2011 Continuous Glucose Monitors

Do you know what your blood glucose is doing right now? If you just tested with a blood glucose meter, you have a pretty good idea. But what if your last finger stick was an hour ago—or more? With continuous glucose monitoring, you can know whether you’re high, low, or just right, any time of day.
By Tracey Neithercott

 

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Using a continuous glucose monitor (CGM) can help you catch spikes and dips you may have missed between tests with your meter. And with the data downloaded from your device, you can use trends to better manage your diabetes.

So, what is a CGM? The device uses a sensor to measure glucose levels in the fluid just under the skin (very similar to glucose levels in the blood). The sensor transmits the results to a handheld receiver or insulin pump every few minutes, so you know what your glucose levels are throughout the day. Depending on the CGM you choose, you’ll wear the sensor for three to seven days before replacing it. You’ll insert the sensor much like an infusion set for an insulin pump, with a handheld applicator and special adhesive tape.

There are four CGMs on the market today, and while they differ a bit—one has a built-in blood glucose meter; another doubles as an insulin pump—some key functions are available on each, as described below.

Before you purchase a CGM, talk with your insurance company, since some cover only a specific brand. Many insurance companies won’t cover CGMs for people with type 2 diabetes, so it’s important to ask. If your doctor or diabetes educator has sample products available, take the opportunity to play around and get a feel for the system. Once you’re ready to buy, a representative from the device company will guide you through the process.

Choosing a CGM is personal, and what works for someone else may not be right for you. Some people don’t like carrying an extra device (and dealing with the sensors) while others find that constant glucose monitoring keeps their diabetes in check. That’s why it’s important to know your options. From there, consider the bells and whistles until you find a device that suits your needs.

FreeStyle Navigator Note
Abbott Diabetes Care has discontinued sale of the FreeStyle Navigator CGM. New customers can't buy the Navigator nor can existing users get a replacement transmitter or receiver.

Functions to Consider
Continuous Readings
While the different models vary on how often they send glucose readings to the receiver (one transmits every minute while another does every five; the difference is too slight to matter, experts say), they all do it often enough to give you a clear picture of your glucose 24-7.

Glucose Direction
Your blood glucose is 90 mg/dl. But are you stable, heading up, or dropping? Along with your current reading, your CGM’s home screen will use arrows to reveal how yourglucose level is trending.

Trend Graphs
With the push of a few buttons, you can view your glucose levels in graph form. Track your glucose over the past hour, six hours, or 24 hours. Doing so will help you spot trends (say, that nighttime low you never picked up while using a meter) and act on them.

Event Markers
Last week’s glucose graph may show extra low readings, but do you know what caused them? If you mark an event—like the fact that you exercised a lot—you’ll have a better idea of why your glucose levels behaved the way they did.

Safety Alarms
To help you catch high or low glucose even if you’re not staring at your screen, your CGM will sound an alarm. Each model lets you program high and low glucose alarms, which sound if you hit your customized limits. Some alert you if your glucose is rising or falling too fast, or if you’re approaching preset upper or lower glucose limits.

Calibration
To make sure your CGM is functioning properly, you’ll need to calibrate it by testing your blood glucose with a meter and putting the results into your CGM. How often you’ll have to calibrate (and suspend the CGM function) varies with the particular device.

 


Updated Jan. 4, 2011

Photo: Gary Landsman

Comments

Comments are subject to review and will not be posted immediately. If you have an urgent medical question, please consult a health care professional. If you have a question for the staff of Diabetes Forecast, please send it to replyall@diabetes.org.

Insulin pumps and CGM

Is it in the process to incorporate CGM with insulin pumps? I am a Animas pump user, and am interested in a product that will actually talk to the pump. I love the pump, because I feel that I am in control for the first time since 1972 when first becoming a diabetic. Before, it was, pardon me, I must go eat something or I must go test, now all I have to do is pause or bolus. Plus, I don't have the extreme highs or lows that were a problem before.

Thanks

Rick R.

CGM and Medicare

I used a CGM until I retired and went to Medicare. Neither Medicare nor my Supplemental Insurance cover the CGM supplies. Since I can't afford CGM supplies out of pocket, my only choice is to appeal this decision. I am told that very few diabetics win a reversal on this issue. Is ADA lobbying to impress CMS of the value of the CGM for diabetics? What efforts can I join to convince Medicare of the importance of this tool for brittle diabetics?

sadly.........

i have been type 1 diabetic since i was 3, it all started in 1973, i am now 41, i have become a very brittle diabetic since the age of 27, i am already on medicare, due to my disability, and poor health, and sadly, i don't think medicare will EVER give a damn about brittle diabetics, i hate writing this, but just wanted to put it out there, so no one will be thinking it will ever happen. Sorry.

Appeal

You should present them with journal articles showing the decrease in complications from cgm use. Winning an appeal is possible.

insurance coverage

Having difficulty finding articles that show benefits of cgm.

Animas and Dexcom 7plus CGM

If you are an Animas pumper go to their web site and look at the Dexcom 7plus. Currently they do not talk to each other but the two companies are partnering to make that happen. I lost my Dexcom receiver and my insurance company and Dexcom worked it out and got me a replacement in a couple of days. I have had only 1 bad sensor since I have been using this and dexcom replaced it free of charge. They keep tight control of quality and they have the best customer service I have dealt with in the 36 years I have been a type 1. NONE of the CGM units are accurate enough to be allowed to talk with a pump and automatically adjust insulin. The user has to make the final decsion and tell the pump how much insulin to bolus. But catching the lows and highs as they start make work and daily activities so much easier, not to mention driving a hell of a lot safer. The ability to catch lows during sleep and having the alarm wake my spouse has stopped many a 911 call. The alarms could be louder though.

diabetes 2

Charantia tea(put 2 teabag)made in philippines (a bittermellon dried seed)will decrease your sugar 30-50 % within 15-20 min upon ingesting it,very safe no chemicals....proven...NO DIABETES CURE YET.. but this tea lower your sugar instanty promise..this is not advertisement,just trying to help those people who had diabetes like me..

Charantia tea

In India it is known for a long time Bittermelon decreases blood sugar. My question is consistency, interference with other medications one may be taking, potency consistency ( there will be variabilty in bittermelon because of soil, nutrients added or in the soil, plus, rain and sun which are different even in tropical countries. How does one manage these variables, because we do not know from where the product came from. While I am not diasagreeing with the significant effect, consistency and stability of BS is important for diabetics that must be addressed.
Thanks for listening
tryig to serve the diabetes community better through knowledge
vaidy bala

Medicare and diabetes

What we have to convince any insurance company is that the cost for the complications of diabetes will far outweigh the cost of the CGM or any monitor. I went through this with a major insurance company years ago when they would not cover the cost of test strips for my monitor. I went up the chain and asked them if they would rather pay for emergency room visits when I pass out because I do not know what my blood sugar levers are.
They have to know how essential it is to test and know where our blood sugar levels are!
Don't give up but let us keep lobbying for change.

My mom is 83 and a brittle

My mom is 83 and a brittle diabetic. She uses the insulin pump which has been terrific but we still have the problem of not knowing when her sugar levels drop or spike. This new monitor would be a life saving instrument for her, however we hear that medicare will not pay for it. She only has her social security check as her only income so what does one do in order to be able to live? Any ideas, please post. I fear for her each day.

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