What You Need to Know About Continuous Glucose Monitoring
Medically reviewed by Kelly Wood, MD
Continuous glucose monitors (CGMs) are tools that people with diabetes use to better manage their blood glucose (also known as blood sugar). CGMs automatically check your blood sugar levels at any hour of the day—meaning you can see what your glucose level is at any time and whether your levels are fluctuating throughout the day or over a period of time.
Because CGMs track your glucose all day and night, you and your healthcare provider can use the data you receive to make informed decisions about your health. These decisions may include how much movement or physical activity you participate in, which foods you eat, and what treatment options you may need.
How Does Continuous Glucose Monitoring Work?
Before using a CGM, you will need to insert a small sensor underneath the skin on either your arm or your abdomen. The sensor look attaches to your skin using a small needle or a sticky patch. Your CGM will typically look like a thin, white, and button-shaped device. Once the sensor is on your skin, you will be able to connect the sensor to an app on your phone that can give you immediate results about your blood sugar levels at a given moment.
The function of the CGM is to measure the sugar in your interstitial fluid—or, the fluid that flows between your body’s cells. The sensor tests your glucose levels every few minutes and sends that information to a device via a wireless transmitter. Most people use their smartphone as the device, but handheld receivers and insulin pumps can also connect to the CGM.
While your CGM can give you real-time glucose readings, you can also use the device to download data that shows your blood sugar history over a longer period of time. This helps you and your healthcare provider use the data to look for trends in your glucose levels and make any necessary changes to medications, lifestyle habits, or diet.
It's worth noting that older sensors may require to manually prick your finger to test your blood sugar twice a day. This is to compare the results of the finger prick to the results of the CGM. If the numbers are the same or very similar, then you know your CGM is working well.
You may also need to replace the sensor under your skin from time to time—generally, once every two weeks. Fortunately, you can change the sensor yourself using an applicator that comes with the device. Newer sensors, however, have removed the need for finger pricks.
Who Qualifies for a CGM?
Most people who use CGMs have type 1 diabetes (T1D). People with type 2 diabetes (T2D) can also use them too, but often require a history of hypoglycemia (low blood sugar) to qualify. In order to use a CGM, you'll need a prescription for the device from your healthcare provider.
Your provider can also help you figure out the exact device that you need, as different models are available depending on your age and needs. How long you use a CGM can also vary. Some people might only use their CGM for a few short weeks as they adjust to a new diabetes care plan. However, others may opt to use them long-term as a part of their ongoing management of diabetes.
Generally, your may qualify for a continuous glucose monitor if you:
Need daily insulin shots
Are experiencing any trouble managing your blood sugar
Live with hypoglycemia unawareness, a condition that makes it difficult for you to recognize the symptoms of hypoglycemia (or, low blood sugar)
Unfortunately, not all health insurance companies pay for CGMs. Medicare covers CGMs for those who are on insulin therapy or people who have had a history of hypoglycemia episodes. Medicaid covers CGMs for people who are on insulin therapy and either use an insulin pump or require three or more daily injections.
If you have diabetes and are interested in trying a continuous glucose monitor, talk to your healthcare provider and your insurance company about your options.
Benefits
There are numerous benefits to wearing a CGM. According to the American Diabetes Association, people with both type 1 and 2 diabetes have fewer hypoglycemia events while using a CGM, and tend to have lower A1c numbers—a measure of blood glucose over a three-month period.
Other benefits of using a CGM include:
Preventing hypoglycemia or hyperglycemia episodes: If your blood sugar drops too low, you may have hypoglycemia. This complication can cause fainting, shaking, and sweating, among other symptoms. In serious cases, having a blood sugar that's too low can lead to coma or death. In contrast, hyperglycemia occurs when your blood sugar becomes too high. As a result, you may develop a life-threatening complication diabetic ketoacidosis. Using a CGM can alert you when your glucose levels become too high or too low. An alarm will sound on your monitor, letting you know your blood sugar is dropping or increasing too much or too quickly.
Seeing the bigger picture: Without a CGM, people with diabetes prick their fingers to test glucose multiple times a day. That is helpful but only gives one data point—meaning that you can only see your glucose level at one point in time, rather than continuously. With a CGM, you can check your glucose levels instantaneously at any point of the day. This allows you to see trends in your glucose levels, which you can use to better manage your condition.
Needing fewer finger pricks: With an older CGM model, you will only need to prick your finger twice a day to calibrate the monitor. Some newer monitors have even eliminated the need to calibrate the device at all. This saves the hassle and stress of having to prick your finger throughout the day and also allows you to sleep the whole night instead of having to test your sugar in the middle of your rest.
Managing your condition better: Using a CGM gives you more information about your blood sugar levels. This can help you better plan your diet and exercise plan. Additionally, having this information on hand can also lead to fewer blood glucose emergencies, such as hyperglycemia and hypoglycemia. Over time, better diabetes management can also reduce your risk of diabetes-related complications.
Limitations
The main limitation for many people needing a CGM is the cost of the monitor. These devices can be expensive and not all insurance companies cover the cost. Medicaid, a state-based government program that provides healthcare to low-income families, has very strict regulations regarding CGM eligibility. However, if you don't qualify for Medicaid, obtaining a CGM out-of-pocket can be difficult.
On average, CGM kits can cost upward of $1,000—with extra spending needed for replacement sensors, alcohol wipes, medical tape, and other supplies. To use it continuously, you will need to purchase new transmitters and sensors periodically, which can cost a few thousand dollars per year.
When to Contact a Healthcare Provider
If you are living with either type 1 or type 2 diabetes, talk with your healthcare provider about whether a CGM is a good option for you. If they think a CGM can benefit you, they can give you a prescription to obtain the device. A prescription is necessary because some insurance companies may refuse to pay for the device unless you and your healthcare provider can show that a CGM is a medical necessity.
Additionally, it's a good idea to talk to your provider if you have difficulty recognizing when your blood sugar is dropping or if you're having trouble balancing your glucose levels. CGMs are designed to help you manage your diabetes more effectively and your provider can offer insight about the device.
A Quick Review
Continuous glucose monitors are devices that help people with diabetes keep track of their blood sugar levels throughout the day. As the technology of CGMs advances, the monitors are getting more accurate and easier to use. With real-time knowledge of your blood sugar and the ability to see your full glucose history, CGMs can help you feel more in control of your condition and help you better manage diabetes.
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