CONTINUOUS GLUCOSE MONITORING – A1C VERSUS GLYCEMIC VARIABILITY

Diabetes Doctor

Having a good A1C doesn’t always mean your blood sugars are “well controlled.” For example, what about the patient who has an A1C of 6.4% but who’s blood sugars vary from 50 to 300 mg/dL throughout the day.  Regardless of their A1C, these wide fluctuations puts them at risk for passing out from low blood sugars and damage from high blood sugars. The A1C tells us what blood sugars have been averaging over the past 3 months, but does not tell the story of what happens day to day. Finger pokes of blood sugar readings with a glucometer may give us more insight into what’s happening during the day, but not in between readings. If your blood sugar in the morning is 120 mg/dL – was it just coming down from 250 mg/dL? Was it just coming up from a low blood sugar of 60 mg/dL? Or has it been steady at 120 mg/dL all night long?  Certainly the 120 mg/dL reading alone doesn’t tell the full story.

This is where continuous glucose monitoring has emerged as an extremely beneficial option for diabetes patients. Continuous Glucose Monitors (CGMs) have been around for a while now, but more often used in patients with type 1 diabetes. Today, there are plenty of great options for people with Type 2 diabetes to also use and learn from these monitoring devices!

What is a CGMs?

Continuous glucose monitors have sensors placed with a small needle under the skin either on the arm or abdomen that reads glucose levels (the size of a small “cat whisker”). The sensors, ranging in size from a penny to a stack of two quarters, are held in place with adhesives. The sensor is worn in place for 7-14 days at a time before being changed. There is even a sensor that is implantable by your doctor (http://www.senseonics.com/) for 3 months.  The sensor measures blood sugars 24/7 and transmits their blood sugar readings via Bluetooth to a handheld receiver or directly to a smartphone app. The display will tell you at any time 1) what your blood sugar currently is, 2) what direction it is trending, and 3) what blood sugars have been over the last 8+ hours.

 

BENEFITS OF CGMs

  • ALARMS: When glucose levels are too high or too low, you can receive notifications to take steps, such as drinking some juice to prevent a low blood sugar. For example, wouldn’t you like to know if your blood sugar was 80 mg/dL and dropping? Or 200 mg/dL and continuing to increase? It would help give you guidance on what to do to keep blood sugars in range.
  • LOWER A1C WITHOUT MORE MEDICATION: Studies have shown that simply wearing a CGM can lower your A1C through helping you understand your blood sugars better. Better control with less medications and no side effects!
  • LEARN ABOUT FOOD & ACTIVITY: Seeing blood sugars continuously can give insight into how certain foods or exercises may affect your blood sugars (since everyone is different!) Some people see strength training can INCREASE blood sugars whereas cardio exercise can DECREASE blood sugars.  
  • No more painful finger sticks! The FreeStyle Libre (https://freestylelibre.myehcs.com/?gclid=EAIaIQobChMIs4f7tOiL4QIVviCtBh3ARQkYEAAYASAAEgIV_PD_BwE) or Dexcom G5/G6 (https://www.dexcom.com/) are both accurate and approved by the FDA to replace finger pokes from blood glucose monitors.

HOW TO GET A CGMs

Talk with your healthcare provider or pharmacist about options that would be best for you. Often times it will come down to cost of the product and coverage through insurance.   CGM is now covered by Medicare for patients with type 2 diabetes who are on multiple injections of insulin daily. Also, many commercial insurance companies will cover a CGM for type 2 diabetes.  If this is not covered by insurance, the least expensive option at this time is the FreeStyle Libre scan system.  Cash pricing is generally <$100/month for the system – which can be less expensive than glucose meter test strip supplies.

 

 DEXCOM G6 FREESTYLE LIBRE