Continuous Glucose Monitoring: A Major Advance in Blood Sugar Control

| Sep 9, 2007

Life in the trenches with type 1 diabetes is challenging. Unpredictable blood sugars can leave a person with diabetes (PWD) feeling frustrated and helpless. The acute toxic effects of abnormal blood sugars also contribute to depression, anxiety, irritability, and food cravings.

Every PWD knows that the primary goal in managing diabetes is to keep blood sugar levels as close to normal as possible. Unfortunately, one of the "rewards" for those who work hard to control their blood sugar is an increase in low blood sugar attacks, or hypoglycemia.

These occurrences can be frightening, embarrassing, and dangerous. Avoiding low blood sugar attacks generally means keeping blood sugars higher. But higher blood sugars bring with them the proverbial dark cloud of complications.

Advanced treatment programs, like those taught by Dr. Richard Bernstein, have made relatively normal blood sugar levels attainable and much safer. Limiting total carbohydrate intake, matching carbohydrates with precise use of insulin, and frequent blood sugar monitoring have all made it easier and safer to maintain normal sugar levels.

But no matter how motivated a person is or how well a diabetes program works, maintaining tight control of blood sugars always has its teetering tightrope moments. And unexpected blood sugar spikes and drops feel like undeserved cheap shots. Every PWD has many times said in frustration: "What the hell is this and where did it come from!" after checking blood sugar levels.

Maintaining "normal" blood sugar levels requires a PWD to think and act like a pancreas. To achieve this, it's important to be able to react appropriately to changing blood sugars before they reach abnormal ranges. High and low blood sugar levels do not show up out of nowhere. Abnormal outcomes are the product of transitions over time.

Unless we can see these transitions and trends in progress, we cannot preempt and prevent abnormal blood sugars. Outside of checking blood sugars many times an hour, every hour of every day and night, it has not been possible to track blood sugar levels, trends, and patterns at all times. Not having "in-time facts" about sugar trends and patterns has made it difficult to accurately play the role of a pancreas.

But now continuous glucose monitoring (CGM) is making it possible. A company called Dexcom, Inc., of San Diego, California, has developed a monitoring system able to provide ongoing body sugar measurements without repeated finger or arm sticks. The system measures body sugar levels every five minutes, twenty-four hours a day, and wirelessly sends the data to a pocket monitor. This adds up to 288 blood sugar checks per day.

Dexcom's CGM system is set up to alert the wearer when blood sugar levels rise above or drop below preset sugar-level limits. This enables the wearer to identify, preempt, and prevent undesirable high and low blood sugars. The CGM system provides a safety net that prevents being blind-sided by low blood sugar hits and unexpected highs. This safety net is especially important for anyone who experiences hypoglycemia during sleep and for those at risk of low reactions when driving a vehicle.

The wireless monitor has a screen that shows blood sugar trends on a graph over time, making it easy to see what is happening and where things are likely going. Thus, the CGM makes it much easier to make accurate adjustments and play the role of a pancreas.

Set-up and use of the CGM is easy once the process is learned. It is not a completely non-invasive system. It requires the insertion of a small and flexible piece of metal under the skin. The inserted metal and an attached sensor stick to the surface of the skin. The sensor insert needs to be replaced weekly. The system also requires calibration, involving at least two finger sticks per day. Calibration is required to maintain the accuracy of the sugar readings.

The portion of the sensor under the skin is in contact with interstitial fluid, not blood. Interstitial fluid sugar levels adjust approximately fifteen minutes after changes have occurred in blood sugar levels. So there is a small delay in the real-time accuracy of the system. But this issue does not interfere with the use of the Dexcom as a life-enhancing information tool and safety net.

Dexcom's CGM system is the first generation of a relatively new technology, and new technologies always have room for improvement. One problem with the Dexcom system involves the low blood sugar warning system. Because interstitial fluid sugar levels rise more slowly than blood sugar levels, the low blood sugar warning system is slow to adjust to corrections.

After appropriate correction for a low sugar is made, the low blood sugar alarm on the meter continues to go off every five minutes until interstitial sugar levels normalize. This delay can be annoying, especially during the night, or can cause a person to over-compensate with dextrose or other blood sugar raising foods.

At some point in the future, the meter portion of the system will likely shrink down to the size of a small watch. As the manufacturer recoups its initial investment costs, hopefully the monthly costs of replacement supplies will go down enough to allow a majority of PWDs to use this technology. Currently, costs add up to around $240 per month for supplies, on top of an initial $450 for the meter itself.

Besides a few fixable flaws, the overall technological design, accuracy, and function of this first generation system is quite remarkable. The entire Dexcom system is designed and manufactured within the USA. Kudos to the creative technologic design teams at Dexcom.

Steven K. Gordon, ND, is a Naturopathic Physician who has had type 1 diabetes for over 25 years and has maintained an A1c of less than 5.5 % for the past ten years. Dr. Gordon has spent his professional life studying the biological factors that promote quality of life and health, contrasting them with the factors that cause aging, chronic disease, and diabetes. With his unique medical perspective, Dr. Gordon utilizes treatment protocols that re-establish and maximize health, body maintenance, and healing potentials. It is his conviction that while prescription drug treatments are essential for most people with diabetes, many other non-drug biological and metabolic factors have equal importance in improving health and preventing disease complications. When these factors are overlooked, quality of life, overall health and long-term outcomes are less than optimal. Certain forms of diabetes are actually curable, while other more difficult forms can be treated in ways that improve quality of life at all levels in the short and the very long-term. Diabetes, says Dr. Gordon, need not be feared.

Dr Gordon is in the process of finishing his first book, Understanding Metabolic and Blood Sugar Disorders - A Health Restoration Guidebook, which is due out in early 2008.

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Categories: A1c Test, Beginners, Blood Sugar, CGMs, Diabetes, Diabetes, Food, Insulin, Low Blood Sugar, Professional Issues, Type 1 Issues

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Sep 9, 2007

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