Can you guess the exact weight of something without a scale? The same applies to guessing what your glucose (sugar) level might be at any given time of the day. However, continuous glucose monitoring (CGM) devices make the invisible, visible.
CGM sensors are worn on the body and measure continuously what your glucose levels are 24/7. You can also see – in real time – the effects that food, activity, medications, stress and hormonal changes have on your glucose levels. This allows you the opportunity to make adjustments in your lifestyle and insulin dosing decisions (as applicable) that can improve them.
How can CGM help you with food choices?
You can’t fix what you can’t see. If you see that a high glycemic index food like sugary cereal makes your glucose levels rise, you can decide if you want to try a different type of breakfast with a lower glycemic index (such as oatmeal). You can also add protein (such as plain yogurt or eggs), so that your glucose will rise more slowly. You can experiment with food choices at a buffet when you are out for breakfast or dinner and see what works for you.
It is important to understand that not everything you eat will affect your glucose levels the same way every day. We are not machines that have the same reaction every time. Sometimes stress, hormone levels and absorption rates (especially in the case of insulin injections) can vary. But CGM can give you a window into how things are going that day. It’s valuable to experiment with different strategies, such as food choices and ingredients, and food combinations. Try incorporating physical activity after your largest meal and see the impact it has on your glucose levels. It really helps!
How can CGM help you with physical activity?
Data has shown that going for a walk after a meal can help to prevent glucose levels from rising too high. So even if you had a high glycemic index meal, you can help to control your glucose levels by increasing your activity. If you take insulin or a sulfonylurea (such as glyburide or gliclazide) to manage your diabetes, it’s important that you bring a source of rescue glucose when exercising to treat any potential low glucose (hypoglycemia).
Activity in any form helps with cardiovascular, respiratory, mental and physical health, improves glucose levels and helps to keep weight under control. Start with whatever amount and type of exercise works for you. Very few of us are running marathons! If you can walk 5 minutes, begin with that amount and try to increase your time daily. Water walking in the pool, a stationary bicycle, resistance bands, chair yoga and lifting light weights are also excellent options. Choose the ones that fit your fitness and interest levels.
How can CGM help you with medication adjustments?
In recent years, we have seen a lot of new medications that can help manage glucose levels and also improve heart and kidney health. In addition, many of these medications have weight loss benefits.
Sometimes, you and your diabetes healthcare team may decide that you need to change or add medication(s) to better manage your glucose levels. When you wear a CGM, you can see the impact of these changes in real time. You don’t have to wait until your next visit with your healthcare team. CGM data such as “time in range” (TIR) or the “glycemic management index” (GMI) can show you how well the medication is working. This works particularly well for adjusting insulin regimens.
How can you have meaningful discussions about CGM with your diabetes healthcare team?
Wearing a CGM brings valuable information to your healthcare team. You can talk about what has impacted your glucose levels on that particular day and overall, which helps you and your healthcare team make more informed decisions about what needs to be adjusted (e.g. adding or changing medication, insulin, modifying your diet and/or activity, etc.). CGM has been shown to improve confidence in effective decision-making1, allowing you to see the results of adjustments you make and leading to more meaningful conversations with your healthcare team. Having these conversations allows you to be an active participant in your care, and to jointly make decisions about what you can change to reach your glycemic targets.
You live with your diabetes 24/7. It’s important that you understand how to adjust your medications, especially when you are ill, have significant weight loss, are adjusting your activity levels or during times of stress. You can set personal goals for the amount of time you want to stay in target range (e.g. glucose levels between 4 and 10 mmol/L). You can see the progression and don’t have to wait for your next blood work results from the lab.
Continuous glucose monitoring is a valuable diabetes management tool. The results on the graphs and charts are not intended for punishment or blame. You will have good times and not so good times. The important thing is that it allows you to react in real time to benefit your long-term health goals. The diabetes journey requires many decisions on a daily and even hourly basis. CGM gives you insights into how to react to the inevitable curve balls that life will throw at you.
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