unawareness are common in persons on insulin and are on e of the major obstructions to good control. Pregnant patients where tight control is essential for  the benefit  and growth of the  baby is a very important indication.

Training is available here at  the office by educators that are CDE’s ( Certified Diabetes Educators) by the American Association of Diabetes Educators.  Michelle Cordell and I wear Dexcom sensors and both MIchelle and Jody Daily are expert in applying and interpreting the resulting printouts.  They put the sensors on and look at the data that are stored in the memory over one or two weeks.  These sensors can be temporarily applied to any person with control problems identified by having lows or poor control reflected by  their testing at home and their A1c.  The Dexcom sensor now is available for continueing use and is integrated into many. Insulin pumps.  Medtronic has its own sensor for the new 600 series insulin pumps.

Barriers to control have always been the commitment to use the technology and I would like to see motivated patients be able to take advantage of  CGM.  It ihas been found that in many cases the  alarms are ignored and therefore the benefit is lost.  That is why there are now pumps that shutoff for a hour when blood sugar is low and then resumes the basal rate.  The latest development is the Medtronic 670G which responds by adjusting basal rate to move toward a preset goal of better control.  This is in response to  the information it receives from its third generation sensor.  All the insulin pumps are moving toward such integration.  We are at a time of achieving artificial pancrease replacement and have data to show it works.

Persons with diabetes are living longer and healthier lives.  A. Healthier lifestyle is the most important factor including less smoking  and  more of the Mediterranean diet.  For persons on insulin, CGM has improved quality of life.  Application of CGM to all persons with diabetes Type 1 and Type 2 will empower them to reduce stress and frustration associated with this disease.