Diabetes is all about control, from keeping blood glucose levels in check, regular monitoring and evaluation of levels, to making simple everyday choices like what foods to eat, how much exercise to engage in and how much medication to take. A new device that has become available in the last year, known as the Continuous Glucose Monitoring System (CGMS), is making diabetes control a much more attainable goal for many patients.
Vasdev Lohano, MD, an endocrinologist with the Floyd Memorial Joslin Diabetes Center Affiliate, explained how the device works, “The CGMS functions just as its name suggests, it determines blood glucose levels on a continuous basis, allowing patients to see in real time how their daily activities, such as diet and exercise, affect their bodies. They can better manage their diabetes immediately, by adjusting their insulin dosages accordingly for high or low readings, and on an ongoing basis by developing an understanding of how their body responds to changes in medication, diet, exercise, stress levels, etc.”
Continuous glucose monitoring systems typically consist of three components:
- A disposable glucose sensor placed just under the skin to measure interstitial blood glucose levels.
- A non-implanted transmitter that communicates with a radio frequency receiver.
- An electronic receiver usually contained within an insulin pump that is worn like a pager and displays interstitial blood glucose level averages every five minutes. This receiver can be set to alarm if blood glucose levels dip below or rise above a certain level, so that the patient can make an adjustment immediately and prevent hypo- or hyperglycemic episodes.
Patients must be willing to take a proactive role
According to Dr. Lohano, patients must understand that while CGMS is an outstanding tool for managing their diabetes in real time, it is not a total replacement for testing blood sugars. “Since CGMS measures interstitial blood glucose, which lags approximately five to ten minutes behind traditional “fingerstick” measurements, the system must be calibrated by entering fingerstick blood glucose measurements at least twice a day,” he explained. “Because of this, I advise my patients to always obtain a fingerstick reading and consider its results as well before taking corrective action to any hypo- or hyperglycemia reading the device measures.”
Ideal patients for CGMS typically, but not always, have Type 1 diabetes and already use an insulin pump delivery system. “A patient who would like to utilize continuous glucose monitoring must be open to education and be very proactive about managing their diabetes. This technology is excellent, but it requires the patient to be willing to understand the underlying principles of diabetes and its treatment, and be open to making adjustments in their lifestyle and medication delivery to better control and manage their condition. If they are not interested in doing this, the device will not be useful to them,” explained Dr. Lohano.
Busy executive experiences “dramatic” results with CGMS technology
“‘Dramatic’ is the best word I can use to describe the results I’ve experienced in less than a year with the continuous glucose monitoring system,” explained Rich Forbes, CEO of Masterbrand Cabinets in Jasper, Indiana. As a busy executive, Forbes travels three to four days a week and is thrilled not only with the results he’s experienced on CGMS, but also with the flexibility it’s given him. “CGMS has been wonderful because it gives me so much flexibility. Since I can do fingersticks less often, I no longer have to interrupt my schedule to check my blood glucose. I have the peace of mind of knowing that I can simply glance down and see my levels at any time, and that the system will alarm me of any problems before I start experiencing symptoms.” Forbes began using the CGMS device along with his insulin pump in February, 2007. “The system’s ability to download a week’s worth of readings to a custom Web site and share charts of my blood glucose levels with my diabetes educator at the Joslin Center has been wonderful,” he said. “She reads my charts and sends me custom recommendations for how to reach my target range. Being able to make continuous adjustments has been such help in keeping my diabetes under control. My carbohydrate to insulin levels have dramatically improved, my A1C’s have gone from eights in February to sevens today, and most importantly, I feel better and am more confident in managing my health.”