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CGM in Today's World by Tammie Grumski

By Megan Watts posted 12-31-2022 14:22

  

CGM In Today’s World

 

When you think about continuous glucose monitors (CGMs) and their use in diabetes what comes to your mind? Until recently, only those with type 1 diabetes were thought to need CGM. Now, we are seeing more and more people with type 2 diabetes using CGM

The first CGM in the United States was FDA approved in 1999.  This began a new era in diabetes care.  Since that time, CGMs have made numerous improvements. Many insurance companies do not cover CGMs unless the person is injecting insulin at least 3 times a day or using an insulin pump. When I inquire about using CGM in anyone with diabetes, I usually get the response that it is too expensive.  I always come back with asking how much 1 unplanned emergency room (ER) visit or unplanned hospital admission costs.

I have tried CGM on several patients that are not taking insulin, as a teaching tool.  They are always surprised to see how what they eat really impacts their blood sugars.  One patient called and wanted to know why the “healthy option” Chinese food he ate for lunch made his blood sugar go over 400mg/dL for several hours.  He was complaining of numbness and tingling of his feet and blurred vision.  He thought that since the menu read: “healthy option” that it was ok to eat. Upon further investigation, it was found that the “healthy option” did not contain any sauce, but it did come with the same amount of rice that comes with all the meals on the menu.  After several weeks this person began to see how what he ate affected his blood sugars just by wearing the CGM.  Since then, he has continued to wear the CGM and pays out of pocket.  Before the CGM, it was difficult for him to do finger sticks because of the type of work he does, so generally only did a fasting blood sugar.  What he did not realize is how that blood sugar changed throughout the day and what he ate had a lot to do with the readings. Since wearing this CGM several months ago, this patient has lost over 30 pounds, has changed his eating habits, increased his activity level and has seen his HbA1C go down to 6.8%. This CGM has made a dramatic difference in his life.

I have seen this same type of scenario with many patients.  CGM is a valuable tool in the diabetes toolbox.  It is not for everyone but can be a great teaching tool to help patients understand how food affects their blood sugars and make the lifestyle changes necessary to prevent further complications seen with uncontrolled diabetes. Currently there are studies using CGM on patients who are not on insulin.  I am hopeful that the data will change the way we use CGM today.

 

Tammi Grumski, CRNP, BC, CDCES

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01-02-2023 18:44

Thank you Tammi for sharing this information and providing a great patient story on the impact that CGM use can have on improving diabetes self-management!