Apa Itu Cgm Diabetes? - Virtual Office

Apa Itu Cgm Diabetes
Apakah pemantauan glukosa berterusan (CGM)? – Sistem pemantauan glukosa berterusan, atau singkatannya CGM, ialah sistem perubatan padat yang memantau paras gula darah anda secara berterusan dalam lebih kurang masa nyata (biasanya terdapat selang lima minit antara bacaan).

Untuk menggunakan CGM, anda memasukkan sensor kecil ke dalam perut anda yang termasuk kanula kecil yang menembusi kulit.
Tampalan pelekat menahan sensor pada tempatnya, membolehkan anda mengambil bacaan glukosa dalam cecair interstisial (cecair yang mengelilingi sel dalam badan) sepanjang hari dan malam.

Secara umum, penderia perlu diganti setiap 10 hingga 14 hari. Pemancar kecil yang boleh digunakan semula yang dilampirkan pada penderia membolehkan sistem menghantar bacaan masa nyata secara wayarles ke peranti pemantauan yang memaparkan data glukosa darah anda.

Sesetengah sistem datang dengan monitor khusus, dan sesetengahnya kini memaparkan maklumat melalui aplikasi telefon pintar, jadi anda tidak perlu membawa peranti tambahan dengan anda. Selain aliran data yang berterusan, kebanyakan CGM boleh menghantar makluman yang memberitahu anda apabila paras gula darah anda menjadi terlalu tinggi atau terlalu rendah.

Anda juga boleh menetapkan parameter amaran dan menyesuaikan cara anda diberitahu. Ia bukanlah satu kenyataan yang remeh untuk mengatakan bahawa CGM telah merevolusikan penjagaan diabetes. Tidak seperti meter glukosa darah (BGM) tradisional, yang menyediakan bacaan glukosa tunggal, sistem CGM menyediakan maklumat glukosa yang berterusan dan dinamik setiap lima minit.

What does CGM mean in diabetes?

How does a continuous glucose monitor (CGM) work? – A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. Photo courtesy: U.S. Food and Drug Administration A tiny CGM sensor under the skin checks glucose. A transmitter sends data to a receiver. The CGM receiver may be part of an insulin pump, as shown here, or a separate device.

What does CGM mean?

What does CGM stand for? CGM stands for Continuous Glucose Monitoring. It is a form of technology that allows you to track your glucose levels at regular intervals throughout the day and night. CGM systems work to sense, transmit, and receive your glucose data.

Who is eligible for CGM?

CGM coverage if you have Medicare – Over 62 million people are enrolled in Medicare in the US and about 30% of those people live with diabetes. There are several criteria a person has to fulfill to be eligible for a CGM through Medicare, but a redundant barrier to coverage was removed recently which should make it easier to get coverage for CGM.

This barrier was removed at the beginning of July 18, 2021, where Medicare eliminated the four-time-daily fingerstick testing requirement for CGM coverage.
So if you have been denied coverage in the past because you didn’t manually check your blood sugar four times daily, now is the time to re-apply for CGM coverage.

To be eligible for coverage through Medicare, you still have to fulfill these criteria :

You must live with diabetesYou have to manage your diabetes with multiple (three or more) daily insulin injections (MDI) or an insulin pumpYou must require frequent insulin self-adjustment based on the CGM or finger sticksYou must have seen a medical professional in person within 6 months prior to ordering the CGMYou must see the prescribing medical professional in person every 6 months following the initial prescription of the CGM

Your out-of-pocket cost for your CGM will depend on what your Medicare benefit plan looks like. But instead of spending hours on the phone trying to get through to a Medicare representative, another option is to just reach out to US MED and have them run the numbers for you. It’s super easy, just go to USMED.com and you can contact them electronically or give them a call.

Can Type 2 diabetics use a CGM?

Mar 31, 2019 Evidence-Based Diabetes Management March 2019 Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.

PRECIS: Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.
A convergence of several healthcare megatrends will lead to increasingly common use of CGM in people with T2D and even those with prediabetes: (1) improvements in CGM accuracy, size, and cost; (2) the ability to upload data to the cloud; (3) the availability of digital coaching tools and analytic software, and soon, artificial intelligence, and (4) a shift toward value-based care.

In 2019, estimates put more than 30 million Americans living with T2D and 84 million with prediabetes, and both numbers are rising. Direct US healthcare spending on diabetes, both type 1 diabetes (T1D) and T2D, is currently estimated at $237 billion, with 1 in 4 US healthcare dollars going toward the care of people with diabetes.1 The critical importance of early glycemic control to prevent acute complications and halt disease progression to prevent chronic complications only intensifies as these costs, including the rising costs of insulin, increase.

SMBG and A1C Are Inadequate The ability for patients and providers to gauge glycemic control in T2D depends on tools that provide incomplete information: self-monitoring of blood glucose (SMBG) data and glycated hemoglobin (A1C). It is challenging to get more than a limited set of SMBG data due to the inconvenience and pain associated with fingersticks, cost of test strips, and unforgiving requirements for specific timing.

Even in the best of circumstances, SMBG data can be challenging to interpret. Patients and providers must frequently extrapolate from a single fasting blood glucose (BG) value or from glucose values at scattershot time points without clear temporal relationships to the food, exercise, or other stressors that provide key context.

It should come as no surprise that although SMBG remains commonly used in both insulin-treated and noninsulin-treated patients, study results in noninsulin-treated patients have struggled to show efficacy of SMBG in changing patient behavior or reducing A1C.2 While A1C provides a useful measure of overall control, it cannot, either in real time or retrospectively, reveal a person’s specific behaviors and actions to more meaningfully inform patient and provider decisions.

An A1C of 7% may underlie either exquisitely stable BG values or mask a roller coaster, coupling dramatic postprandial BG spikes with overly aggressive insulin use and resultant hypoglycemia. Cheaper and Better CGMs The first CGM was released by MiniMed (now Medtronic) in 1999.

These early systems were rarely used due to cost, painful insertion, bulky size, poor accuracy, and the requirement for numerous fingerstick calibrations. However, as the technology has improved, data have shown improved glycemic control and decreased rates of hypoglycemia in those using CGM, leading both the Endocrine Society and American Diabetes Association to state that CGM use represents standard of care in T1D.3,4 CGM in Americans with T1D is now on an exponential growth curve, rising from 6% in 2011 to 12% in 2014 to 24% in 2016 to 38% in 2018.5 High costs and uncertainty over efficacy and necessity have kept CGM from widespread use in people with T2D.

However, the newest CGM models, the Abbott Freestyle Libre and Dexcom G6, have begun to overcome many of these technical barriers to use of CGM systems. The sensors are inserted painlessly, are small enough to fit easily under clothing, can remain in place for 10 to 14 days, and are FDA approved as sufficiently accurate to use in lieu of fingersticks to make insulin-dosing decisions.

Overcoming another significant barrier to use, data can now be seamlessly and continuously uploaded wirelessly to the cloud via a user’s smartphone. Of note, the Libre is a flash glucose monitor, requiring the user to scan the sensor to reveal glucose information and recent trends. Although it cannot alert a person to acute hyperglycemia or hypoglycemia in the middle of the night, this is a nonessential feature for the majority of people with T2D.

Perhaps most importantly, Abbott has introduced a new, lower-pricing category with Libre, at around $75 to $150 each month for sensors (2 sensors that last 14 days each), translating to $900 to $1800 per year compared with what is typically $3000 to $5000 per year for traditional CGM.

Real-time Biofeedback Enables Behavior Change CGM affords 2 major benefits over the current standard of SMBG coupled with A1C testing: first, a vast increase in the quantity of blood glucose information, which provides a more comprehensive view of glycemic control.
Rather than snapshots in time, continuous information allows us to capture important metrics like time in range, time in hypoglycemia, glucose variability, and many other emerging “glycometrics.” These additional metrics cannot be captured with SMBG, even in the most diligent patients.

A CGM recording BG every 5 minutes will record 105,120 BG readings per year compared with between just 1000 to 2000 in a person doing frequent SMBG. Second is the ability of CGM systems to provide real-time biofeedback. With real-time data now seamlessly available on a user’s mobile device and the internet, easily visible trends and trajectories can help a person understand their own glycemic response in a more meaningful way.

Patients can observe which foods and exercises affect them the most.
Iterative exposure to this immediate biofeedback allows patients to learn about their own bodies and physiologic responses.
For example, we recently saw a 70-year-old man with T2D and heart disease, with an A1C of 7.5%, who takes metformin but had resisted making any changes to his diet.

When he saw his graph of Libre data ( Figure 1 ), he immediately identified the daily morning spike in his glucose level and its source: his daily glass of orange juice and banana. He cut these from his diet and reported an immediate improvement in his glucose levels.

Also noteworthy is that had he used traditional fingersticks, he would have been completely unaware of these significant glucose spikes. His postbreakfast CGM scans showed readings of 81, 114, 131, and 99 mg/dL ( Figure 2 ). Clinical study results demonstrate that CGM in T2D is powerful for behavior change, a critical pillar in management.

Patients adhere to exercise recommendations more consistently 6,7 and decrease their caloric intake when using CGM systems.7 In addition, patients with T2D using CGMs have less hypoglycemia 8 and, importantly, they have A1C reduction without intensification of their existing treatments.9 New Opportunities for Data Analysis and Coaching Another challenge to date has been the lack of delivery system capacity to review, analyze, and interpret data, and then coach people with T2D based on their day-to-day glucose levels, a constraint which could potentially be magnified with the increased data provided by CGM.

However, tech-enabled digital coaching services are emerging to help provide on-demand, accessible support for people with diabetes and prediabetes. Companies like Omada Health, Canary Health, Lark Health, Livongo, and others provide multiple touch points with enrolled patients to use biometric data (eg weight, blood pressure, blood glucose) for coaching and behavior change.

Several of these services are already certified by CMS to provide digital diabetes prevention programs (DPP), and the availability of cheaper CGM means they will soon have access to rich, continuous BG data to be able to guide patients in interpreting and acting upon them.

This will soon enable a capacity and scale for diabetes coaching that has never before been possible using the traditional care delivery system.
The emergence of artificial intelligence tools to aid in data interpretation and even to automate some of the coaching via “chatbot” will only make this more efficient and cheaper.

Cost Implications of CGM Use in Type 2 Diabetes One study looked at long-term cost-effectiveness for CGM use in people with T2D based on A1C reduction, projecting decreased rates of diabetes associated complications.10 Although we anticipate that A1C reduction through lifestyle changes by CGM users could prevent the addition of costly new medications or dose intensification of existing treatments, more study is needed to test this.

This matters: Studies looking at A1C compared with healthcare costs have found significant impacts.11,12 In one case, a 1% or more decrease in A1C was associated with $685 to $950 per year lower total healthcare costs, 13 and in another, a 1% increase in A1C was associated with a 7% increase in healthcare costs over the next 3 years.14 There are likely to be cost savings for people switching from frequent SMBG to CGM.

Given that a person using 4 test strips a day at a cost of $1.30 per test strip—costs can vary widely from $0.10 to $2.00—is consuming $156 per month in test strips, not to mention other consumables like lancets, the direct cost of CGM might actually be lower in this population in some cases, assuming these patients can largely eliminate their use of test strips.

For those using much less frequent SMBG today, such as those not on insulin or with prediabetes, the incremental costs of CGM may seem imposing—but this doesn’t need to be the case.
If one were to use a Libre for only 14 days every 3 months, the cost of sensors would be $300 per year, at most, equivalent to about 4 to 5 test strips per week (at $1.30 per strip), and we would argue the CGM would be of substantially higher value.

Periodic CGM use enables treatment regimen changes, but more importantly, as seen by Vigersky et al, observations people make and behaviors they change while using CGM result in lower blood glucose levels even after they have stopped using CGM.15 We believe that intermittent CGM use paired with coaching will provide much more impetus for lifestyle change than the current standard of every-3-months A1C with sporadic SMBG.

Summary With rapidly improving CGM technology, wireless data upload, lower-cost CGM devices, and the availability of digital coaching tools, we believe the time is ripe for CGM use in a much broader population, including those with T2D who are on oral medications and those with prediabetes.
Although additional studies will need to be done to demonstrate benefit in these populations, costs will likely continue to fall and technology will continue to improve, only further strengthening the value proposition for wider CGM use.

AUTHOR INFORMATION: Division of Endocrinology, University of California, San Francisco (TK, AN); UCSF Center for Digital Health Innovation (AN). CORRESPONDING AUTHOR: Aaron Neinstein, MD University of California, San Francisco 1700 Owens Street, Suite 541 San Francisco, CA 94158 [email protected] 415-476-5397 FUNDING: There are no relevant funding sources.

DISCLOSURES: Dr Neinstein has received research support from Cisco Systems Inc.
And The Commonwealth Fund.
He has been a consultant to Steady Health, Nokia Growth Partners, WebMD, and Grand Rounds and has received speaking honoraria from Academy Health and Symposia Medicus.
He is an uncompensated medical adviser for Tidepool.

Dr Kompala has no disclosures.REFERENCES:

American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care.2018;41(5):917-928. doi: doi.org/10.2337/dci18-0007. Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev.2012;1:CD005060. doi: 10.1002/14651858.CD005060.pub3. Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.2016;101(11):3922-3937. doi: 10.1210/jc.2016-2534. American Diabetes Association. Chapter 7: diabetes technology: standards of medical care in diabetes-2019. Diabetes Care.2019;42(suppl 1):S71-S80. doi: 10.2337/dc19-S007. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther.2019;21(2):66-72. doi: 10.1089/dia.2018.0384. Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring in non-insulin-using individuals with type 2 diabetes: acceptability, feasibility, and teaching opportunities. Diabetes Technol Ther.2009;11(3):151-158. doi: 10.1089/dia.2008.0053. Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: a narrative review. J Diabetes Investig.2018;9(4):713-725. doi: 10.1111/jdi.12807. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther.2017;8(1):55-73. doi: 10.1007/s13300-016-0223-6. Park C, Le QA. The effectiveness of continuous glucose monitoring in patients with type 2 diabetes: a systematic review of literature and meta-analysis. Diabetes Technol Ther.2018;20(9):613-621. doi: 10.1089/dia.2018.0177. Fonda SJ, Graham C, Munakata J, Powers JM, Price D, Vigersky RA. The cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) in type 2 diabetes. J Diabetes Sci Technol.2016;10(4):898-904. doi: 10.1177/1932296816628547. Fitch K, Pyenson BS, Iwasaki K. Medical claim cost impact of improved diabetes control for Medicare and commercially insured patients with type 2 diabetes. J Manag Care Pharm.2013;19(8):609-620, 620a-620-d. doi: 10.18553/jmcp.2013.19.8.609. Juarez D, Goo R, Tokumaru S, Sentell T, Davis J, Mau M. Association between sustained glycated hemoglobin control and healthcare costs.2013;5(2):59-64. Wagner EH. Effect of improved glycemic control on health care costs and utilization. JAMA.2001;285(2):182-189. doi: 10.1001/jama.285.2.182. Gilmer TP, O’Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care.1997;20(12):1847-1853. Vigersky RA, Fonda SJ, Chellappa M, Walker MS, Ehrhardt NM. Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care.2012;35(1):32-38. doi: 10.2337/dc11-1438.

How long can you wear a CGM?

How long does a CGM last? – A continuous glucose monitoring sensor generally needs to be replaced every 7 to 14 days, depending on the device. The exception is one device that has an implanted sensor, which is replaced every 3 months or longer. For devices that have a detachable transmitter, this component can last 3 months to a year or more depending on the device.

Does CGM give insulin?

When might I need to do a fingerstick check when using a CGM device? – You may need to do fingerstick checks to calibrate (set up or adjust) a CGM device. Either way, you’ll likely still need to do fingerstick checks to look at your blood glucose in certain situations.

For example, a fingerstick check may give you peace of mind if your CGM device shows rising or falling numbers, but you feel OK.
It can also provide answers if you don’t feel well, but the CGM says your glucose levels are in target.
Reach out to your provider if you have any questions about how to use a CGM device safely.

Very high or low blood sugar levels can be dangerous when left untreated for too long. In the most severe cases, this can lead to seizures, or even death. You can avoid these complications by keeping blood sugar levels in a healthy range. Call your provider if you have any symptoms you’re worried about.

More frequent urination (peeing).
More thirst than usual.
Problems thinking clearly.

No, CGM devices and are not the same. They do very different things:

CGM devices measure your glucose level automatically every few minutes, all day long.
Insulin pumps deliver a steady flow of insulin based on instructions you give.

But they are similar in some ways. Both CGM devices and insulin pumps are:

Automated: They work all day and night for as long as you wear them.
Worn directly on your body: Most people wear CGM devices and pumps on their arm or belly.
Customizable: You can adjust CGM and pumps based on your life and how diabetes affects you.
Convenient: With CGM, you need fewer fingerstick tests. Insulin pumps mean fewer injections (insulin shots).
Not a quick fix: CGM and pumps both help you better manage diabetes. But each device requires you to actively use it and direct your own treatment decisions.

What is CGM cost?

9,000Rs.5,500. Add to cart. Total Health Focus – Full Body Check.

How is CGM inserted?

The sensor is inserted by making a small incision and placing it under the skin. This process may cause infection, pain or skin irritation. Additionally, the adhesive may cause a reaction or skin irritation.

Can you shower with a CGM?

It’s comforting to know that your CGM is water-resistant, so you can swim or shower without fear of breaking or losing it. If you are concerned about keeping the sensor in place, a body adhesive or clear overlay tape can help. Just be sure nothing blocks the sensor itself, or, if you’re using Dexcom 6, the transmitter.

Can I get a CGM without a doctor?

How to get a continuous glucose monitor – In the U.S., you need a prescription from your doctor to get a CGM. This is because CGMs are medical devices. Many doctors will prescribe CGMs to patients with Type I or Type II diabetes, but they may also prescribe them to patients looking to track their blood sugar to optimize health and prevent disease.

Can I get a CGM for free?

Sign up and receive a free* CGM sensor If you’re commercially insured or cash paying, you may be eligible to receive a voucher for a free* trial of the FreeStyle Libre 2 system or FreeStyle Libre 3 system when you sign up for the MyFreeStyle program.

Who should not use a CGM?

Who should not have a CGM? According to DeVries, not everyone needs, or should have, a CGM. Referencing the MOBILE study, DeVries argued that CGM would not benefit people with type 2 who are not on MDI. In other words, according to DeVries, people with type 2 on basal only and those not on insulin should not use a CGM.

Can I get a CGM without insulin?

A complex and time-consuming therapy will not overcome patient and physician inertia. – Most clinicians agree that CGM use among people with type 2 diabetes using insulin, at least for the multiple daily injection population, can be helpful. The use of CGM among people with type 2 diabetes prescribed oral diabetes therapy is much more controversial, as there is less data around this topic.

Big picture, diabetes is a disease of managing glucose values.
If you have more data, the patient and the provider can see that data in real time.
As CGM becomes more cost-effective, we will use it for those patients on basal insulin, people who are newly diagnosed and even in prediabetes.
There is real-time value for the person using CGM when they get to see how certain foods, drinking alcohol or going for a walk affect them.

Once they see it, it really starts to hit home. Jeremy H. Pettus That said, available data are a lot less impressive with respect to changes in HbA1c following CGM use in this population. If you have an individual with type 2 diabetes on metformin monotherapy and their HbA1c is 6.5%, what else is CGM data going to do other than provide education? That tipping point will change as costs come down.

For right now, CGM is not practical.
Our patients prescribed oral agents might not need that information.
For now, clinicians should focus on getting patients to adhere to current regimens.
The emphasis should be placed on adding therapy at an appropriate, and ideally early, time.
These therapies must be easy to prescribe, easy to obtain and easy to take, and have a large and recognizable benefit.

Currently, CGM does not fit these criteria for people with type 2 diabetes not taking insulin. CGM will one day become the standard of care for type 2 diabetes, especially as the technology becomes easier to use and cost comes down. With the proper support, CGM could become a powerful motivational tool.

However, we need innovative training materials and new methods for providing CGM feedback. Episodic use may be useful for some patients, but much more evidence is needed to determine who will derive the most benefit. Jeremy H. Pettus, MD, is assistant clinical professor of medicine in the School of Health Sciences at the University of California, San Diego.

Disclosure: Pettus reports he has served on advisory boards for Insulet, MannKind, Novo Nordisk, Sanofi, Tandem and Valeritas, and has received speaking fees from Sanofi and Valeritas. ADD TOPIC TO EMAIL ALERTS Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on,

Does a CGM have a needle?

Microneedle Patch Glucose Monitor Proves Virtually Painless and More Accurate Breaking News The completion of a system for clinical tests is now underway. Apa Itu Cgm Diabetes KTH The Royal Institute of Technology 01.03.19 A more comfortable and reliable blood-sugar monitoring system is being designed by researchers in Sweden for people with diabetes. After successfully testing a prototype of a microneedle patch on a human subject, the completion of a system for clinical tests is now underway.

Continuous monitoring is a way to safely and reliably lower blood glucose—giving the user a full picture of their glucose levels throughout the day and helping them avoid severe hypoglycemia.
But the continuous glucose monitoring systems (known as CGMS) in use today have two main drawbacks: they are uncomfortable since they require a minimum 7mm needle that’s inserted into the skin; and, because of their size, they take measurements in the fat tissue—not the most ideal location.

Researchers at KTH Royal Institute of Technology in Stockholm have developed a promising alternative: a microneedle patch that is 50 times smaller than the needles used in today’s CGM systems. The combination of the patch and an extremely miniaturized three-electrode enzymatic sensor was shown in a recent study to be capable of correctly and dynamically tracking blood glucose levels over time, with a delay of about 10 minutes, when applied to a human subject’s forearm.

One of the researchers, doctoral student Federico Ribet, said the next steps are to develop a transferable adhesive patch, along with algorithms and embedded electronics for a fully-realized system to take to clinical trial. “Our solution is painless to the user,” Ribet said. “We measure directly in the skin, and there are no nerve receptors that detect pain—just a fine mesh of very tiny blood vessels.” Within the dermis, the hollow microneedles rely on natural capillary action to fill up with interstitial fluid, the liquid surrounding the cells in the skin.

Nutrients like sugar, diffuse out of the blood capillaries in this fluid to reach the cells. “An important distinction is that unlike commercially available CGMS which measure the subcutaneous fat tissue, ours measures within the skin less than 1mm deep, where the interstitial fluid follows closer and more homogeneously the blood-glucose oscillations,” Ribet said.

This would offer an alternative to pricking one’s fingers several times a day to take a blood test, although a user would still occasionally have to do so—as they do with commercial CGMS—in order to recalibrate the sensor and get the most accurate and immediate readings.
But with this new system, that could one day change.

Ribet pointed out that the most advanced CGM device now on the market is factory calibrated and reduces the frequency of having to conduct a finger blood test. He said the research team at KTH believes it could ultimately match, or even surpass this level of quality. : Microneedle Patch Glucose Monitor Proves Virtually Painless and More Accurate

Can you exercise with CGM?

Factors that Impact Blood Sugar During Exercise – A person’s blood sugar may rise or fall in response to exercise depending on the following:

Blood sugar level before starting exercise Length of exercise session Changes to insulin doses Type of exercise (intensity of the activity)

For example, aerobic exercise such as walking, biking, and swimming usually decreases blood sugar levels. Anaerobic exercises such as sprinting and lifting weights often raise blood sugar so that it can match the high energy of your active muscles. Both aerobic and anaerobic exercises are safe to do as long as you are monitoring your blood sugar and making adjustments along the way.

It’s extremely important to know where your blood sugar levels are prior to exercise, and how they’re trending, which is where a CGM comes in.
If your blood sugar is over 250 mg/dL, don’t start exercise,” cautions Vettleson.
Give yourself some insulin.
If you’re below 90 mg/dL, make sure to have some carbs prior to starting.

That’s because if you’re at 90 mg/dL and your CGM’s trend arrow is going down, you’re more than likely going to crash and burn during exercise without eating something.” A good rule of thumb for out of range numbers prior to exercise is to wait 15-30 minutes after taking insulin (in the case of a high) or eat something (in the case of a low) to make sure your blood sugar is in its target range in order to complete a workout safely.

Does the CGM hurt?

‘A continuous glucose monitor eliminates most finger pricks,’ Dr. Trachtenbarg says. ‘ There may be mild discomfort when first inserting the sensor, but there is no pain afterward.’ One big advantage to continuous glucose monitoring is reducing the number of low blood sugar readings.

Where is the best place to put a CGM?

A CGM is typically placed on the back of your upper arm, where it is most safe from knocks as you go about your daily life.

Where is the best place to wear a CGM?

Best practices when applying your Freestyle Libre CGM: –

The Freestyle Libre device manufacturer has confirmed here that the back of the upper arm is the only FDA approved location for the CGM. Avoid placing the sensor directly over the muscle. The best location to apply your sensor is in the fatty part of the back of your upper arm, in the river between tricep and deltoid. Watch the application video below to see exactly where we like to apply the sensor. The spring load in the applicator is plenty pressure to insert the filament and activate the adhesive – there’s no need to apply extra pressure once the sensor is applied. Try to relax your arm and nervous system when applying the sensor – Inhale deeply, and press down on the applicator during your exhale. Members may experience differences in glucose between arms, so we encourage using the same arm for more consistent results.

During the first 48 hours of wearing your sensor, you may experience extreme high/low glucose readings. Please note that this is normal as the sensor goes through a 48 hour calibration period. If you would like to read more information on the calibration process, visit: Extreme High/Low Readings During First 48 Hours If you feel persistent pain or discomfort, please review the following article for more information on how to help: What should I do if I feel pain or discomfort?

Why do people stop using CGM?

Abstract – The purpose of this study was to determine clinician attitudes about the distinct barriers to uptake of continuous glucose monitoring (CGM) among people with diabetes. Survey data were collected measuring individual barriers, prerequisites to CGM, confidence in addressing barriers, and clinic staff resources.

Results show that clinicians commonly report barriers to using CGM among people with diabetes in their clinic. Furthermore, clinicians who report a high number of barriers do not feel confident in overcoming the barriers to CGM. Interventions that attempt to empower clinicians to address concerns about CGM among people with diabetes may be warranted because low uptake does not appear to be directly related to available resources or prerequisites to starting CGM.

Diabetes technologies such as continuous glucose monitoring (CGM) improve glycemic control and reduce hypoglycemia in people with type 1 diabetes ( 1, 2 ). Use of CGM can also increase health-related quality of life and satisfaction with the treatment regimens and is associated with fewer depressive symptoms ( 3 – 5 ).

Despite these benefits, the rate of CGM uptake has been low, at only 5–23% depending on the age-group ( 6 ).
Many barriers may prevent people from CGM, including device cost, wear discomfort, and social factors ( 7, 8 ).
Clinicians’ perceptions of the barriers faced by people with diabetes in their clinic may affect their willingness to prescribe CGM devices and encourage and support their use among people with diabetes.

Clinicians for people with type 1 diabetes tend to perceive more barriers to device use and to rate these barriers as being more significant than they actually are for adults with type 1 diabetes ( 9 ); yet it is important for clinicians to help people with diabetes develop realistic, as opposed to overly high, expectations of CGM so they will not be disappointed by their device upon initiation ( 10, 11 ).

Addressing barriers requires time and resources, which are often scarce among clinicians and staff.
Research has shown that adequate time and clinic resources are necessary to promote continued use and maximize benefits of CGM devices ( 12 – 14 ).
Clinicians may also expect people with diabetes to meet certain criteria before prescribing a CGM system, such as having family support ( 15 ) or performing frequent blood glucose measurements ( 16 ).

These prerequisites may help people with diabetes use their devices to the full potential, but they are not uniform across clinics and are often based on subjective decision-making. For these reasons, we sought to determine the specific barriers that clinicians perceive as most crucial to CGM uptake and to compare clinicians who perceive higher barriers to CGM to those who perceive lower barriers to inform future efforts to efficiently and effectively increase CGM uptake.

A previous study of clinicians’ perspectives on diabetes technology use and barriers by Tanenbaum et al.
17 ) identified three clinician personas based on readiness to promote CGM uptake: “Ready,” “Cautious,” and “Not Yet Ready.” Results showed that clinicians most resembling the Cautious persona held positive attitudes toward CGM devices and technology in general, but they perceived that people with diabetes face significantly more barriers to CGM use and therefore would not encourage their use ( 17 ).

The Not Yet Ready clinicians held negative attitudes toward technology and perceived the people with diabetes that they treat to face a moderate number of barriers to CGM use. The Ready clinicians perceived the people with diabetes that they treat to face a low number of barriers to CGM use and held positive attitudes toward these devices.

In this study, the Cautious clinician cluster was compared with the Ready clinician cluster to better understand why these clinicians perceive such high barriers despite having positive attitudes toward diabetes technology. The aims of the study are to 1 ) further examine clinician-perceived barriers to CGM use in people with diabetes and their link to clinician characteristics and 2 ) compare in greater depth clinicians perceiving a high number of barriers to CGM use among people with diabetes (the Cautious group) and clinicians perceiving a low number of barriers to device use among people with diabetes (the Ready group) to understand differences between the two clinician groups.

This study adds to the literature by better outlining the differences between these personas that may lead to higher perceived barriers to CGM use among clinicians. By understanding these differences, possible interventions or educational materials can be created to help clinicians better promote uptake of CGM.

Does CGM use blood?

With a blood glucose meter, you use blood to do the test. With the sensors, they actually measure the glucose in your interstitial fluid, not your blood. The CGM system can be used whether you wear a pump wearer or use injections for your insulin delivery.

What is a good CGM level?

Based on the data of healthy individuals wearing CGM, it appears that it is safe and healthy to strive for a fasting glucose between 72-85 mg/dL, a post-meal glucose level of 110 mg/dL or lower, and an average glucose of 100 mg/dL or lower.

Does the CGM hurt?

Can you get a CGM without being on insulin?

“Dramatic impacts’ with personal CGM – More than half of Hirsch’s patients with type 2 diabetes and more than 90% of those with type 1 diabetes in his clinic are currently using a personal CGM to monitor their glucose, he said. “One of the reasons for that is in our state, Medicaid and Medicare approved use of these,” Hirsch said.

New advances in CGM will make the devices even more accessible for patients, he said.
The new Freestyle Libre 3 (Abbott) will send readings to a smartphone every minute, has a disposable sensor and is smaller than its previous iteration, about the size of two pennies stacked on top of each other.
It has a longer range than the previous Libre sensor (33 feet vs.20 feet), and allows for direct upload to the cloud with the LibreLink app.

The Dexcom G6 is also FDA-approved for non-adjunctive use and is an integrative CGM, or i-CGM, meaning it can be paired with smartpens and other devices. It has a 10-day sensor and sharing features, allowing family members to monitor children or older adults with diabetes.

Both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinology (AACE) recently updated their Standards of Care and 2021 Clinical Practice Guidelines, respectively, to include recommendations for CGM use in type 2 diabetes.
The ADA states the real-time or intermittently scanned CGM should be offered for diabetes management in adults with diabetes on multiple daily injections or insulin pump therapy who are capable of using devices safely and can be used for diabetes management in adults with diabetes taking basal insulin.

AACE similarly states that CGM “may be recommended” for adults with type 2 diabetes who are treated with less intensive insulin therapy. ” Anyone insulin should be on CGM; even if not on insulin,” Hirsch said. “In fact, I will say that, anecdotally, CGM can have dramatic impacts even for people with prediabetes.