This content material initially appeared on diaTribe. Republished with permission.
By Paul Heltzel
Key takeaways:
- Steady glucose monitoring (CGM) units present blood sugar tendencies over time.
- Think about some tips about tips on how to elevate the problem in case your physician hasn’t but prompt 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 recognized and see steady glucose monitoring (CGM) as an effective way to start out your care. Regardless, congratulations in your determination to undertake a extra knowledgeable manner of managing your diabetes.
CGM know-how 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 every week or two. Within the meantime, you’ll get practically 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 just a few concerns. If you wish to strive CGM however your physician hasn’t talked about it, you could 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. Beneath you’ll additionally discover steerage on sharing info in your tendencies, so you possibly can work along with your physician’s workplace to make choices about your care.
Find out how to get a CGM
To start out utilizing a CGM system, you’ll sometimes want a prescription. And whereas some CGM units are now accessible and not using a prescription, the out-of-pocket price could also be a barrier.
Moreover – and importantly – the over-the-counter units are designed to indicate blood sugar tendencies however don’t have alerts for top and low blood sugar.
“For security, sufferers with a threat of hypoglycemia – for instance, who’re taking insulin – must be on CGMs with security alarms in-built,” mentioned Dr. Marilyn Tan, medical 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 mentioned, and a few insurance policies will cowl CGM use even for individuals who don’t take insulin. For an in depth take 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 strive a CGM system, however your doctor hasn’t prompt it or doesn’t appear on board with the thought?
Tan mentioned that there are a variety of causes a healthcare supplier could not have raised the thought: “Lack of time, pondering the affected person will not be , or that they could not qualify for insurance coverage protection, pondering the affected person doesn’t want one, or not being conversant in CGMs. A affected person ought to really feel snug mentioning CGM to the healthcare supplier.”
You possibly can speak to your physician about the way you’d wish to get a greater image of your general diabetes administration and enhance time in vary. You may also 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 individual and may be harmful.
Analysis reveals that CGM use advantages individuals with all forms of diabetes, and may result in dramatic enchancment even in individuals with diabetes with excessive A1C ranges.
What to anticipate as a first-time CGM person
You’ll have to study to insert a sensor, which is often very simple. CGMs now include a one-time injection system that makes the method fast and practically painless. In comparison with only a few earlier generations of CGM, most individuals, together with kids, can do the insertion with one hand.
The insertion occurs so shortly you could not even notice the sensor is inserted. (That mentioned, listed here are some ideas 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 methods, some nonetheless require calibration. Be aware that there’ll seemingly be a small distinction in readings between a blood glucose meter and a CGM system.
“The glucose readings on the CGM are likely to lag [behind meters] and may be much less correct at extremes and with fast glucose modifications,” Tan mentioned.
“Sufferers ceaselessly notice 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) may trigger issues with CGM readings. In the event you’re taking one in every of these, the supplier of your CGM system can let you know if it’s a difficulty (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 have to get used to the concept that your blood sugar is now being checked each jiffy, 24 hours a day, a number of hundred instances a day. That’s lots of info and you could wish to work along with your practitioner to decide on which alerts you wish to obtain, at numerous blood sugar ranges — and instances 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 possibly can act, based mostly in your supplier’s suggestions, earlier than the state of affairs turns into pressing. CGM know-how continues to enhance in predicting near-term blood glucose, and therapy may be much more finely tuned when a CGM system is used with an automated insulin supply (AID) system.
Sharing CGM knowledge along with your healthcare supplier
Developments captured by the CGM can present a transparent, general image of your diabetes administration. This knowledge can be displayed in studies which are very particular, for instance to indicate what your blood sugar ranges appear like at sure instances through the day. The power to customise these views can assist you and your physician work collectively to make changes.
There are typically three most important methods to share your blood sugar tendencies along with your physician’s workplace.
First, you possibly can often share your CGM readings along with your physician’s workplace in order that they will see your knowledge in an ordinary view particularly designed for a healthcare group. This may increasingly permit, relying on the options of your CGM, the power on your supplier to view knowledge with only a small time lag.
“The data is most important to medical determination making,” Tan says. “Many clinics have clinic accounts the place the information may be shared through a particular share code or entry granting course of.”
Reviews are one other method to share your knowledge along with your supplier. Your physician or different supplier could ask you to carry sure studies generated by the software program that comes along with your CGM to share at your visits. These could possibly 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 studies can embrace your common blood sugar over time, your time in vary, and your commonplace deviation, which is a measure of how your blood sugar readings various based mostly in your common studying.
One other method to share your CGM knowledge is by utilizing a third-party on-line instrument which takes your blood sugar readings and information them, then shows them as a graph or in studies which are particular to that instrument. Tidepool, Nightscout and Glooko are three of those providers, which work with most forms of CGM units.
“There are various third-party choices,” Tan says, “however we advise sufferers to make use of the producer apps.” These embrace, 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 start out 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 additionally the speed of change and an estimation of the place your blood sugar is headed. You’ll additionally get alerts – while you’re headed too low or too excessive, for instance – ideally in time to get again in vary shortly.
Right here’s one other profit: You possibly can select a CGM system that connects with an computerized insulin supply (AID) system, which integrates an insulin pump to manage dosing and helps preserve your blood sugar in vary.
In the event you’re able to strive a CGM however your physician or different healthcare supplier hasn’t raised the thought, you possibly can talk about proactively the way you’d wish to strive 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 fee could also be a difficulty 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.
