Blogs

Contact With LindaRD

Recent Posts

Living with Diabetes and a CGM

View More

April – Ozempic Update with Our Clients

View More

How to Talk To Your Kids About Nutrition And They Will Listen

View More

Is Intermittent Fasting a Good Way to Lose Weight?

View More

Living with Diabetes and a CGM

by

It is amazing how technology has and will continue to improve the lives of people living with diabetes.You might see a CGM (Continuous Glucose Monitor) on a friend or family member and they will talk about how it has transformed their life. A CGM is a device that is inserted into the body that continuously monitors blood sugar levels giving you real-time updates without having to prick your finger. Without a CGM, living with Type 1 diabetes, the recommendation is to prick your finger 5-6 times per day to know how much insulin to take. With a CGM they do not have to do that anymore, which is life changing. You see these devices on the back of the arm, upper thighs or abdomen. It can be scary after receiving a diagnosis of Type 1 or Type 2 Diabetes and you are wearing this device that your doctor really has told you nothing about. If you are referred to us we can take the time to thoroughly explain how this device could be a great benefit to you. There are many different types of CGMs out there such as Freestyle Libre, Guardian, Dexcom, Stelo and Eversense. The company might teach you how to insert the sensor with a quick video and you will see what your blood sugar is. Unfortunately, it is not that easy.

Let us tell you about Jack who was referred by his endocrinologist and went through the training for his new Omnipod insulin pump but still had many questions about why he was experiencing many low blood sugars. We discussed the importance of carb counting with his new insulin pump to ensure the pump is providing the accurate amount of insulin. We learned Jack was informing the insulin pump that he was eating more grams of carbohydrate than he was actually consuming and instructing the insulin pump to provide too much insulin to cover his meals. This was a major cause for the low blood sugar levels after meals since too much insulin causes low blood sugar. Jack was experiencing low blood sugar levels while he was sleeping. The cause of these “false lows” was from a compression low. A compression low is an inaccurate reading from a CGM that occurs when pressure is applied to the CGM such as laying on the sensor in bed, which pushes the interstitial fluids (fluid between cells) away from the sensor not allowing the sensor to read a glucose level. Once you change your position or relieve that pressure from the sensor your blood sugar will shoot right back up to where it was before. It is important to speak with a specialist to discuss where to insert the sensor on your body to avoid these compression lows. The first time this happened to Jack or anyone else it can be a bit of a shock and cause a sense of panic but if you met with a Certified Diabetes Educator you would
hopefully know about this before it happens.

Another factor that impacts CGM accuracy is the importance of hydration. Jack admitted to not drinking enough water. We could tell on very hot days some of the sensor readings might have been a bit inaccurate since dehydration causes the interstitial fluid to become thicker and more concentrated with glucose, causing higher blood glucose readings. He is now drinking water before each meal and after each meal.

We discussed CGM readings vs glucometer readings with a fingerstick. Jack was surprised how his meter using a fingerstick read a blood sugar level of 96 mg/dL while his CGM read 115 mg/dL. Which number is correct?

Your blood glucose meter is reading the glucose in your blood, which is the more accurate reading if compared to your CGM reading. These CGMs do not measure blood glucose, they measure the glucose that is in the interstitial fluid and that is why you see a difference between a blood glucose and CGM value. That difference is displayed by an approximate 5-15 minute “lag” when you compare a finger stick vs. a CGM reading.

Nutrition related to CGM Management:
If your blood sugar is well managed, then this will add to the quality of your CGM accuracy. If your blood sugars are not constantly bouncing up and down, you are going to see more stable and
accurate readings.

We enjoy reviewing patients’ CGM data. We are happy to show people living with diabetes how right now we have the best technology that has ever existed. The big issue we see almost every day is the complaint of “I put the device on, and the thing does not work”. With our expertise we can provide a bigger picture, because this is going to be a very important part of your life, living with diabetes. CGMs are the best advancement for people using insulin in the history of diabetes care. CGMs are not always 100% accurate, but we still should go with those readings because we must go with something to track progress and can be helpful in deciding to increase or decrease medications.

If you need assistance with understanding your diabetes devices to lessen the burden of having to always prick your finger please reach out to Linda Michaelis MS, RD and Jackie Peterson RD,
CDCES.

The good news is that most insurance companies pay for nutritional counseling for Diabetes including ABMG, Aetna, Blue Cross, Blue Shield, CCHP, Cigna, Hill, Sutter and UHC. We are happy to call your insurance and check on coverage.

Refer to my website www.LindaRD.com for information about my services. Please call me at (925) 855-0150 about your nutrition concerns or email me at lifeweight1@yahoo.com and refer to my website www.LindaRD.com.