Diabetes Technology Part 1 – CGM

I know that if you aren’t familiar with T1 diabetes, you might think it will be hard for you to understand diabetes technology. But I think I can explain to you just how huge recent diabetes technology advancements have been and the BIG impact it is making on management! If you haven’t yet, it will be helpful for you to read the blog: https://thelazypancreas.com/2019/10/04/all-about-basal/ This will be a three part blog in my attempt to cover everything and I promise it will be interesting! While the hope is that someday there will be a cure for T1 diabetes, it does not seem like that is in the near future. But the advancements being made in management through new technology are game changers.

CGM (continuous glucose monitor) is the best thing to ever happen for diabetes management. It is a small sensor inserted under the skin and it gives updated blood sugar readings every 5 minutes, 24 hours a day. The sensor is attached to a transmitter which sends the readings to an insulin pump, smartphone/watch or receiver (depending on the brand/model). More advanced brands of CGM require almost no finger pricks anymore, diabetics can go a week or longer without having to prick a finger even once! As you can see, when otherwise testing 8-14 times a day, fingers get beat up.

One of the big game changers of CGM is it’s ability to alert the user when BGs are out of range. For example, my range is set for between 80-130/150 (and different ranges can be set for different times of the day, I have 150 for after meal time but 130 the rest of the time). If I go lower or higher, I get an alert allowing me to make adjustments before I go too high or too low.

CGM is an amazing tool for parents of T1 diabetics as it allows them to monitor their child’s BG no matter where they are! While kids are in school, parents and teachers can receive alerts when the child is out of range. Parents of T1 diabetics have long lived with the fear that their child will sleep through a low BG at night, have a seizure and never wake up. Children have died in their sleep as their young bodies are less able to detect or feel the symptoms and awaken. With CGM technology, parents sleep a little easier knowing their phone will alert them if needed.

CGM also allows the diabetic to make much more precise decisions in BG management. Before CGM, if I tested my BG and saw that I was at 90, I couldn’t tell in that moment if my blood sugar is going up or down. But with CGM, if I see that over the past hour I have been going down, I will eat a small snack to stop the trend before I go too low. On the flip side in the past if I tested my BG and saw I was at 200 but already have active insulin, I may choose to keep waiting and see if the insulin will kick in. But with CGM if I see that my BG has been at 200 for 2 hours and hasn’t moved much, I’ll likely take more insulin. Seeing the trends and where my BG has been in the last few hours allows me to make much more precise management decisions than I could with just the occasional finger prick.

CGM also allows collection of data that is very helpful for both the T1 diabetic and the doctor. The A1C blood test has for years been the standard at which doctors determine if BG has been well controlled. But since the A1C is an average BG, if the diabetic is having many highs and many lows, their A1C may be “good” even when their BG management isn’t. With CGM now available, we look at time in range and standard deviation. 90% or better time in range and a low standard deviation are much better indicators of good management than just the A1C.

CGM data is so game changing that I’ve practically forgotten how to manage BG without it! A few months ago, my transmitter broke and it took 3 days to get a new one. During those days, I was often going hours without even thinking of checking my BG! I am so used to only checking when I receive an alert that without the alerts, I don’t even think about my BG most of the time. CGM has allowed me to live my life and have hours of the day when I don’t have to think about BG or being a diabetic because I have a safety net that will let me know when something needs my attention.

What is heartbreaking to me is that although everyone in the T1 diabetic community knows how invaluable CGM technology is, there are still many diabetics that don’t have access to it. It is expensive (about $1200-2000 for a 3 month supply) so those with no health insurance or high deductible insurance can’t afford it. Even some people with “good” insurance have such a high copay that they can’t afford it. Medicare is now covering CGM but not every state’s Medicaid does and many insurance plans purchased through the state exchanges (Obamacare plans) don’t have CGM coverage. In other countries, especially those with universal health care, CGM is not always covered. Last year I became aware that New Zealand still wasn’t covering CGM. Second and third world countries typically have no access at all.

You may think that insurance companies have a valid reason not to want to cover such an expensive technology. But studies have shown that ER trips go down almost 90% for diabetics on CGM and consequently hospitalizations go down too. Rates of complications is also much lower for diabetics using CGM. Tighter control and better management lead to better overall health which saves insurance companies money. CGM has proven itself to be worth more in health care savings than it costs.

Words can’t express how thankful I am for my CGM. I hope and pray that I will always be able to afford to have it. I pray for those who don’t have access and that one day that will change. The higher quality of life it offers is priceless ❤️