Continuous Glucose Monitoring Systems is perhaps one of the newest and most exciting advances in diabetes care.
I know that these have been mentioned in other columns, but I would like to take some time to focus on this technology and raise the community's awareness. The first step to understanding the value of CGMS is the recognition of the limitations of blood-glucose testing.
When a patient checks their blood sugar, they are given information for a single moment in time. Patient's are often encouraged to aim for a good blood glucose and often only feel successful if their sugars are normal. Normal is a value or range that should be determined by the provider and patient.
Not all patients can be treated the same. For example, a young, healthy patient with plenty of support could aim for a lower goal. One must remember that the lower the blood-sugar goal is set, the more likely hypoglycemic events can occur. Hence, I never have my older patients, or those with poor health or support, set their blood-sugar goals too low.
The value of safety must not be overlooked. Hypoglycemic events not only put the patient at risk for trauma, they can also stress the body and lead to cardiovascular events. When a patient and provider determine a safe range for normal, adequate blood testing will indicate how well the patient is doing.
No matter how the patient is doing, it is crucial to understand that a blood sugar is only one moment in time. The true blood-glucose level is constantly fluctuating depending on carbohydrate intake/absorption, exercise and general health.
This is best demonstrated as a graph of blood sugar vs. time. These graphs demonstrate the fluctuation of glucose levels in a linear fashion. One blood-glucose value does not determine a line; at least two points are necessary. One must remember that while you may have one glucose level, that provides no information concerning the direction that sugar may be going.
For example, many patients tell me the story of having a normal blood sugar, eating the same food they normally do, and on some days ending up significantly higher, on others they remain normal, and on some their sugars even go low. This is secondary to the direction or trend that the sugar is following.
The CGMS systems work in the fluid surrounding the cells of the body, not the blood. The sensor interacts with this fluid, and a transmitter device calculates a sugar level. This is then transmitted to either a pump or other type of device. That device will provide the patient with a graphical representation of their blood sugars.
The value in this data is not the number displayed but the trend of the sugar level. Using this data, patients can adjust their medications, meals and exercise. Likewise, this data enables them to observe the effects of medication, food and exercise. The flow of the trend will enhance the care the patient receives and provide some protection from adverse events.
For example, if I look at my sensor and see a value of 100, but the graph is heading down, I understand that I may need to eat something to avoid a low sugar. Similarly, a value of 150 heading up sharply might inspire me to decrease the carbohydrates I eat, increase insulin or exercise. These minor adjustments based on the data trend can significantly improve blood-sugar levels and quality of life. If you have an interest in the continuous monitoring systems, research your options or discuss it with your health-care provider. The safety and security provided by these devices is unmatched in the diabetes world. Clearly, the trend is your friend.
Dr. Jonathan Beach, who has lived with diabetes himself since age 4, heads the Northeast Center for Diabetes Care and Education at Urgicare of the Northeast in Plattsburgh. Send questions for this column, which runs the second Tuesday of every month, to: Features Editor, P.O. Box 459, Plattsburgh, NY 12901 or email features@pressrepublican.com.
