Continuous glucose monitoring (CGM) is here to stay

When I was first introduced to continuous glucose monitoring, I watched while the patient had quite a long needle threaded through their skin. While this procedure provided extremely useful information for diabetes care, I didn’t think it would ever be very popular with my patients. After all, while necessary, needles are not to everyone’s liking.

We have come a long way since then. Unless you don’t mind pricking your fingers to get an isolated glucose reading with a meter, there are now many other painless ways of obtaining reliable and immediate readings.

We are about to climb yet another mountain with the recent launch of the Freestyle Libre 3 and the upcoming release of the Dexcom G7 CGM. The respective manufacturers, Abbott and Dexcom, are the two biggest suppliers of continuous glucose monitoring. Their latest offerings are the best-in-class CGM devices with smaller sensors, updated adhesives, minute-by-minute measurement and much greater sensitivity and accuracy.

The original Freestyle Libre and Freestyle 2 models are not true CGM devices; rather, they are flash glucose monitoring solutions, which means you have to scan or ‘flash’ the sensor with a hand-held reader or mobile phone to access your data. The new Freestyle Libre 3 is a true CGM that gives readings every minute. At London Diabetes Centre, we have been using CGM not only in patients with type 1 diabetes but also for those with type 2 diabetes with great success. It should be remembered that type 2 represents 90% of diabetes patients. Continuous glucose monitoring has different but equally effective advantages for those individuals with type 2 diabetes.

The first advantage is what I would call “involvement”. Getting patients on board in managing their diabetes is the first step toward successful diabetes care. A patient who is aware that they have diabetes, that their lifestyle and eating habits must change and who is reminded of this regularly will always do better than someone who is only reminded at their annual outpatient visit. A CGM gets patients interested in their diabetes and fascinated by what causes their blood glucose to go up and then return to normal.

The two things that cause blood glucose levels to rise are food and stress. With food, you should limit those foods with a high carbohydrate content but bear in mind that not all carbohydrates are the same. It helps to understand the glycaemic index and glycaemic load of your food to intuitively learn which food choices cause fast and high glucose rises.

In addition to selecting the right diet, exercise can also help control type 2 diabetes. However, not all exercise is the same. Anything that causes adrenaline to be secreted and is associated with a fast heart rate may raise blood glucose, whereas a slow walk is good at causing a slow decrease in blood glucose levels. An appropriate level of activity for 30 minutes a day, even split into three 10-minute chunks, is perfectly acceptable.

The great news is that technology is more helpful than ever when it comes to monitoring your diabetes. For example, you can use your smartphone to track your activities and food and link to your CGM device. If you’re looking to upgrade your CGM, the Freestyle Libre 3 is out now ‒ the app is available now for Android users and will be released to the Apple Store in a few months’ time for Apple users. The highly anticipated Dexcom G7 will also be available very soon. Meanwhile, we already support other CGM systems, including Glucagen and Medtrum’s TouchCare Nano System, so the ease with which our diabetes patients can access their blood glucose levels has never been better.

Whilst the improvements in technology in CGM devices and smartphones must be welcomed in the management of diabetes, these are no substitutes for contact with an experienced Diabetes Educator or Consultant. These specialists can help you understand how your behaviour and medications impact your blood sugar levels. CGM devices can be overused and misinterpreted, particularly if you have stable, well-controlled diabetes and unwittingly become too focused on using these tools to watch your glucose levels obsessively. For those whose glucose levels exhibit wild swings, continuous glucose monitoring can lead to inappropriate behaviour – using insulin to lower very high glucose levels and eating sweets to correct the resulting low level.

The London Diabetes Centre offers a new Peace of Mind plan where we will remotely monitor your CGM readings and contact you if a serious issue arises. If you need advice and help from our team, the Diabetes Connect package (£180 for three months) is a popular choice that helps you get back on track when there are problems. It features regular contact with an experienced Diabetes Nurse Educator.

Technology is an excellent tool, but you must make sure it works for you. At London Diabetes Centre, we can help you make the best use of technology to manage your diabetes so you can get on with living your best life!