Why I Want Everyone With Or Without Diabetes To Have Cgm Access
Elias Eid is a med student who lives with Type 1 diabetes. He shares what CGM has meant for him and why he believes wider CGM use benefits everyone.
4 min read
Living with Type 1 diabetes has always been an adventure. Every day feels like a journey into the unknown: neither my physicians nor I understand how and why my blood sugar fluctuates. When I got my diagnosis more than 20 years ago, managing that uncertainty meant finger pricks every two hours. Now continuous glucose monitors have changed the way I live my life.
In those of us with Type 1 diabetes, our bodies dont make enough insulin . CGMs enable us to track our daily glucose fluctuations more precisely, which helps us better manage food and insulin injections, the two tools we have to keep our blood sugar from reaching dangerous levels. Its no overstatement to say that CGM can be a life-saving device for people with diabetes.
As a wrestler and powerlifter, I know CGM can even help healthy people optimize athletic performance. Endurance is a function of how we use energy. We want to burn both carbohydrates and fat for energy during long workouts, but if our glucose and insulin are chronically elevated, its harder for us to burn fat for fuel. The ability to monitor my blood sugar and how it fluctuates in real time allows me to optimize my diet to be the best athlete I can be.
Driving And Checking Your Blood Sugars Using A Cgm Or Flash
You can use a flash glucose monitor or CGM to check your sugar levels when driving, but you must confirm your levels with a finger-prick test if:
- your blood sugar level is 4 mmol/l or below
- you have symptoms of a hypo
- your monitor gives a reading thats not consistent with the symptoms youre getting for example, if you feel like youre having a hypo but the reading doesnt show this.
Who Can Use A Cgm And How Do You Get One
A doctor may prescribe a continuous glucose monitor for people with type 1 diabetes and some people with type 2 diabetes.
These monitors can be helpful for people who are unaware that their blood sugar is too low, which is called hypoglycemia. This includes young children and some older adults.
It also includes people who regularly have hypoglycemia and no longer feel the typical warning signs.
Doctors may also prescribe a continuous glucose monitor if you regularly have high or low blood sugar levels, or if you are on intensive insulin therapy.
Certain types of monitors can be paired with an insulin pump as part of a closed-loop system.
With these devices, if the monitor detects that your blood sugar levels are outside your target range, it communicates with your insulin pump. The pump then delivers the right amount of insulin directly into your body. Some people call this device an artificial pancreas.
Evidence suggests that this technology can improve the quality of life for people with type 1 diabetes.
But anyone can use a continuous glucose monitor as a tool to better understand their blood sugar levels, which can impact many aspects of their overall health.
In the U.S., continuous glucose monitors are typically only available on prescription.
But the ZOE at-home testing kit includes a CGM for most people who opt to take part in our research program, depending on location and health status.
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How To Get Cgm For Medicaid Patients
Medicaid in Colorado has certain eligibility requirements that must be met in order to provide coverage for personal CGM. If the patient does not meet them, Professional CGM may be an option for intermittent use. This resource will help you navigate Colorado Medicaids eligibility requirements for coverage, ordering and insurance authorization, and documentation. To download this resource as a PDF, .
For a comparison guide on helping your patient choose a CGM and tips on navigating common problems, .
Colorado Medicaid Eligibility Requirements for personal CGM
In order to be eligible for Colorado Medicaid coverage of personal CGM, the followingrequirements must be met:
Chart note example: The following is an example of text that you can add to your chart notes for patients meeting Colorado Medicaids eligibility criteria. You can copy/paste, add to your EHRs macro library , and/or modify as needed:
How to Order a Dexcom
- Complete the Byers CGM Order Form .pdf?sfvrsn=ad9d8fba_2″ rel=”nofollow”> printable form or fillable form)
- Email or Fax: chart notes, Byers CGM Order Form, and patient contact information to:
How Do Continuous Glucose Monitors Work
CGMs use a minimally invasive electrochemical sensor thats inserted below the skin to measure blood sugar levels in interstitial fluid .
It emits a low frequency signal to communicate blood sugar data to a reader device. Different CGM systems vary in the specifics, but you essentially end up with a vast amount of data on your blood sugar patterns. Instead of relying on fingersticks and a regular glucometer, you can keep tabs on whats happening 24/7 .
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Troubleshooting Information For Freestyle Libre2 Users
We know that lots of people have been reporting issues they’ve been having with the Freestyle Libre 2.
We previously collated some of these issues and fed this back to Abbott who have provided us with some ‘Top Tips’ for issues with Libre 2 alarms.
If you have any concerns or specific issues with your Freestyle Libre2, please contact Abbott directly via their Libre2 support pages. Or use the Abbott guides we’re sharing below.
Cgm Coverage If You Have Private Insurance
Most private insurance plans cover CGM for people living with diabetes, but youll have to check your insurance benefits to see if thats the case with your plan, which brands it covers, and at what price.
Plan coverage can change from year to year, so if you have been denied coverage in the past, its worth checking up on your plan benefit annually or choosing a plan that covers CGM during open enrollment .
Most people will have some sort of copayment when using a private insurance plan. If you, for example, have a 20% co-pay, that means that youll pay 20% of the price your insurance plan has negotiated with the CGM manufacturer.
If you use a distributor for your medical supplies, such as US MED that Im using, they will contact your insurance company for you, before you even sign up with them, to find out if youre covered and what your co-pay is.
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What Are Normal And Abnormal Blood Sugar Levels
This is a surprisingly hard question to answer. If you go by American Diabetes Association standards, normal blood sugar is less than 100 mg/dl fasting , and less than 140 mg/dl two hours after eating.
In general, they state that non-diabetic people have blood sugar in the range of 70-130 mg/dl.
For an official diagnosis of type 2 diabetes, fasting blood sugar would be 126 mg/dl or higher, and 200 mg/dl or higher 2 hours after a 75 gram glucose tolerance test .
For an official diagnosis of prediabetes, blood sugar levels are below the criteria for type 2 diabetes, but above 100 mg/dl fasting and 140 mg/dl 2 hours after a glucose tolerance test .
What is not specified in these guidelines is how high its normal to see your blood sugar spike after meals. Since these guidelines are focused on diagnosing and treating diabetes/prediabetes, they dont give us much insight into truly normal blood sugar levels. Ill explain more on this later in this post.
Beyond Our Diabetes Bubble
While Ramseys mainstream CGM review may raise some hackles in the diabetes community, we have to remember thats not who this article was written for. Business Insiders intended audience is a much broader swath of people who follow the expanding market for a variety of medical sensors to help consumers track their overall health.
And when reading our communitys visceral responses, we couldnt help but reflect on the fuzzy lines that exist between the good, bad, and ugly of diabetes: Do we PWDs wish to be seen as sick or not? On the one hand, there are so many inspirational stories of Olympic athletes with diabetes and those who can do anything. But on the other hand, many PWDs suffer debilitating complications, and want to be recognized for their struggles. How is the general public supposed to reconcile those two faces of diabetes?
Its a tricky balancing act, for sure.
Ramsey wraps up her article by noting: Ill be curious if theres a world in which glucose monitoring becomes more popular among people without diabetes.
It definitely seems like thats where were headed. We have to believe that as CGM becomes more mainstream, it will become more accessible and affordable to the masses, including many more PWDs.
And that seems like something we can all get behind despite the emotions we may have about non-diabetes folk being privileged and superficial, or not using a particular device in the same life-critical way that we do.
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When Should I Call The Doctor
Reach out to your provider if you have any questions about how to use a CGM device safely.
Very high or low blood sugar levels can be dangerous when left untreated for too long. In the most severe cases, this can lead to seizures, coma or even death. You can avoid these complications by keeping blood sugar levels in a healthy range. Call your provider if you have any symptoms youre worried about.
Common symptoms of high blood sugar include:
- More frequent urination .
Who Can Use A Cgm
Most people who use CGMs have type 1 diabetes. Research is underway to learn how CGMs might help people with type 2 diabetes.
CGMs are approved for use by adults and children with a doctors prescription. Some models may be used for children as young as age 2. Your doctor may recommend a CGM if you or your child:
- are on intensive insulin therapy, also called tight blood sugar control
- have hypoglycemia unawareness
- often have high or low blood glucose
Your doctor may suggest using a CGM system all the time or only for a few days to help adjust your diabetes care plan.
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Flash Sensors And Cgm Sensors
With a flash glucose monitor, sensors should be worn on the arms only. And we recommend that they arent placed over areas with tattoos as this could impact your results. With a CGM, you can wear the sensor on different parts of the body, such as your abdomen.
The sensors dont normally need to be taken off. You can usually wear them in the bath, shower and during sports. But some people do have problems with them falling off. There are adhesives you can buy to keep them in place.
You cannot remove a sensor for a while once it has come off you need to replace it with a new one.
How often you have to change the sensor will depend on the type of model youre using and the manufacturers instructions. Youll usually need to change it at least once every 14 days.
Its quick and painless to put on a sensor. You insert them just under the skin using an applicator.
Coming Soon To Your Smartwatch: Cgm For Healthy Adults
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Continuous glucose monitors have revolutionized diabetes care since the first such device was approved by the FDA for personal use in 2005. Today, improvements in glucose sensor accuracy, smaller sensor size and ease of use have made it easier than ever for people with diabetes to monitor their blood glucose trends in real time and Silicon Valley is taking notice.
Fitbit, Apple and Google are all reported to be investing in CGM technology, and dozens of smaller startups are developing CGM products aimed at adults without diabetes, according to industry experts. In 2018, Fitbit, which Google announced it would acquire last November, invested $6 million in the glucose monitoring startup Sano, which is developing a patented biometric sensor contained in a patch, according to the companys website. In August 2018, AppleInsider reported on Apples patent application for a proprietary technique to noninvasively measure glucose with the Apple watch.
Currently, four companies have FDA-cleared, personal CGM devices on the U.S. market that are available with a prescription for people with diabetes: Abbott , Dexcom , Medtronic and Senseonics . With several CGMs aimed at healthy adults already in development, the devices could soon become as common as activity trackers.
A growing trend
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Is A Continuous Glucose Monitor The Same As An Insulin Pump
No, CGM devices and insulin pumps are not the same.
They do very different things:
- CGM devices measure your glucose level automatically every few minutes, all day long.
- Insulin pumps deliver a steady flow of insulin based on instructions you give.
But they are similar in some ways. Both CGM devices and insulin pumps are:
- Automated: They work all day and night for as long as you wear them.
- Worn directly on your body: Most people wear CGM devices and pumps on their arm or belly.
- Customizable: You can adjust CGM and pumps based on your life and how diabetes affects you.
- Convenient: With CGM, you need fewer fingerstick tests. Insulin pumps mean fewer injections .
- Not a quick fix: CGM and pumps both help you better manage diabetes. But each device requires you to actively use it and direct your own treatment decisions.
Monitoring Your Blood Sugar
Regular blood sugar monitoring is the most important thing you can do to manage type 1 or type 2 diabetes. Youll be able to see what makes your numbers go up or down, such as eating different foods, taking your medicine, or being physically active. With this information, you can work with your health care team to make decisions about your best diabetes care plan. These decisions can help delay or prevent diabetes complications such as heart attack, stroke, kidney disease, blindness, and amputation. Your doctor will tell you when and how often to check your blood sugar levels.
Most blood sugar meters allow you to save your results and you can use an app on your cell phone to track your levels. If you dont have a smart phone, keep a written daily record like the one in the photo. You should bring your meter, phone, or paper record with you each time you visit your health care provider.
Sometimes having high blood sugar can feel like a test you didnt pass. But numbers are just numbers. Think of them instead as information. Did a certain food or activity make your levels go up or down? Armed with that knowledge, you can make adjustments and get closer to your target range more often.
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What To Do When Youve Tried Everything And Still Cant Get A Cgm Approved:
If youve exhausted all of your options for getting CGM coverage, its not over yet! Though CGMs can cost anywhere from a couple of hundred to a couple of thousand dollars out-of-pocket for a 30 to 90 day supply, there are still some saving strategies you can try to get this cost down.
First, you may be eligible for CGM manufacturers patient assistance programs if they have them. Patient assistance programs can lower the cost of diabetes supplies and medications for low-income households.
Second, several websites offer people with diabetes cost-savings options on old or refurbished supplies for filling blood glucose meter and CGM orders like Save Rite, Lifeline Direct, and Diabetic Warehouse. Though its not ideal, older and refurbished CGMs are better than no CGMs to most people with diabetes who benefit from and love them!
Finally, you may also find that some CGMs cost less without insurance than CGMs with insurance! Before ordering your supplies, you should be able to get a quote from a direct medical supplier. This will give you the most transparency before you fill your prescription.
Getting a CGM approved and filled is bound to take time, so hang in there and dont get too discouraged on your path to getting one.
Educational content related to type 1 diabetes is made possible with support from Abbott Freestyle, the makers of the Freestyle Libre 2. Beyond Type 1 maintains full editorial control of all content published on our platforms.
Is It Still Blood Glucose Monitoring
People may assume CGM is continuous glucose monitoring but it is not blood glucose monitoring, as the sensors used are placed into the body but not into the bloodstream.
With a blood glucose meter, you use blood to do the test. With the sensors, they actually measure the glucose in your interstitial fluid, not your blood.
The CGM system can be used whether you wear a pump wearer or use injections for your insulin delivery.
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Are Continuous Glucose Monitoring Devices Easy To Use
CGM devices are complex little machines. They do require some upfront time to understand their technical aspects.
For example, you will need to learn how to:
- Insert the sensor properly.
- Transfer data to a computer or your phone.
- Respond to and make changes to your care plan based on the collected data.