This content originally appeared on diaTribe. Republished with permission.
By Paul Heltzel
Key takeaways:
Continuous glucose monitoring (CGM) devices show blood sugar trends over time.
Consider some tips on how to raise the issue if your doctor hasn’t yet suggested CGM use.
There’s a small but manageable learning curve when starting to use a CGM device and reporting back your results to your doctor’s office.
So you’ve decided to trade finger pricks and in-the-moment blood sugar readings for the ability to view your blood sugar’s past, present and forecasted future. Or perhaps you’re newly diagnosed and see continuous glucose monitoring (CGM) as a great way to start your care. Regardless, congratulations on your decision to adopt a more informed way of managing your diabetes.
CGM technology uses readings from the interstitial fluid in your body using a device called a sensor, which monitors blood sugar levels through a small wire inserted under the skin and worn for a week or two. In the meantime, you’ll get nearly real-time blood sugar readings – and you can get alerts of current or impending high or low blood sugar levels on your CGM reader or smartphone.
But before you get started, there are a few considerations. If you want to try CGM but your doctor hasn’t mentioned it, you may want to think about how to request a prescription. There are also a handful of issues to think about so you get off to a good start. And, of course, you’ll want to report back your glucose results with your healthcare provider. Below you’ll also find guidance on sharing information on your trends, so you can work with your doctor’s office to make decisions about your care.
How to get a CGM
To start using a CGM device, you’ll typically need a prescription. And while some CGM devices are now available without a prescription, the out-of-pocket cost may be a barrier.
Additionally – and importantly – the over-the-counter devices are designed to show blood sugar trends but don’t have alerts for high and low blood sugar.
“For safety, patients with a risk of hypoglycemia – for example, who are taking insulin – should be on CGMs with safety alarms built in,” said Dr. Marilyn Tan, clinical associate professor of endocrinology at the Stanford University School of Medicine.
Most insurance policies will cover a CGM for someone who uses insulin and has experienced low blood sugar, Tan said, and some policies will cover CGM use even for people who don’t take insulin. For a detailed look at navigating insurance hurdles around CGM, see our guide.
Advocate for yourself
So what should you do if you want to try a CGM system, but your physician hasn’t suggested it or doesn’t seem on board with the idea?
Tan said that there are a number of reasons a healthcare provider may not have raised the idea: “Lack of time, thinking the patient may not be interested, or that they may not qualify for insurance coverage, thinking the patient doesn’t need one, or not being familiar with CGMs. A patient should feel comfortable bringing up CGM to the healthcare provider.”
You can talk to your doctor about how you’d like to get a better picture of your overall diabetes management and improve time in range. You can also mention that you’d like to use CGM to avoid severe low and high-blood sugar levels, which if left untreated can require the assistance of another person and can be dangerous.
Research shows that CGM use benefits people with all types of diabetes, and can lead to dramatic improvement even in people with diabetes with high A1C levels.
What to expect as a first-time CGM user
You’ll need to learn to insert a sensor, which is typically very easy. CGMs now come with a one-time injection device that makes the process quick and nearly painless. Compared to just a few previous generations of CGM, most people, including children, can do the insertion with one hand.
The insertion happens so quickly you may not even realize the sensor is inserted. (That said, here are some tips for those who find the process intimidating, along with some solutions to day-to-day CGM issues.)
And while you won’t be required to use a finger stick to ensure the accuracy of your CGM (a process called calibration) with the most recent generation of CGM systems, some still require calibration. Note that there will likely be a small difference in readings between a blood glucose meter and a CGM device.
“The glucose readings on the CGM tend to lag [behind meters] and can be less accurate at extremes and with rapid glucose changes,” Tan said.
“Patients frequently note differences in CGM and finger stick measurements; this is normal.”
What to avoid when using a CGM
Some medicines can lead to CGM readings that display higher than they actually are. One such drug is hydroxyurea, which is used to treat cancer and blood disorders. Large doses of acetaminophen (Tylenol) can also cause problems with CGM readings. If you’re taking one of these, the provider of your CGM system can tell you if it’s an issue (this can vary by model), and it’s an area where you’ll definitely want to consult with your healthcare provider.
You may also need to get used to the idea that your blood sugar is now being checked every few minutes, 24 hours a day, several hundred times a day. That’s a lot of information and you may want to work with your practitioner to choose which alerts you want to receive, at various blood sugar levels — and times during the day — so that you’re not overwhelmed with too many alerts.
Ideally you’ll be alerted before you go too high or too low so you can act, based on your provider’s recommendations, before the situation becomes urgent. CGM technology continues to improve in predicting near-term blood glucose, and treatment can be even more finely tuned when a CGM device is used with an automated insulin delivery (AID) system.
Sharing CGM data with your healthcare provider
Trends captured by the CGM can provide a clear, overall picture of your diabetes management. This data can also be displayed in reports that are very specific, for example to show what your blood sugar levels look like at certain times during the day. The ability to customize these views can help you and your doctor work together to make adjustments.
There are generally three main ways to share your blood sugar trends with your doctor’s office.
First, you can usually share your CGM readings with your doctor’s office so that they can see your data in a standard view specifically designed for a healthcare team. This may allow, depending on the features of your CGM, the ability for your provider to view data with just a small time lag.
“The information is most critical to medical decision making,” Tan says. “Many clinics have clinic accounts where the data can be shared via a specific share code or access granting process.”
Reports are another way to share your data with your provider. Your doctor or other provider may ask you to bring certain reports generated by the software that comes with your CGM to share at your visits. These could be emailed or shared through your doctor’s health portal site as a PDF file, or printed and brought along to your appointment. Among other views, these reports can include your average blood sugar over time, your time in range, and your standard deviation, which is a measure of how your blood sugar readings varied based on your average reading.
Another way to share your CGM data is by using a third-party online tool which takes your blood sugar readings and records them, then displays them as a graph or in reports that are specific to that tool. Tidepool, Nightscout and Glooko are three of these services, which work with most types of CGM devices.
“There are many third-party options,” Tan says, “but we advise patients to use the manufacturer apps.” Those include, for example, the software that comes with Abbott’s Freestyle Libre system, or Dexcom’s Clarity app.
The bottom line
If you’re ready to start using CGM, you’ll trade finger sticks and a reading that measures a point in time for a display of your current blood sugar level but also the rate of change and an estimation of where your blood sugar is headed. You’ll also get alerts – when you’re headed too low or too high, for example – ideally in time to get back in range quickly.
Here’s another benefit: You can choose a CGM device that connects with an automatic insulin delivery (AID) system, which integrates an insulin pump to control dosing and helps keep your blood sugar in range.
If you’re ready to try a CGM but your doctor or other healthcare provider hasn’t raised the idea, you can discuss proactively how you’d like to try it . Most insurance policies will cover CGM for people taking insulin and some will cover CGM use for people with diabetes who don’t take insulin. Medicare and Medicaid cover CGM use for type 1, type 2 and gestational diabetes. There are also new over-the-counter (OTC) choices, but the cost may be an issue when paid out-of-pocket and the OTC devices lack alarms.
Finally, there are multiple options for sharing this information with your healthcare provider. As in other areas of diabetes care, use the approach that works best for you and your provider, which can lead to a more comprehensive understanding of your blood sugar levels and improved diabetes care.
Learn more about continuous glucose monitoring here:
7 Common CGM Hang-Ups (and How To Get Around Them)
10 Tips to Stay in Range With Type 1 Diabetes
42 Factors That Affect Blood Glucose
7 Strategies for Self-Advocacy in Diabetes Care