Blood Glucose Monitoring
Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia). Particularly important in diabetes management, a blood glucose test is typically performed by piercing the skin (typically, on the finger) to draw blood, then applying the blood to a chemically active disposable 'test-strip'. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood. The test is usually referred to as capillary blood glucose. Healthcare professionals advise patients with diabetes mellitus on the appropriate monitoring regimen for their condition. Most people with type 2 diabetes test at least once per day. The Mayo Clinic generally recommends that diabetics who use insulin (all type 1 diabetics and many type 2 diabetics) test their blood sugar more often (4-8 times per day for type 1 diabetics, 2 or more times per day for type 2 diabetics), both to assess the effectiveness of their prior insulin dose and to help determine their next insulin dose. Purpose Blood glucose monitoring reveals individual patterns of blood glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications. Also, testing allows for quick response to high blood sugar (hyperglycemia) or low blood sugar (hypoglycemia). This might include diet adjustments, exercise, and insulin (as instructed by the health care provider). Blood glucose meters Main article: Glucose meter Four generations of blood glucose meter, c. 1991–2005. Sample sizes vary from 30 to 0.3 μl. Test times vary from 5 seconds to 2 minutes (modern meters are typically below 15 seconds). A blood glucose meter is an electronic device for measuring the blood Continue reading >>
Using The Continuous Glucose Monitor (cgms)
Most of us have jobs that bring us into contact with other people during the day and family with whom we have contact after work. These contacts offer considerable protection from severe hypoglycemia, as colleagues and relatives will intervene if you start walking into walls or talking silly. A sleeping partner can frequently pick up on the labored breathing and cold, clammy skin or damp nightclothes that accompany hypoglycemia and then awaken you and ask you to check your blood sugar. If you live or sleep alone, or if your sleeping partner is an extremely deep sleeper, however, you don’t have this protection at night.* A new backup is now available. Several companies are now marketing continuous blood glucose monitors.† A continuous blood glucose monitor works via a tiny sensor implanted beneath the skin, using a technique similar to that used for insulin pump tubing. The sensor constantly measures glucose concentration in the tissue fluid present at its subcutaneous location. A combined power supply and radio transmitter attaches to your skin or clothing. The transmitter sends up to several hundred glucose readings daily to a small portable receiver that you can keep in a pocket. The number displayed is approximately equal to the blood sugar about 20 minutes prior to the reading. So if you had taken a reading with your conventional method 20 minutes ago, this would be roughly the same as the reading from the sensor right now. Also displayed is an up or down arrow to indicate whether blood sugar is increasing or decreasing. What’s most valuable is an audible alarm that can be set to sound at any selected blood sugar value and also to signal rapid drops in blood sugar. There are some potential problems associated with these devices, so they’re not for everyone, Continue reading >>
Apple Monitoring Blood Glucose
Apple appears to be working on blood glucose monitoring as a way to address Type 2 Diabetes.“Stick it in your ear”. Literally. Not all Apple product rumors are equal. Speculation that the headphone jack will reappear with the iPhone 8 has been rightly ridiculed. But the evidence Apple will introduce a glucose monitoring device is worthy of our interest. “Glucose monitoring” is a code word for fighting the growing scourge of Type 2 Diabetes. Unlike Type 1 Diabetes, which is unpreventable, the Type 2 variety is, to be polite, a “lifestyle” disease, meaning we eat too much and don’t exercise enough. (As usual, the French are more brutal: for them, Type 2 is Diabète gras, Fat Diabetes). A 2016 Harvard School of Public Health study places the global cost of Type 2 Diabetes at $825B per year and growing [as always, edits and emphasis mine]: “… in the last 35 years, global diabetes among men has more than doubled — from 4.3% in 1980 to 9% in 2014 — after adjusting for the effect of aging. Meanwhile diabetes among women has risen from 5% in 1980 to 7.9% in 2014. This rise translates as 422 million adults in the world with diabetes in 2014 — which has nearly quadrupled since 1980 (108 million).” In theory, there is, of course, an “easy” remedy: Eat less and exercise more…for the rest of your life. A healthy lifestyle adds days to one’s life, and life to one’s days. Easier nagged than done. In reality, a growing percentage of the human population keeps growing. Enter blood glucose monitoring. Devices that tell you your blood sugar concentration, once the province of the lab, have moved into the home. With just a minuscule drop of blood — as little as .3 microliter — you can get an answer in seconds: The subject is immediately alerted to an Continue reading >>
Is Continuous Glucose Monitoring Worth It?
Continuous glucose monitoring systems (CGMS) may not make life with diabetes any easier. But they can definitely improve health, if you can deal with the hassle and expense. So how do you know if such a system is right for you? As many readers already know, CGMS give a nearly continuous readout of glucose levels in tissue fluid, the wet stuff that oozes out when you have a scrape or a burn. To read these levels, you insert a long-lasting sensor under your skin, a process that feels similar to a needle stick. The sensor is made of material like the filters used in dialysis. It measures glucose levels and radios the results, via a connected transmitting device, to a small receiving device about the size of a pager. This sounds nice — much more information without all the needle sticks. Unfortunately, you still have to do fingertip blood checks 2–4 times a day to keep the monitor calibrated. And the information you get from the meter is only valuable if you know how to use it. Originally, CGMS was for your doctor. You got a continuous 72-hour readout of blood sugar levels, with a nice graph to go with it. If you conscientiously wrote down what you ate, your exercise, and medicines, your doctor would learn a lot about your body’s use of food and insulin. The doc could adjust insulin dosages and other aspects of your care. Then you gave the monitor back. Studies showed this treatment reduced A1C levels by 0.4% to 1.0% or so. Many people with diabetes wanted this capability for themselves, so they could regularly adjust their own treatment and self-management. Now thousands of people use CGMS continuously. But how well do they work? Advantages According to manufacturers’ data, “You can easily and discreetlyview your current glucose values continuously throughout the Continue reading >>
Continuous Glucose Monitoring
What is continuous glucose monitoring? Continuous glucose monitoring automatically tracks blood glucose levels, also called blood sugar, throughout the day and night. You can see your glucose level anytime at a glance. You can also review how your glucose changes over a few hours or days to see trends. Seeing glucose levels in real time can help you make more informed decisions throughout the day about how to balance your food, physical activity, and medicines. How does a continuous glucose monitor (CGM) work? A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor. The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Association’s product guide . Special Features of a CGM CGMs are always on and recording glucose levels—whether you’re showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings: An alarm can sound when your glucose level goes too low or too high. You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels. You can download data to a computer or smart device to more easily see your glucose trends. Some models can send information right away to a second person’s smartphone—perhaps a parent, partner, or caregiver. For example, if a child’s glucose drops dangerously low overnight, the CGM could be Continue reading >>
Apple Reportedly Has A “super Secret” Project To Change The Way We Treat Diabetes
Apple is reportedly working on a “super secret” medical project: building sensors to monitor blood sugar levels without piercing the skin. According to CNBC, the iPhone maker has been working on this for at least five years, quietly hiring dozens of biomedical engineers and sequestering them in a nondescript Palo Alto office. It may be intended to connect to the Apple Watch, which Apple CEO Tim Cook has previously hinted at trying to make more medically useful, even suggesting that an app developed “adjacent to it” might have to get approval from the US Food and Drug Administration. And Reuters reported in 2014 that Apple, Samsung, and Google were all interested in merging their respective mobile devices with glucose monitoring devices. What Apple’s reportedly trying to do here hasn’t worked out so well for Google, whose life-sciences arm, Verily, is also located away from company headquarters in its own unassuming office building and has long been working (publicly) on a smart contact lens for blood sugar monitoring. That project hasn’t been fruitful yet. Keeping track of how blood sugar levels rise and fall throughout the day is a big job for people with type 1 diabetes, whose bodies don’t produce insulin—a crucial hormone in blood sugar regulation. Diabetics typically test blood samples from their fingertips several times a day to measure these levels, but since the numbers can fluctuate so much in response to food, exercise, stress, and other factors, a few data points per day isn’t always enough information. That’s why enthusiasm has been building for continuous glucose monitoring (CGM) sensors. These sensors rely on a small needle that stays under the skin for days at a time to analyze interstitial fluid—the stuff that surrounds tissue cell Continue reading >>
Continuous Glucose Monitoring Systems (cgm) Medtronic & Dexcom Review & Comparison
Since my first detailed report comparing the various Continuous Glucose Monitoring Systems (CGMs) back in 2014, a lot has happened. And not much has changed. The systems have improved in terms of accuracy, features and ease of use, but the main players remain the same (Medtronic and Dexcom). Access via insurance coverage and professional loaner systems has grown exponentially, yet less than 20% of those eligible for CGM are currently using them. In many cases, insurers make the process of receiving coverage onerous and needlessly complex. This doesn’t even touch on Medicare, which continues to sit idly by with its head up its proverbial butt while older Americans suffer needlessly from dangerous glucose swings. New and improved software programs (plus a brilliant new book called “Practical CGM”) provide guidance on how to interpret/analyze CGM reports, yet few patients bother to look at their own data, and very few healthcare providers have the expertise to convert the reports into useful therapeutic insight to help guide their patients. So let’s get down to business. How do the latest Medtronic and Dexcom CGM systems compare? Dexcom’s latest and greatest, the G5, features a transmitter that sends data directly to either a handheld receiver or a mobile phone. Dexcom’s G5 Mobile App displays data on the phone and generates the various alerts; Dexcom’s Clarity App generates reports for retrospective analysis. G5, as well as G4 Platinum, utilizes Dexcom’s up-to-date 505 algorithm for translating subcutaneous electrical impulses into glucose values. Why call it 505? My best guess is that Medtronic copyrighted every other number below 1000. (for some reason, they skipped 505 when naming their various pumps) Medtronic’s latest CGM features their new-generati Continue reading >>
- Type 2 Diabetes: Will Continuous Glucose Monitoring (CGM) Help?
- Exercise and Glucose Metabolism in Persons with Diabetes Mellitus: Perspectives on the Role for Continuous Glucose Monitoring
- Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes | Journal of the Endocrine Society | Oxford Academic
Insulin Pump Therapy And Continuous Glucose Monitoring
Insulin pump therapy and continuous glucose monitoring systems can be invaluable tools for patients with type 1 and type 2 diabetes. Diabetes mellitus is a chronic disease characterized by elevated levels of blood glucose. To prevent diabetes complications, high blood glucose must be controlled with diet, exercise, and medications.1 Type 1 diabetes occurs when the pancreas cannot supply adequate amounts of insulin to regulate blood glucose levels due to a cellular-mediated autoimmune response, which destroys the pancreatic beta-cells.2 The most common diabetes is type 2 diabetes mellitus (T2DM), in which patients no longer produce sufficient amounts of insulin and are insulin resistant.2 Insulin is the key for unlocking the cells to allow glucose to act as a fuel to create energy. Insulin is indicated for all patients with type 1 diabetes, most patients with gestational diabetes when diet is not enough to achieve control, and patients with T2DM who cannot control blood glucose levels with other forms of therapy. Therapy for Type 1 Diabetes The Diabetes Control and Complications Trial (DCCT) concluded that intensive insulin therapy was superior to conventional therapy in improving glycemic control and slowing the progression of retinopathy, nephropathy, and neuropathy in patients with type 1 diabetes.1 The study defined conventional therapy as 1 or 2 insulin injections daily. Intensive insulin therapy was considered to be 3 or more insulin injections daily or the use of an insulin pump, which provides continuous subcutaneous insulin infusion. The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists’ recommendations for type 1 diabetes concur with the DCCT results.2,3 Multiple daily injections or insulin pump therapy are the 2 option Continue reading >>
3 Reasons Why You’ll Love Wearing A Continuous Glucose Monitor (cgm) For Diabetes
We’ve come a long way in diabetes technology. Just as recent as the 1970s, checking your blood sugar as a type 1 diabetic meant dropping little tablets into your collected urine. “I had to urinate in a cup and then set up a mini science experiment. The system was called Clinitest,” explains Barb Peterson. “You put a pill in the test tube along with 10 drops of urine. If it was blue you were negative or had what was considered no sugar. If it was green it could be anywhere from 100 to 280 mg/dL and it if was orange it was considered high and you could be anywhere from 300 to 1200 mg/dL.” Today, not only do we have glucose meters that give us mostly accurate blood glucose readings within 5 seconds, we also have impressive little gadgets known as CGMs or Continuous Glucose Monitors. A CGM is a two-part device: the first part is a tiny flexible sensor, much smaller than even the thickness of a syringe, that you place in your skin every 1-2 weeks. It sits in your skin comfortably (you don’t feel a thing once it’s in there) with a small adhesive. The second part is the receiver which is smaller than most of today’s cellphones and provides a constant number and graph of your blood sugar (actually, it’s really measuring your glucose with “interstitial fluid,” but let’s not get into that in this article!). Check out these links to learn more about the DexCom CGM or the Medtronic Enlite Sensor CGM. Generally, it’s intended for people with type 1 diabetes, but people with type 2 diabetes who are on insulin may want to consider a CGM as well. As a former insulin pump user I was very skeptical about putting something in my skin and leaving it there for a week or two weeks at a time, because with pumping I often struggled with irritated sites, rashes, and bl Continue reading >>
Continuous Glucose Monitoring
With Continuous Glucose Monitoring (CGM), you get a more complete picture of your glucose levels, which can lead to better treatment decisions and better glucose control. Without diabetes, your body tracks glucose levels all day and night to ensure the right amount of insulin is released at the right time. To successfully manage diabetes, a monitoring system is needed to consistently check your glucose levels. The most common glucose monitoring solutions are blood glucose meters and continuous glucose monitoring (CGM) systems. Sensor overtape not shown in depiction How Does CGM Work? CGM is a way to measure glucose levels in real-time throughout the day and night. A tiny electrode called a glucose sensor is inserted under the skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information via wireless radio frequency to a monitoring and display device. The device can detect and notify you if your glucose is reaching a high or low limit. The latest Medtronic CGM systems can actually alert you before you reach your glucose limits. CGM systems usually consist of a glucose sensor, a transmitter, and a small external monitor to view your glucose levels. MiniMed insulin pumps have built-in CGM so the information can be conveniently seen on your pump screen. The CGM monitor or insulin pump is small, discreet, and easy-to-wear. It can be attached to your belt, hidden in your pocket, or placed under your clothing. This component will show your current glucose levels and your historical glucose trends. It also notifies you before you reach your low or high glucose limits and if your glucose level rises or falls too quickly. The CGM transmitter is a small, lightweight device that attaches to the glucose sensor, gathers your glucose data, Continue reading >>
Continuous Blood Glucose Testing: How Do Sensors Work?
Share: Sensors record glucose levels continuously around the clock! They allow you to see how fast and in what direction glucose levels are trending. You can also see what your sugar levels were overnight. Glucose readings are transmitted to a monitor or insulin pump where the values are displayed. Currently there is only one on the market. It’s made by Medtronic. Others may be available in the near future. How do they work? A tiny glucose-sensing device called a "sensor" is inserted just under the skin (subcutaneous tissue). It's very similar to insertion of an insulin pump catheter. Sensors are typically inserted in the abdominal or upper buttock area, and tape is used to hold them in place. The sensor measures the level of glucose in the interstitial fluid (fluid surrounding the cell) every 10 seconds and changes it into an electrical signal. The signal represents the amount of sugar in the blood. A small transmitter attaches to the sensor. It sends a signal to an insulin pump or a pager-sized device called a "monitor" that you attach to a belt or the waistline of your pants. The system automatically records an average glucose value every 5 minutes for up to 72 hours. Results of several finger stick blood glucose readings taken with your glucose meter at different times each day are entered into the monitor for calibration. After 3 days, the sensor is removed and the information stored in the CGM is downloaded into a computer. You and your diabetes educator can then review your glucose levels in relation to the other data collected and make any necessary adjustments in your diabetes management plan. The information will be presented as graphs or charts that can help reveal patterns of glucose fluctuations. When Is It Used? A monitors is used to look for trends in g Continue reading >>
Abbott’s Freestyle Libre – Transforming Glucose Monitoring Through Utter Simplicity, Fingersticks Aside!
by Adam Brown and Kelly Close Twitter Summary: Wearing Abbott’s #FreeStyleLibre, a 14-day sensor intended to replace glucose meters, but provide CGM-like info; now available in Europe In October, Abbott launched its highly awaited FreeStyle Libre Flash Glucose Monitoring system in Europe. The unique product is intended as a replacement for blood glucose meters, while giving patients many of the benefits of continuous glucose monitoring (CGM), including real-time glucose values, trend information and comprehensive reports. Though it is not yet approved in the US, we were able to test the product over the past month (the device can only be ordered online from websites in Europe). Given what we had heard from so many European bloggers, we had high expectations going into our test, and FreeStyle Libre absolutely met them at every step – the system was easy to setup and use (a major win for healthcare providers); discreet to wear on the upper arm; accurate enough from which to dose insulin, with performance similar to Dexcom’s G4 Platinum CGM (though no fingersticks were required); and it gave an excellent picture of glucose trends through real-time and on-device reports. In short, it is transformative compared to the limited information provided by traditional blood glucose meters, all in a package anyone can pick up and learn to use. We give FreeStyle Libre an emphatic thumbs up and would recommend it to nearly anyone with diabetes, especially those on insulin who test their blood glucose frequently and want more actionable information than fingersticks alone can provide. One key point of difference from CGM is that FreeStyle Libre does not have high or low alarms, meaning it is not as ideal for those with lots of hypoglycemia or hypoglycemia unawareness. This articl Continue reading >>
- No More Routine Finger Sticks(1) for Americans with Diabetes: Abbotts FreeStyle Libre Approved in the U.S.
- Abbott's Revolutionary Continuous Glucose Monitoring System, FreeStyle Libre, Now Available To Medicare Patients - Jan 4, 2018
- The FreeStyle Libre, a device for monitoring blood sugar, is a pleasure to use.
Continuous Glucose Monitoring
Topic Overview When you test your blood sugar, you learn your blood sugar level at that time. But you can't tell what's happening to your blood sugar the rest of the time-especially overnight. A continuous glucose monitor, or CGM, can do that for you. It reports on your blood sugar at least every 5 minutes, day and night. And it sounds an alarm if it sees that your levels are headed out of range. How does a continuous glucose monitor work? A CGM has several parts. You wear one part-the sensor-against your skin. It has a tiny needle that stays under your skin. A transmitter is attached to the sensor and constantly reads your blood glucose level. It sends this information to the other part of the monitor, a wireless receiver that you (or a caregiver such as a parent) wear on your belt or in your pocket. Some insulin pumps include CGM. In this case, the insulin pump is also the receiver. At any time, you can look at the receiver and see what your glucose level is. Some systems use text messages, apps, and websites. You can see if your level is going up or down-and how fast. You can see the trends and patterns of your glucose levels. You note on the receiver when you eat, do exercise, and take insulin. That way you can see how those activities affect your blood sugar throughout the day and night. All this detailed information gives you and your doctor a better idea of what your treatment needs are. Continuous monitors are not as accurate as standard meters. At least several times a day, depending on the manufacturer's directions, you will have to prick your finger and use your standard meter to confirm what the CGM is telling you. What are the benefits? A CGM is constantly measuring your blood sugar. This information helps some people who have diabetes make decisions about Continue reading >>
Health Library Article
When you test your blood sugar, you learn your blood sugar level at that time. But you can't tell what's happening to your blood sugar the rest of the timeespecially overnight. A continuous glucose monitor, or CGM, can do that for you. It reports on your blood sugar at least every 5 minutes, day and night. And it sounds an alarm if it sees that your levels are headed out of range. How does a continuous glucose monitor work? A CGM has three parts. You wear one partthe sensoragainst your skin. It has a tiny needle that stays under your skin. A transmitter is attached to the sensor and constantly reads your blood glucose level. It sends this information to the other part of the monitor, a wireless receiver that you (or a caregiver such as a parent) wear on your belt or in your pocket. At any time, you can look at the receiver and see what your glucose level is. You can see if your level is going up or downand how fast. You can download the information to your computer and see the trends and patterns of your glucose levels. You note on the receiver when you eat, do exercise, and take insulin. That way you can see how those activities affect your blood sugar throughout the day and night. All this detailed information gives you and your doctor a better idea of what your treatment needs are. Continuous monitors are not as accurate as standard meters. At least once or twice a day, depending on the type of monitor you buy, you will have to prick your finger and use your standard meter to confirm what the CGM is telling you. What are the benefits? A CGM is constantly measuring your blood sugar. This information helps some people who have diabetes make decisions about what to eat, how to exercise, and how much medicine to take. Using a CGM has been shown to give people with type 1 Continue reading >>
Insulin Pumps And Continuous Glucose Monitors
Using an insulin pump and continuous glucose monitor can help people with diabetes better manage blood glucose levels. Should you be using them? This article provides clear information on insulin pumps and continuous glucose monitors so that you can talk to your diabetes treatment team about these diabetes devices. check your blood sugar every few minutes—that’s a continuous glucose monitor pump small and continuous doses of fast-acting insulin—that’s an insulin pump Many people with diabetes report that continuous glucose monitors and insulin pumps help them reduce their average blood glucose and drive down their hemoglobin A1c scores. Some people who use these sensing and pumping systems are even able to reduce their blood glucose to levels close to those of non-diabetics. How Does a Continuous Glucose Monitor Work? A small sensor is inserted into your skin within a few inches of your belly button. That sensor sends blood glucose readings to a little computer unit you carry with you. If your blood glucose (blood sugar) goes too high or low, the computer unit beeps to alert you that you need to administer insulin or eat some carbohydrates. How Does an Insulin Pump Work? The same computer unit that captures your blood glucose data also contains short-acting insulin and pumps it out a little at a time. It pumps the insulin through a small tube inserted into you abdomen. Some systems also have a bolus feature that lets you administer a little bit more insulin if your blood sugar gets too high. Drawbacks to Continuous Glucose Monitors and Insulin Pumps While continuous glucose monitors and insulin pumps have many advantages, they are not for everyone—that’s why you need to education yourself on these diabetes treatment options and discuss them with your doctor Continue reading >>