The Ultimate Guide to Continuous Glucose Monitors (CGMs) and How They Work

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Today on the podcast, we’re super excited to talk with Isabel again all about CMS, also known as continuous glucose monitors.

And the reason we want to talk about these is because it is an advancement in technology when it comes to managing diabetes.

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And we’ll go into the traditional way that many people still are checking their blood sugar and why CGMs or continuous glucose monitors might be a better tool, especially for people with diabetes.

Welcome to the Diabetes Digital Podcast.

I’m Wendy.

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And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

Visit diabetesdigital.co That’s Co to book your first appointment.

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We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

Hello everyone.

Welcome back to another weekly episode of Diabetes Digital.

We have one of our dietitians back on the podcast, Isabelle.

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Full name Isabelle Rexen and she is a dietitian and also a diabetes educator.

We had her a few weeks ago talking about insulin and just destigmatizing insulin use and ways to effectively incorporate insulin into your treatment if that is something that your doctor thinks that you would benefit from.

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So make sure that you scroll on up and listen to that episode if you haven’t already.

And for today, we thought that we would bring Isabel on to talk about innovations in diabetes technology.

She has a public health degree to which she obtained to promote HealthEquity.

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She specializes in hypertension, chronic kidney disease, kidney stalls and has so much experience, including clinical, pediatric telehealth experience.

She’s all about prioritizing individual needs and preferences, and we are just so lucky to have her as part of our diabetes digital team.

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Welcome to the podcast, Isabel.

We’re so excited to have you back.

Thank you.

I’m excited to be back and talk about this really exciting topic, so.

Isabel, my first question is what exactly is a CGM or continuous?

Glucose monitor CGM.

These are continuous glucose monitors or sensors and these are devices that you wear on your body and they check blood sugars every 5 minutes automatically.

2:24
So basically they look at the fluid in your body and needle doesn’t stay in your body, a catheter does and they check your blood sugars and can give you readings that go to a either something called a receiver or a phone.

And so the main ones right now or something called a Dexcom, we’ve got a freestyle libre and then there is one with Medtronic, the Medtronic pump called the Guardian.

2:46
So those are the, the big ones.

There are also implantable ones that that exist.

They’re a little less common, but I think in the future we’ll see more of those.

And those ones don’t need to be changed as often they stay, stay on the body.

Diabetes technology has really come a long way.

Traditionally, people check their blood sugars using something called a glucometer or blood glucose meter.

3:05
So that’s a device where you use your fingers generally, and you get a little bit of blood from there and it can read your blood sugars on the moment.

Isabel, you mentioned catheter, which sounds very intense and painful.

And I mean, I I do know that a big concern for people who have diabetes, especially gestational diabetes where they’re doing finger sticks four times a day, is the pain with, you know, having to prick your finger.

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And so, you know, someone hearing that might be like, OK, well, I don’t want to be in more discomfort by, you know, going with the CGM.

So how is it different from a finger sticker?

How does that catheter work?

Is it something that’s painful?

Yeah, great question.

So a CGM generally is put on the body and then replaced every 7 to 14 days.

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We could say that’s a range just depending on the kind of brand.

So rather than having to do multiple daily finger stick, somebody is able to trust the CGM data unless they feel different from what the rating is.

They can trust the CGMCGM data without those finger sticks.

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So the process, usually it uses an applicator that’s basically just like some kind of fancy device where you stick it on your body, A needle goes in and out, but the needle is never seen.

You don’t see it go in and it comes right out.

And a catheter is a plastic sort of little tube that stays on the skin and that’s what does the blood sugar readings.

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So any pain would just be at the initial insertion.

It isn’t too bad.

I’ve done it a few times.

It might be a little bit of a pinch, but after that you shouldn’t feel any pain.

And if somebody continues to feel pain in that area, that’s a sign that they might not have injected it in the best spot.

We want it to be somewhere where we’ve got a little bit of tissue that we can grab, a little bit of fat tissue we say not into someone’s muscle that might cause some pain.

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And where would somebody typically place this?

I know back of the arm is 1 common place anywhere else.

Yes.

So it’ll be a bit dependent on the brand.

Each separate sensor has approved areas that are studied.

Generally we recommend back of the arms, the stomach, outer thighs and upper buttocks.

5:05
Pretty much the same place as someone can give an insulin injection if they’re also on insulin and.

I’m curious, ’cause I know there’s a lot of people who might be resistant to technology and they’re like, oh, I’m good with my finger sticks.

Like I don’t need this drama, Not that it’s drama, honestly, it’s it’s really easy.

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But I can see how in the beginning it might feel like that.

What do you say to people who are in that mindset in terms of how does using ACGM improve their experience with managing their blood glucose?

Yes.

So what happens in ACGM is that the CGM tests the blood sugar automatically every 5 minutes and sends that results to either a device or a smartphone.

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So the blood sugars automatically pop up on someone’s phone and they come with something called trend arrows, which can be up, down or neutral, sideways.

And that shows where the blood sugars are going.

And that’s a predictive kind of equation and that information is really helpful.

So for example, if somebody is 100 and they have two arrows going down, that means that the CGM predicts they’re going to have a low blood sugar and they could treat that ahead of time.

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Another thing that’s really beautiful about a CGM is that it can help us a little bit if we have fear of low blood sugars because of that kind of treating and being able to prevent it really helps with sleep in the sense that, you know, especially if you have a caregiver or a parent or someone who’s really worried about you, but they know you have a CGM on, they’re like, oh, OK, it’s going to send an alert if the blood sugars go too low.

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I love that.

Now, what about someone who is comparing numbers between their CGM and their glucometer and they’re noticing that there’s a huge gap in the values that they’re getting?

I’ve seen this a lot with people that have gestational diabetes.

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They’re testing very often and you know the difference can be as much as 15 to 20 units.

So what are your thoughts on that?

You are correct that there is a difference.

There’s a couple reasons why.

One is that technology is good but just not that good where like it’s normal to have up to 50 point difference there.

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If you’re seeing like 100 points, that means that the something is off.

With the CGM and I, you can do something called calibrating where you can check a blood sugar and put it in or you can call the company.

Also, it’s good to know that the CGM checks the blood sugar data from something called your interstitial fluid, whereas A glucometer checks the actual blood.

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So CGMS can be a little bit delayed that they’re not actually getting the blood reading.

So they’re they do try to predict where the blood sugars are going and they do that quite well.

But differences are something that we do see.

So they have been approved to to give insulin and dose medication based off of those numbers at a CGM.

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So just remember that they’re approved.

So they’re OK to use.

One other thing I always tell people is that if they see a number on their CGM and they feel really different, like you know what this says I’m low but I feel great or this says I’m high and I feel low.

Always check a finger stick as a backup.

7:54
Good advice.

Now, one thing that we talk about a lot, especially as dietitians, is this idea of coordination of care and also being able to coordinate with patients directly, right.

And I think a CGM can be a great tool for doing that, for just getting more data, more information.

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Can you talk about how a patient might share that information with their care team or their dietitian, kind of how we even do it at diabetes digital?

And then how you’re able to incorporate that information into the work that you do with?

Your patients, yes.

I will say Full disclosure, help.

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Your healthcare providers will love it if you decide to wear CGM because we know what’s going on with your blood sugars and it makes it so much easier to make changes and figure out like how can we keep these levels more in limit, more in range and make you feel your best.

So all CGMS have options to share with your healthcare clinics and providers.

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There are also often options to share with family members.

That’s a personal choice, but some people like that security know that there’s got somebody out there watching out for them, right?

So those sharing options are really wonderful and can keep other people in the loop of what’s going on with your blood sugar so that you do have that extra support.

9:07
Yeah.

And at diabetes digital, we actually have a software system that integrates into most diabetes devices including CDMS.

And it’s nice because it automatically goes into the software and then your dietitian is able to see those results and review them with you identify trends.

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So that really helps with just like creating an intervention and plan, especially around nutrition.

Can you talk about some of the financial considerations associated with CGMS?

You know, because I think a lot of people think, OK, well this is going to cost money, my insurance might not cover it.

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So do you know like who qualifies to get ACGM?

And is this something that can be covered by insurance?

CGMS can definitely be covered by insurance.

Whether or not someone has coverage will vary greatly depending on their state and their insurance.

So I’m in New York City and we have really good coverage for CGM for people with diabetes post with private and public insurance.

10:05
So that’s definitely something that is wonderful going around here though I know it can be really different states.

I would always advise asking your healthcare provider sometimes insurances needs specific diagnosis to cover technologies and you may be able to fit in that diagnosis.

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For example if you do have diabetes that there was going to be improve coverage for someone who has insulin resistance or pre diabetes.

So good to have that conversation with the healthcare provider and see what we can do to get these tools for you.

Yeah.

And I think even having a conversation with your healthcare provider, if your insurance denies it, maybe you can have that conversation in terms of them doing a peer-to-peer where the doctor might have a conversation with another doctor at an insurance company to to make the case for why you need it and getting a prior authorization.

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So I do think it’s important to, even if you do initially get denied, to have that conversation if it’s something that you want in order to fight for getting it because it can make management so much easier.

OK.

So I want to now talk about a couple of troubleshooting questions because you know, with every technology there can always be issues.

11:17
So the first question I have is I hear often when people are wearing CGMS, especially we mentioned at the back of the arm is a common placement for them.

But sometimes a sensor can come off, right, like you’re working out or you’re putting on a coat.

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So I’m curious if you have had this happen with patients and if you ever share any strategies for how to keep that thing on?

Definitely.

So I work with a lot of kids with diabetes and as we know kids are active and messy and run around and roll around.

So we definitely hear the sensor can come off and and such they make a lot of products.

11:55
There are a lot of products on the market that are patches that you could put over a CGM that help it stick on for a bit bit more.

So most CGM brands make some kind another brand of skin grip, they make some and then on Amazon if you do a search for like CGM patches or or such you will find a lot of results that way.

12:14
So there are definitely things out there to to help.

With that super helpful.

And then the other thing that comes up a lot and even when I was testing ACGM on myself, this was happening, it could be because I don’t have diabetes also, which that’s a whole another episode in terms of the data with people without diabetes using CGM.

12:34
But this idea of your blood sugar going low overnight, can you explain a little bit more about that and when you might get a false?

Low.

Definitely.

So there’s something called compression lows, which means that someone might have a low blood sugar from ACGM reading if the if they’re lying on their CGM.

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So if you’re noticing that frequently, it would be good to not every time in the middle of night.

I know it’s quite exhausting, but if you if you get that pattern, you can check your blood sugars and see if they’re actually normal range, then it could be a sign it’s a compression low I would say.

I would not ignore low blood sugar overnight.

13:13
We do have drops in hormone levels and so we sometimes do see drops in blood sugars overnight even if there were no changes to eating activity and such.

So good to address it, but yes, compression lows do happen for sure.

Well, this was super helpful.

And I just want to kind of close out with advice for people who are looking to get started with CGMS, Like what do you recommend?

13:36
What is step one?

And also are there, can you share a couple of brands?

Because there may be people who are like, I don’t even know, like what are the reputable, reputable brands out there.

Yeah.

What are your last words of advice?

Yes.

Definitely.

So there are different CGMS and it the one that someone chooses will depend on a few things.

13:52
It’ll depend on preference, insurance, coverage, like we mentioned earlier and such.

There’s the Dexcom and that one reads your blood sugar and sends it to your phone every 5 minutes.

So you’ll always see what your blood sugars are.

There are other ones like the Freestyle Libre where you actually scan it.

So you’re not going to get that automatic number pop up, you’re only going to see it when you scan it.

14:12
It still checks it every 5 minutes, but the difference with that one is for someone who doesn’t want as much alerts and alarms, that could be a better option.

For someone who wants to know every second, then the Dexcom might be a better option.

So definitely can just depend on what someone’s preferences they are.

I will say that it’s CGM can be a big choice.

14:30
It is something on someone’s body and not everybody wants something on their body.

I like to remind my my patients and my clients though that anything you put on can come off.

So if you were like, you know what, I might try this.

I’m not sure.

Go ahead, try it.

If it’s not for you, you can go off.

14:45
If you decide to go back to finger sticks and then you know if you want to go back to the CGM, great, Like nothing is permanent and we have that kind of flexibility.

I would just recommend staying in care in touch with your healthcare team so they know what’s going on with you there.

If you’re interested in a continuous glucose monitor or CGM, I’d recommend reaching out to you or healthcare professional and see what the options are for you.

15:07
There are also some sites you can go on.

There’s something called Diabetes wise and it compares diabetes technologies such as CGMS and pumps, but it does give an overview of the different CGMS in the market and what some of their features are.

So checking out a website like that is definitely a good good starting place to learn some more.

15:23
Amazing.

Thank you so much, Isabelle.

I’m sure there’s a lot of people listening who are like, Oh well, is Isabelle taking new clients?

And if so, how do I work with her?

So can you share how people can work with you through Diabetes Digital?

You can head over to Diabetes Digital dot Co slash patient and fill out an intake form and our team will reach out to you.

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We cover a lot of insurances, so hopefully yours is included there, but any questions, concerns, just reach out to our team and I look forward to working with you.

Thank you so much, Isabel.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit **@*************al.co.

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We’ll catch you later.

Bye.