October 30, 2024
As a diabetes doctor, I try to support my patients by providing both medical and practical advice to help improve their diabetes control. But what makes my connection to my patients particularly strong is my ability to understand their challenges as well as their wins because I have lived with Type 1 diabetes myself since age 5.
Among the topics we discuss regularly is what’s in their diabetes toolkit. The introduction of continuous glucose monitoring (CGM) marked significant progress in self-management by improving easy access to glucose data that may help inform treatment decisions and reduce the daily grind of diabetes. I use a continuous glucose monitor (CGM) myself and also always have a blood glucose meter close by. It is an essential part of my tool kit and I recommend my patients do the same. Here’s why:
BGM and CGM work differently: Blood glucose monitors – also referred to as glucometers -- measure sugar in the blood, while CGMs measure sugar in the interstitial fluid (ISF) in the subcutaneous tissue (fluid under the skin). The readouts from a CGM can differ from those on BGM because changes in glucose in the interstitial fluid can "lag" behind those in the blood, especially when values are increasing or decreasing rapidly.
May provide better assessment of recovery from hypoglycemia: Given the lag between blood and ISF glucose levels, it may take extra time for higher values to be shown with CGM following treatment for hypoglycemia, often leading to additional intake of carbs and rebound hyperglycemia. In these circumstances, I check – and instruct my patients to do the same -- with a glucometer 15 minutes after treating hypoglycemia as it may provide a more accurate reading and help prevent overtreatment of hypoglycemia.
When the CGM device comes off: CGM sensors can detach at inopportune times. In warmer weather months, for example, patients tell me their CGM adhesive may not stick if they’re perspiring during a walk or while playing a sport, say a heated pickleball match. My sensor popped off when my arm brushed against the car door while I was getting out in front of my favorite restaurant. It was reassuring that I had a glucometer in my pocket and had an alternative way to check my glucose before the meal.
Fallibility—technology and human: No technology is perfect, and it follows that CGM sensors may not be 100% accurate all the time. Sometimes, people with diabetes experience symptoms that do not match the CGM sensor readings. And who among us hasn’t left their smartphone or CGM reader at home, or it wasn’t powered up? There are any number of other life situations where people with diabetes benefit from having an alternate testing method available.
Supply issues: In the last few years, many of us have experienced a delay in receiving our diabetes supplies. In case of a gap between CGM orders or if the sensor received isn’t working properly, it’s comforting to know that a glucometer, batteries, and test strips can be found at most local pharmacies.
A tech vacation: Data confirm that people using health monitoring technology experience physical and mental health benefits.1 But it’s not unusual to feel overwhelmed2 by technology. Burned out. Need a break. On those days, people with diabetes may want their bodies to be free of devices. Glucometers today are also connected with tracking apps like mySugr that enable healthcare providers to still see relevant data uninterrupted.
Glucose monitoring is one of the most important parts of diabetes self-management. Whether used alone or alongside CGMs, having a glucometer in the toolkit provides critical information, peace of mind, confidence, and safety.
