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The Continuous Glucose Monitor
One of the latest tools used to manage glucose levels and prevent hypoglycemia is called a CONTINUOUS GLUCOSE MONITOR, or “CGM”. CGMs consist of three parts: A sensor placed just below the skin, a transmitter for sending a glucose signal, and a receiver for displaying the data. The sensor is a disposable filament that is changed on a regular basis. The transmitter holds an electric charge and is re-usable. The receiver can take the form of a handheld display, an app on a smartphone or smartwatch, or even an insulin pump.
Another unique benefit of CGMs is that they can provide trending information. This allows the user to know not just what their current glucose level is, but what direction it is headed and how fast it is either rising or falling. This allows for better decision making for things like insulin dosing, food, exercise, driving and going to sleep.
CGM Options Now let’s take a quick look at the various CGM options. Currently there are four companies that produce CGM systems. Dexcom’s G6 system features a sensor that is changed every 10 days and a transmitter that lasts 3 months. The system does not require fingerstick calibrations, and the readings may be used as a replacement for fingersticks. It features high/low alerts, predictive low alerts and rate-of-change alerts. The transmitter sends a Bluetooth signal continuously to a smartphone, pump or Dexcom-specific receiver, and the data may be shared and viewed by loved ones on their smart phones. Calibration is not required but is permissible. The data is deemed accurate enough to be used as a replacement for fingerstick blood sugar measurements.
Abbott’s Freestyle Libre is called a “Flash” monitor. Each sensor and transmitter lasts for up to 2 weeks and has the transmitter pre-attached to the sensor. Data is viewed on a Freestyle Libre handheld receiver or smart phone with LibreLink app by “scanning” or “waving” device past the sensor at least once every eight hours. Although it does not alert the user of pending high or low glucose levels, it does show current glucose values and trend graphs. Calibration is not required or permissible with this system. The data is deemed accurate enough to be used as a replacement for fingerstick measurements.
Medtronic’s Guardian Connect features a 7-day sensor and a rechargeable transmitter which sends a radio signal to a smartphone. It provides hi/low alerts, predictive hi/low alerts and rate-of-change alerts for the user. The same sensor and transmitter can also send data for display directly on the Medtronic insulin pump. Users must perform fingersticks at least twice daily to calibrate the system. At this point, the data has not been deemed accurate enough to be used as a replacement for fingerstick measurements.
The Eversense sensor from Senseonics is quite different from the others. The sensor is the size of a small caplet and is placed below the skin in a doctor’s office through a minor outpatient procedure. The sensor lasts for 3 months and must then be removed and replaced in the doctor’s office. After insertion, a transmitter is taped to the skin surface. The transmitter must be removed from the skin daily for re-charging. When on the skin, it sends a Bluetooth signal to a smartphone app, which generates high/low alerts, predictive alerts and rate of change alerts for the user.
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