Download What is continuous glucose monitoring?

MONITORING page changes
General Guidelines
1. When opening VIDEO TAB, the Diabetes Answers page shows description:
Daily self-monitoring of blood glucose provides people with diabetes the information they need to
assess how food, physical activity and medications affect their blood glucose levels. Monitoring,
however, doesn't stop there. People with diabetes also need to regularly check their blood
pressure, urine ketones and weight. Diabetes education classes instruct patients about
equipment choice and selection, timing and frequency of testing, target values, and
interpretation and use of results.
Suggested – add:
‘Diabetes counseling can also include having a Continuous Glucose Monitor placed by an
educator, or physician, which track the glucose between your body’s cells every 3-5 minutes.
The patient wears it for 3-5 days, during which time the patient also performs 2-5 finger stick
blood glucose tests daily and tracks food and beverage intake. The educator can then take all
the information, and graph it, to better evaluate a 24 hour cycle of blood glucose.’
2. The current ‘Video on Importance of Monitoring’
Suggested change: this new version shows someone actually monitoring, rather than an illustration;
although it is from the U.K., the glucometer used is international. It is not as detailed, but is simpler.
It will need to be re-titled if used, to: ‘How to test your blood glucose (sugar) levels’
http://www.youtube.com/watch?v=rMMpeLLgdgY
3. The current ‘Knowing your Blood Sugar Numbers’
Suggested change – delete current version, insert newer version:
https://www.optumrx.com/vgnlive/CHP/Assets/PDF/DiabetesBehaviors/KnowingYourBloodSugarNu
mbersIsKey.pdf
4. The current ‘Understanding Home Blood Glucose Goals.’
Suggested change, because the goals are not standard goals, per the ADA, AADE, or ACE. I suggest
removing the recommendations for morning, etc, and add the following (some of the wording is my
own):
What Are the Target Ranges?
Blood glucose targets are individualized based on:
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duration of diabetes
age/life expectancy
comorbid conditions
known CVD or advanced microvascular complications
hypoglycemia unawareness
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individual patient considerations.
Three US organizations that contribute and create guidelines for people with diabetes
1. The American Diabetes Association suggests the following targets for most nonpregnant
adults with diabetes. More or less stringent glycemic goals may be appropriate for each
individual. The following goals are especially appropriate if you have complications of
diabetes, heart disease, and/or are elderly:
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A1C: 7%
A1C may also be reported as eAG: 154 mg/dl
Before a meal (preprandial plasma glucose): 70–130 mg/dl
1-2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than
180 mg/dl
*Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial
glucose goals.
2. The American College of Endocrinology suggests the following targets, for most nonpregnant adults with diabetes who are not having complications of diabetes:
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A1C: 6.5%
A1C may also be reported as eAG: 140 mg/dl
Before a meal (preprandial plasma glucose): less than 110 mg/dl
2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than
140 mg/dl
3. The American Association of Diabetes Educators suggests the following targets, for most
non-pregnant adults with diabetes who are not having complications of diabetes:
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A1C: 6.5%
A1C may also be reported as eAG: 140 mg/dl
Before a meal (preprandial plasma glucose): 80 - 120 mg/dl
2 hours after beginning of the meal (Postprandial plasma glucose)*: Less than
140 mg/dl
What Do My Results Mean?
When you finish the blood glucose check, write down your results and review them to see
how food, activity and stress affect your blood glucose. Take a close look at your blood
glucose record to see if your level is too high or too low several days in a row at about the
same time. If the same thing keeps happening, it might be time to change your plan. Work
with your doctor or diabetes educator to learn what your results mean for you. This takes
time. Ask your doctor or nurse if you should report results out of a certain range at once by
phone.
Keep in mind that blood glucose results often trigger strong feelings. Blood glucose numbers
can leave you upset, confused, frustrated, angry, or down. It's easy to use the numbers to
judge yourself. Remind yourself that your blood glucose level is a way to track how well your
diabetes care plan is working. It is not a judgment of you as a person. The results may show
you need a change in your diabetes plan.
5. The current ‘ FAQ About Monitoring’
Suggested change – delete current version, insert newer version:
https://www.optumrx.com/vgnpreview/CHP/Assets/PDF/FAQsAboutSelfMonitoring_English.pdf
6. The current ‘Monitoring (Source: CDC)’ is very hard to read; it is a PDF, that may be from a scanned
image? I found more updated version, tried to create a word document, but failed.
Suggested change – delete current version, insert newer version, but you may be more masterful in
doing it…differently?? Here’s where I found the information:
http://www.cdc.gov/diabetes/pubs/tcyd/ktrack.htm
7. Add a new heading: Continuous Glucose Monitors
I attached a word document
Tools
8. The current ‘My Blood Sugar Card’
Suggested change – delete current version, insert newer version:
https://www.optumrx.com/vgnpreview/HCP/Assets/PDF/MyBloodSugarGoalCard_eng.pdf
9. The current ‘Blood Sugar Log’ is easy to read; the newer version is smaller appearing, until you
enlarge it within link.
Possible change – delete current version, insert newer version:
http://www.diabetescostars.com/docs/pdf/BloodSugarLog.pdf
Problem Solving
10. The current ‘Cost of Strips’ has some typos.
Suggested change – delete current version, insert newer version: I attached a word document for the
new version
11. The current ‘What to know when Blood sugar Swings Low’.
Suggested change – firstly, change the title on the webpage to: ‘What to Know When Your Blood
Sugar Swings Too Low’
Secondly, delete current version, insert newer version:
https://www.optumrx.com/vgnlive/CHP/Assets/PDF/DiabetesBehaviors/WhattoKnowWhenYourBlo
odSugarSwingsTooLow.pdf
12. The current ‘Why is my Blood Sugar High in the Morning’ has some poor etiquette, labeling
“diabetics,” instead of “an individual with diabetes.” Therefore, I copied original, made changes, and
saved it as a new word document.
Suggested change – delete current version, insert newer version: I attached a word document for the
new version
13. The current ‘How Often Should You Check Your Blood Sugar’
Suggested change – firstly change title to reflect the link to How Often Are Your Blood Sugar
Readings in Your Target Range,‘ secondly, delete current version, insert newer version:
https://www.optumrx.com/vgnlive/HCP/Assets/PDF/DiabetesBehaviors/HowOftenAreYourBloodSug
arReadingsinYourTargetRange.pdf
14. The current ‘Monitoring when not taking any Medications’
Suggested change – capitalize the first letter of each word of title, then delete current version, insert
newer version:
https://www.optumrx.com/vgnlive/HCP/Assets/PDF/DiabetesBehaviors/MakingSenseofMonitoring
withoutMedication.pdf
15. The current ‘Making Sense of Monitoring: when on oral diabetes medications’
Suggested change – firstly, change order of this topic, have it follow the prior when not taking any
Medications, then capitalize first letter of each word of title, then delete current version, insert
newer version:
https://www.optumrx.com/vgnlive/HCP/Assets/PDF/DiabetesBehaviors/MakingSenseofMonitoring
withOralMedication.pdf
16. The current ‘Making Sense of Monitoring: when on insulin’
Suggested change – capitalize first letter of each word of title, then delete current version, insert
newer version:
https://www.optumrx.com/vgnlive/CHP/Assets/PDF/DiabetesBehaviors/MakingSenseofMonitoring
withInsulin.pdf
Meter Companies
17. The current links for all of these meter companies initially takes one to Diabetesnet.com, and
compares all meter brands. Then one has to individually find the correct title of a meter company
and click on the appropriate link. My suggestion is that firstly, being able to view the comparison of
meters is a good thing to put in, but then the link needs to be re-titled. Maybe you or someone else
wanted to have this indirect link???
Suggested change – use updated newer version of link:
http://www.diabetesnet.com/diabetes-technology/meters-monitors/blood-glucose-meters
delete current title of Abbott link, change to ‘Comparison of Glucose Meters’
Suggested change – delete link for Diabetes Supply of Suncoast – company must have folded??
Overall, I suggest adding the direct links for each of the meter companies, and here they are:
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Abbott Diabetes Care https://www.abbottdiabetescare.com/
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Advocate
http://www.advocatemed.com/AboutUs/OurProducts/MedicalSupplies/DiabeticSupplies/tabid/
67/language/en-US/Default.aspx
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Bayer Contour http://www.bayercontour.com/
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delete name and link for Diagnostic Devices as company has changed to Prodigy
insert Prodigy Diabetes Care http://prodigymeter.com/
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Entra Health Systems http://www.entrahealthsystems.com/
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delete name and link for Hypoguard as company has changed to Arkray USA
insert Arkray USA http://www.arkrayusa.com/
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delete name and link for HealthPia as company appears to have disappeared
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Lifescan http://www.lifescan.com/
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Nipro Diagnostics http://www.niprodiagnostics.com/
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Nova http://www.novacares.com/
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Nova Biomedical (more of a direct link to product)
http://www.novabiomedical.com/nova-diabetes-care-offers-free-nova-max-link-meter-formedtronic-minimed-paradigm-pump-users/
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Relion http://www.relion.com/
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delete name Roche, since many patients don’t know this name (?)
insert Accu-chek https://www.accu-chek.com/index.html
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U.S. Diagnostics https://www.usdiagnostics.net/
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WaveSense http://agamatrix.com/
Videos: How to Use Your Meter
Delete Ascensia Contour (Part 1) (Part 2) now obsolete?
Insert Bayer Contour Next & Next EZ (Part 1- Set up and Maintenance)
http://www.youtube.com/watch?feature=player_embedded&v=sYoFYlTL-zw
(Part 2 – Performing a Test)
http://www.youtube.com/watch?feature=player_embedded&v=C4oxhzCz40E
(Part 3 – The Microlet 2 Lancing Device)
http://www.youtube.com/watch?feature=player_embedded&v=-QLYy5CaL_k
(Part 4 – Safe Lancet Disposal)
http://www.youtube.com/watch?feature=player_embedded&v=s5VwjfBatms
Add FreeStyle Freedom Lite (bigger meter) http://www.youtube.com/watch?v=pEP9bQ5TEKg
Delete Accuchek Aviva – now obsolete?
Add AccuChek Nano http://www.youtube.com/watch?v=3a8ikYsjjR0
Add True Result http://www.niprodiagnostics.com/our_products/bgm_true_result.aspx
Why is my Blood Sugar High in the Morning?
Although this seems to be a more common concern in individuals with type 1 diabetes, this often happens
in individuals with type 2 diabetes and even those without diabetes.
Higher morning blood sugars are commonly due to the "dawn phenomenon." The dawn phenomenon
refers to the natural release of excess hormones, such as growth hormone, in the morning between 5 am to
8 am. This results in an increase in blood sugar levels in the dawn, or early morning.
Less commonly, one can have high blood sugars in the morning as a protective response to low blood
sugars during the middle of the night. This is referred to as the "Somogyi effect." Another reason for a
high blood sugar in the morning is that you may need a higher dose of your usual diabetes medication
(insulin and or pills).
Even though both the dawn phenomenon and Somogyi effect can result in higher blood sugars in the
morning, they are very different causes and have very different treatments. Your doctor may ask you to
check your blood sugar at bedtime, 3 am and first thing in the morning to help distinguish between the
two. For example, if your 3 am blood sugar is low, then the morning high blood sugar is probably the
body’s protective response to this low blood sugar (Somogyi effect). What would the treatment be? The
treatment would then be to either decrease the nighttime dose of insulin or add more food at bedtime. On
the other hand, if your 3 am blood sugar is also high, then the morning high blood sugar is probably due
to the natural increase in hormone production in the morning (dawn effect). In this case, treatment would
consist of increasing the bedtime dose of insulin or oral diabetes medication (pill) or shifting a portion of
the dinnertime insulin toward bedtime.
One tool to identify changes in the body’s glucose levels is to wear a Continuous Glucose Monitor
(CGM) for 3-5 days. Ask your diabetes educator where this service is available.
Cost of Strips
For patients that are insured, or for cash paying patients, almost all meters are free or offered at a reduced
rate. The real cost is the strips and lancets (needles used for drawing the blood). Test strips for the most
common brands of meters traditionally run roughly between 44 cents and $1 dollar per strip, depending
the meter, and on your co-pay if you are insured.
Discounts directly from manufacturers
Here are a few examples:
The FreeStyle Lite™ meters include a discount card that can save patients money. Cost would be about
$50 for 100 strips. The draw back on discount cards is that the patient must call to activate the card and
must have the card with them for every purchase. They also might get “junk mail” from the meter
company. Many patients, especially seniors, prefer not do this.
The Reli™ Meter offered at WalMart costs only $9 and the strips are about $23 for 50; or $46 for 100.
Discounts from mail order suppliers
The following companies ship your diabetic supplies directly to your home at no cost to you, often with a
free blood glucose meter in your first shipment. They bill Medicare or your private insurance for your
diabetic testing supplies, so you won’t have to wait for reimbursement. With some qualified plans you
may only need to pay your co-pay and deductible for your diabetes supplies.
Byram Healthcare – phone 1-877- 902-9726: they carry several brands that they give free with a
purchase of 50 strips; theses strips cost approximately $23 for 50 or $46 for 100. This deal is only good
through mail order; shipping is free. They also have an ‘Uninsured Program’ that includes:
• Low Cost and Discounted Diabetes Testing Supplies
• Free Meter Program (supporting patients without health
insurance)
• Free Blood Glucose Meter Kits (containing sample strips,
lancet device, lancets)
CCS Medical – phone 1-800-260-8193: may provide a free blood glucose meter in your first shipment.
Costs for strips are comparable with the Byram Healthcare.
Mini Pharmacy – phone 1-800-545-6464: is another mail order company that has meters they give
patients free, with purchase of 50 strips; cost is approximately $27 - $54 for 100 strips.
What is continuous glucose monitoring?
A continuous glucose monitoring system (CGMS) is an FDA-approved device that records blood
sugar levels throughout the day and night. There are several approved devices -- Medtronic's MiniMed
device, DexCom, and the Navigator, for example -- that can provide up to 288 blood sugar measurements
every 24 hours. The system is used to measure an average blood sugar for three to seven days (depending
on the model you have), while the person with diabetes continues daily activities at home.
How Continuous Glucose Monitoring Works
CGM systems provide glucose measurements as often as
once per minute. The measurements are transmitted to a
wireless monitor.
First, a tiny glucose-sensing device called a "sensor" is inserted just under the skin of the abdomen. The
insertion is quick, and is usually not painful. It's very similar to insertion of an insulin pump catheter.
Tape is used to hold it in place.
The sensor measures the level of glucose in the tissue every 10 seconds and sends the information via a
wire to a cell phone-sized device called a "monitor" that you attach to a belt or the waistline of your pants.
The system automatically records an average glucose value every five minutes for up to seven days.
Results of at least four finger stick blood sugar readings taken with a standard glucose meter and taken at
different times each day are entered into the monitor for calibration. Any insulin taken, exercise engaged
in, and meals or snacks consumed are both entered into a paper-based "diary" and then recorded into the
monitor. They are recorded by pushing a button to mark the time of the meals, medication, exercise, and
other special event you wish to record.
After the three- to seven-day time period, the sensor is removed at the doctor's office and the information
stored in the CGMS is downloaded into a computer. You and your doctor or diabetes health care team can
then review your blood sugar levels in relation to the other data collected and make any necessary
adjustments in your diabetes management plan. The information will be presented as graphs or charts that
can help reveal patterns of glucose fluctuations.
When a Continuous Glucose Monitor Is Used
The continuous glucose monitor is not intended for day-to-day monitoring or long-term self-care, and it is
not a replacement for standard blood sugar monitoring. It is only intended for use to discover trends in
blood sugar levels. This helps your health care team make the most appropriate decisions regarding your
treatment plan.
The main advantage of continuous glucose monitoring is that it can help identify fluctuations and trends
that would otherwise go unnoticed with standard HbA1c tests and intermittent finger stick measurements.
For example, the device can capture dangerously low overnight blood sugar levels, which often go
undetected, reveal high blood sugar levels between meals, show early morning spikes in blood sugar,
evaluate how diet and exercise affect blood sugars, or provide a review of the effects of changes made to
your treatment by your health care team.
Your doctor can prescribe the procedure as often as he or she believes it necessary to properly evaluate
your blood sugar patterns. Continuous monitoring is reimbursed by Medicare and covered by many
private insurance plans (check with your individual carrier). Additionally, there are professional and
personal CGMs being used.
People who use CGM systems can download data to a computer to see patterns and trends in their
glucose levels.
CGM systems are more expensive than conventional glucose monitoring, but they may enable better
glucose control. CGM devices produced by Abbott, DexCom, and Medtronic have been approved by the
U.S. Food and Drug Administration (FDA) and are available by prescription. Special software is
available to download data from the devices to a computer for tracking and analysis of patterns and
trends, and the systems can display trend graphs on the monitor screen.
After the three- to seven-day time period, the sensor is removed at the doctor's office or Diabetes Center
and the information stored in the CGMS is downloaded into a computer. You and your doctor or diabetes
health care team can then review your blood sugar levels in relation to the other data collected and make
any necessary adjustments in your diabetes management plan. The information will be presented as
graphs or charts that can help reveal patterns of glucose fluctuations.
The main advantage of continuous glucose monitoring is that it can help identify fluctuations and trends
that would otherwise go unnoticed with standard HbA1c tests and intermittent finger stick measurements.
For example, the device can capture dangerously low overnight blood sugar levels, which often go
undetected, reveal high blood sugar levels between meals, show early morning spikes in blood sugar,
evaluate how diet and exercise affect blood sugars, or provide a review of the effects of changes made to
your treatment by your health care team.
Your doctor can prescribe the procedure as often as he or she believes it necessary to properly evaluate
your blood sugar patterns. Continuous monitoring is reimbursed by Medicare and covered by many
private insurance plans (check with your individual carrier).
This information was sourced on December 15, 2013, from:
http://diabetes.niddk.nih.gov/dm/pubs/glucosemonitor/
http://diabetes.webmd.com/continuous-glucose-monitoring