Choices in Blood Glucose Monitoring
January 25, 2018
By Karen Wilkinson, RN, NHA, CLNC – CareerSmart® Learning Contributor
Centers for Disease Control and Prevention (CDC) now reports that 23.1 million people in the United States have diagnosed diabetes. For those Americans, monitoring of blood glucose levels is a fact of life, and essential for managing the disease and preventing health problems. But many people struggle to maintain a healthy blood glucose target range, and the simple steps of diabetic care are not so simple for many. Eating more carbohydrates than usual, physical inactivity, infection, illness, and changes in hormone levels, stress, and medication can all cause blood glucose to rise. Other diabetics need to quickly identify hypoglycemia when blood sugar falls in order to manage symptoms. Testing and tracking blood glucose levels allows both patients and providers to better manage and control the disease and more effectively reach glycemic goals.
For self-monitoring, the use of a blood glucose meter is still the most common method used by the majority of diabetics. These meters give a measurement of blood glucose at a point in time, reporting results in milligrams of glucose per deciliter of blood. This type of testing requires the skin to be pricked and blood applied to a one-use test strip multiple times a day. A different type of monitor, called a continuous glucose monitor or “CGM”, is recommended for those whose blood glucose rises and falls frequently, generally Type 1 diabetics. These devices measure interstitial glucose rather than blood glucose, and generally use a small sensor placed under the skin, a transmitter attached to the sensor, and a receiver that provides and stores results. Readings are provided every minute or every few minutes around the clock; ideal to show trends in glucose levels. Most CGMS are equipped with auditory or vibratory alarms to alert to hyperglycemia or hypoglycemia, and some work in conjunction with insulin pumps to deliver adjusted doses of insulin based on parameters programmed within the system. Because the CGM results are not as accurate as finger-stick blood sugar results, it remains necessary to validate the readings through finger-stick testing a few times a day.
Newer monitoring devices are becoming less invasive and more technologically savvy. Monitoring systems are now available to provide real-time, on-demand glucose information for up to 14 days, without the requirement for a finger-stick each time. These systems use a small, thin wire that barely pierces the skin as part of an externally-worn sensor on the back of the arm. The amount of sugar present in the interstitial fluid under the skin generates an electrical signal that can be scanned by the reader at any time as long as the sensor remains in place. New models have a sensor life of 14 days, at which time the sensor stops working and needs replacement. Calibration using finger-stick testing is usually not required; however, a warm up period from one hour to several hours is required after the sensor is first applied. Generally messages or alerts are not delivered through the on-demand systems. At least one of the on-demand systems is Bluetooth compatible through associated applications compatible with some smartphones and watches. Synced information may include current glucose readings with text-to-speech option, trending of glucose results, and eight-hour glucose history. Features also include the ability to add notes, store data for up to 90 days, and share reports with physicians or others.
As millions of Americans are diagnosed with diabetes, the biomedical industry is responding with newer and smarter ways to manage glucose levels and diabetes. Physicians and diabetes educators can assist patients with choosing the type of meter that provides the necessary information to manage diabetes within the cost and technology limits of the individual.
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Merendino, J. What is a continuous glucose monitor for diabetes? Sharecare.com. Retrieved January 07, 2019 from https://www.sharecare.com/health/diabetes/what-is-continuous-glucose-monitor
U.S. Food & Drug Administration. (2018). 2018 Device Approvals. Retrieved January 07, 2019 from https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm596872.htm
Abbott Laboratories. (2018). Real-time glucose information. Retrieved January 09, 2019 from https://www.freestylelibre.us/system-overview/continous-glucose-monitor-app.html