Diabetes – What is Continuous Glucose Monitoring?

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What is Continuous Glucose Monitoring?

Continuous glucose monitoring (CGM) is a method of monitoring blood glucose levels through the use of a thin wire sensor placed just under the skin, which samples glucose levels every few minutes throughout the day. The information is transmitted to a device that enables the user to view the information in real time. The data is useful for individuals with diabetes who need to constantly monitor glucose readings in order to prevent dangerous highs or lows. CGM data is also stored for later upload to a computer to help evaluate trends and make treatment optimization.

Why Is It Important To Monitor Blood Glucose Levels?

Many people with diabetes may not have noticeable symptoms until their blood glucose levels are either too high or too low. Hyperglycemia occurs when blood glucose levels are too high. If left untreated, this can lead to more serious complications, such as ketoacidosis.

Alternatively, hypoglycemia occurs when blood glucose levels are too low. If hypoglycemia is left untreated, the individual may experience a seizure or lose consciousness. Blood glucose levels must be controlled in order to avoid serious complications of diabetes.

Monitoring Blood Glucose Levels With a Standard Blood Glucose Meter

The most traditional method of checking blood glucose levels is through the use of a small lancing device to prick the tip of the finger to obtain a drop of blood. The blood sample is inserted into a blood glucose meter, which then measures glucose levels. These meters provide a single data point in time, and are effective for many individuals with diabetes when used several times per day, including before and after meals. For individuals who may need to test their glucose levels more often, CGM may offer an easier and more effective solution than finger sticks alone.

Monitoring Blood Glucose Levels with a CGM

Continuous glucose monitoring is a blood glucose monitoring method that can provide more than 250 readings per day. Minimal finger-stick readings from a standard blood glucose monitor are still required to double check the CGM device accuracy.

All of these readings together provide a pattern of blood glucose levels that may identify trends. Healthcare providers can use these trends to understand fluctuating glucose levels and how they relate to:

●  The kinds of food a patient eats

●  The types of activity they do

●  Medications and dosages

Trends may also help reveal:

●  Fluctuations in glucose levels overnight, which are often undetected

●  Blood glucose spikes early in the morning

This information enables healthcare providers to understand the effectiveness of an individual’s current treatment plan, and to make adjustments when needed.

Making Continuous Glucose Monitoring More Convenient

A variety of insulin pumps now integrate with CGM systems, helping reduce the number of devices that have to be carried.  Newer models even have bright, color touchscreens like smartphones, making them simple to learn and use.

How Does Continuous Glucose Monitoring Work?

Continuous glucose monitoring uses a sensor that is placed under the skin of the abdomen for up to 7 days. The sensor reads the amount of glucose in the surrounding fluid using an enzyme called glucose oxidase, the same technology used for testing strips.

When glucose in the surrounding fluid interacts with glucose oxidase, the enzyme converts the glucose into hydrogen peroxide. The hydrogen peroxide reacts with platinum inside the sensor that then sends a signal to a transmitter. This signal is converted into a glucose reading.

Who Can Use Continuous Glucose Monitoring?

Individuals with diabetes who may benefit from the use of continuous glucose monitoring include those who:

●  Have unexplained extreme highs or lows in glucose levels

●  Have a diagnosis of gestational diabetes

●  Have consistent high or low blood glucose levels

●  Are currently using an insulin pump

Speak With Your Healthcare Provider

Continuous glucose monitoring systems may require extra training and practice to use the device properly. Speak with your healthcare provider and your diabetes management team to learn more about continuous glucose monitoring and to determine whether CGM would be an effective addition to your current diabetes management plan.

Resources:

http://www.niddk.nih.gov/health-information/health-topics/Diabetes/continuous-glucose-monitoring/Pages/index.aspx

http://www.webmd.com/diabetes/guide/continuous-glucose-monitoring

http://www.joslin.org/info/the_facts_about_continuous_glucose_monitoring.html

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html?referrer=https://www.google.com.mx/

http://www.brunet.ca/en/advices/the-importance-of-monitoring-blood-glucose-levels.html

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html?referrer=https://www.google.com.mx/

http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

http://www.diabetesforecast.org/2014/05-may/anatomy-of-a-cgm-sensor.html?referrer=https://www.google.com.mx/

http://www.fauquierhealth.org/diabetes.diabetes_continuous_glucose_monitoring_right_for_me

Fear and shame leading to people with Type 2 diabetes risking future life threatening conditions

diabeteshighsandlows.co.uk
diabeteshighsandlows.co.uk
  • Research amongst patients with Type 2 Diabetes on insulin reveals how emotional and psychological factors are negatively impacting their condition
  • A quarter suffer from anxiety over getting hypos (low blood glucose levels) with more than 40% preferring to have high blood glucose levels instead of risking another hypo. This can lead to serious long term health risks
  • A new campaign launches today called ‘Diabetes Highs & Lows: Better Balance for a Better Future’ which highlights how emotional and psychological factors can have an impact on effective T2 diabetes management
  • The campaign includes the launch of a patient support website, DiabetesHighsAndLows.co.uk which is dedicated to helping patients with T2 diabetes better manage their blood glucose levels. The website is developed and funded by Sanofi.

A quarter of people with T2 diabetes feel anxious or fearful about ‘hypos’ (low blood glucose levels), with 42% preferring to have high blood glucose levels instead, despite the risk of life threatening conditions in the future.[i]

The findings also revealed that a significant proportion of patients with T2 diabetes believe that other people think they are to blame (15%), and some patients believe that other people think they are just greedy (14%) 1 . Likewise, 25% of patients with T2 diabetes only tell close friends, family or their healthcare professional about their diabetes, and 58% feel self-conscious or avoid injecting in front of other people, negative emotions are stopping people managing their condition properly.[i]

 Another Sanofi-funded study conducted in adults with Type 1 and Type 2 diabetes in the UK, and  published in the journal Diabetic Medicine, showed even modest improvement in blood glucose control could help prevent almost a million serious medical complications such as eye disease, kidney disease, foot ulcer and amputations, and potentially blindness, which could  avoid billions in future NHS costs.[ii]

With the UK having the worst control of T2 diabetes blood glucose levels in Europe[iii], Sanofi, who conducted the report, is launching a new patient support website to help the 52% of T2 diabetes patients who find it hard to balance their blood glucose levels.[i]

The Sanofi ‘Diabetes Highs and Lows: Better Balance for a Better future’ campaign aims to help people with Type 2 diabetes feel in control and positive about how they can balance their blood glucose levels. A new website, developed and funded by Sanofi has been launched, diabeteshighsandlows.co.uk, which includes key information on recognising and managing blood glucose highs and lows.

[i] Sanofi Data on File 2016. “Highs and lows: better balance for a better future” market research

[ii] Baxter et al, Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the

number of clinical complications and the associated financial benefit. Diabetic Medicine (2016). DOI: 10.1111/dme.13062

[iii] Khunti K et al. Study of Once Daily Levemir (SOLVETM) insights into the timing of insulin initiation in people with poorly

controlled Type 2 diabetes in routine clinical practice. Diabetes, Obesity and Metabolism (2012)

Diabetes – so what are Type 1, Type 2, Type 3, Type 1.5 and gestational diabetes? (and pre-diabetes as well)

Doctor Max Pemberton
Doctor Max Pemberton

One of the big confusions, for a lot of people, is what are the different types of diabetes. In fact a lot of people have never heard of type 1.5 and type 3 diabetes. So we though we would ask Dr Max Pemberton who is an expert in this field!

He told us “I think this causes people a lot of confusion. There’s three main ones – Type 1, Type 2 and gestational diabetes and they’re all quite different. Type 1 diabetes is caused by an immune response whereby the body creates antibodies to the cells that make insulin in the pancreas, and it destroys those cells. So people with Type 1 diabetes no longer have the cells that make insulin, and so therefore they have low or no insulin in their blood.

Type 2 is quite different and that’s where the cells in the body have become resistant to the effects of insulin, so their body still makes insulin but the cells aren’t responding to it in the way that they should.

Now, gestational diabetes, that refers to a condition where women who are pregnant can sometimes develop diabetes and it’s just for the time that they are carrying a baby. So when they then give birth the majority of them, the diabetes then sort of passes. It’s really a response to being pregnant and the physical and hormonal changes that take place. People with gestational diabetes are at risk in the future of possibility developing diabetes but it is one of those things at the time, it then does go.

Now there’s these other terms that you mention, 1.5 and Type 3 and to be honest these complicate matters a bit. So all that 1.5 means really, it used to be thought that Type 1 diabetes affected people when they were very, very young and that’s when they first got diagnosed with it, and Type 2 was a result of lifestyle like being obese and so on, and that tended to happen when people were much older. Actually what they realised, that there is a group of people who despite might be relatively normal weight, they don’t have high cholesterol and so on and so on, so relatively physically healthy and yet still it’s often in their 40s or so they develop diabetes. So it’s not clear if it’s because of lifestyle changes, and it’s got a component probably of auto immune to it but it’s just presented much later, so it sits in-between Type 1 and Type 2 so they call it Type 1.2. To be honest I don’t think it is particularly helpful, I think it just confuses people.

Type 3 again I find it a slightly confusing term. It’s used by researchers just to talk about the evidence that shows that in some types of Alzheimer’s, the brain has become resistant to the effects of insulin. It’s just purely one of those scientific anomalies no one really quite understands quite what this means or the implications for either Alzheimer’s or indeed diabetes, but it’s one of these things you hear very occasional, sort of banded around usually within academic circles. It’s not something to worry about. Personally I definitely don’t think about Type 3 diabetes. The main three don’t forget are Type 1, Type 2 and gestational diabetes. ”

We also asked for a definition of pre-diabetes.  Max told up “Although there are three main types of diabetes, there’s also a stage before diabetes and that’s called pre-diabetes. It’s noticed impaired glucose tolerance and it’s a condition where your blood “

Diabetes Week. Read our Diabetes FAQ with Dr Rob Hicks.


Dr Rob Hicks on diabetes
Dr Rob Hicks on diabetes
As many of you know by now this week is Diabetes Week. To help promote understanding and awareness of diabetes we have conducted this fascinating interview with TV’s Dr Rob Hicks.

PATIENTTALK.ORG: Ok so just to start, can you please tell me what diabetes is?

DR ROB HICKS: Well diabetes is a condition where basically there is too much glucose in the blood and the consequence of that is that the glucose damages the blood vessels in the circulation and it damages the nerves and if somebody has diabetes and it’s not properly treated or managed then there is a risk of damage to the circulation or the nervous system resulting in complications like heart attacks, stroke, kidney disease and damage to the skin around the feet and indeed blindness which is why we make a big effort in healthcare to encourage people to watch out for the warning signs and indeed to get themselves checked to see if they have got diabetes.

PATIENTTALK.ORG: And can you explain the differences between the various types: type 1, type 2, and type 3, 1.5 and gestational diabetes

DR ROB HICKS: Yeah there are different types of diabetes, type 1 diabetes is where the body for some unknown reason turns on itself, it damages the pancreas which is the organ in the body which makes insulin such that a person really doesn’t have any insulin or at least they have a very tiny amount and that’s why people with type 1 diabetes need to have insulin usually by injections in order for them to remain fit and healthy. Type 2 diabetes which is the more common form of diabetes, it affects around 90% of people who have got diabetes, it happens when either there isn’t enough insulin or the insulin that is there doesn’t work properly so the body becomes resistant to the insulin and you also mentioned gestational diabetes and that diabetes that essentially develops for a woman when she is pregnant and that makes up about 5% of women who are pregnant will develop gestational diabetes.

PATIENTTALK.ORG: And what that just be in the period of the pregnancy or would that then turn into a different type of diabetes?

DR ROB HICKS: For the most part women who develop gestational diabetes once they have had their baby the diabetes disappears however saying that they are at a greater risk at developing type 2 diabetes later on in life so it would again be important to keep an eye on.


PATIENTTALK.ORG: What are the warning signs of diabetes?

DR ROB HICKS: Well there are symptoms for many people that act as warning signs I mean particularly for type 1 diabetes, they are passing urine more often particularly at night, feeling very thirsty despite drinking lots of liquid, feeling very tired or indeed losing weight when you are not trying too and one of the places I work is a sexual health clinic and we often see that people are get recurrent bouts of thrush infection despite the right treatment it comes back and get treated then comes back again , they often have underlying diabetes, another possible symptom is the slow healing of wounds or blurred vision. Now for someone with type 1 diabetes these symptoms become quite obvious and can happen over a couple of weeks. The challenge is that with type 2 diabetes which tends to affect more mature adults so traditionally over the age of 40 although it is possible to get type 2 diabetes earlier in life often the symptoms are not so obvious so somebody might get diabetes but may not get any symptoms which is why we encourage people to get tested, in face the current figures suggest that just short of 600,000 people in the UK have diabetes but are not yet aware of it because they haven’t been diagnosed so again this is why it’s important to get this checked , particularly if you have got diabetes in the family , if your over weight and if you are in an specific ethnic group so if you from south east Asia , Chinese , African Caribbean or black African origin then the risk of diabetes is greater in these groups so again it should prompt you to have a chat with your doctor about whether you should be tested.

PATIENTTALK.ORG: And what are the complications of diabetes in particular foot ulcers and sight problems?

DR ROB HICKS: Yeah I mean diabetes that is not treated or managed properly the damage to the heart and circulation is likely to increase the risk of someone having a heart attack or a stroke, the damage to the kidneys a form of kidney disease can happen, in men diabetes can also be the cause of erectile dysfunction, you also mentioned foot ulcers and because they are harder to treat and harder to heal or sometimes can be ignored for a while by an individual may result in amputation being needed off a foot or a lower limb. You mentioned the issues with sight, if diabetes isn’t treated properly it can damage the back of the eyes can damage the retina and indeed if that’s not treated properly then that can result in blindness.

PATIENTTALK.ORG: What treatments are available and how effective are they?

DR ROB HICKS: Well nowadays we have a host of treatments available, so everyone will be offered for type 1 insulin because they need it as they are not making any or are making very tiny amounts. For type 2 diabetes they will be advised to follow a healthy lifestyle such as losing some weight and being more active and there are different ways of achieving that so somebody might choose to use a health app for example. Who did a health report make health apps to help try and encourage people to adapt their lifestyle to healthy one and then there’s medications for people with type 2 diabetes and indeed some people with type 2 diabetes also need insulin to keep the condition under control.

PATIENTTALK.ORG: And what are the best ways of preventing diabetes/

DR ROB HICKS: With type 1 diabetes you can’t prevent it but thankfully with type 2 diabetes many people can prevent it and the best way really is to maintain a healthy weight, so lose weight that you need too to achieve a healthy weight and particularly try to get rid of the fat around your middle around your tummy as that alone increases the risk significantly of somebody being diagnosed with type 2 diabetes.

PATIENTTALK.ORG: And what advice would you give to somebody who has just been diagnosed with diabetes?

DR ROB HICKS: I think the advice I would give to somebody who has just been diagnosed with diabetes is to take it seriously, make sure that you seek the advice of your doctor / diabetes nurse, know that you can be in control of it I think I important and the control of it is extremely important to avoid the potential complications and if it means losing weight as it often does then choose a way that works for you , choose a way that suits you so that may be going for a brisk walk a day or a bike ride, it might be using a health app to motivate you and help you in a fun way monitor how well you are doing. I think that the bottom line increasingly we are seeing many people who are not following a healthy lifestyle I mean the Noom Report showed that around 1 in 3 people said that they never exercise and almost 2 in 5 said that they would wait till they have a health scare or a warning from their G.P before they did anything healthy or adopt a healthy lifestyle, I always say to people don’t wait get onto it and do it now whether you have got diabetes or not.

PATIENTTALK.ORG: That’s fantastic, Rob is there anything you would like to add at all?

DR ROB HICKS: I mean if people want to find out more about diabetes or whether they should be tested then obviously they can have a chat with their G.P or if they want to find out about Noom Then they can log onto noom.com/diabetes.

PATIENTTALK.ORG: Wonderful thanks so much for your time and for answering all of those questions.

DR ROB HICKS: Thank you, bye bye.

Diabetes and Sleep – Dr Rob Hicks tells us why too little sleep puts us at risk from Diabetes.


Dr Rob Hicks on Diabetes and Sleep
Dr Rob Hicks on Diabetes and Sleep
Recent research has suggested that too little sleeps increases the risk of developing type 2 Diabetes. Indeed 9 in 10 are consistently plagued with disturbed or sleepless nights and almost half say that it was worrying about something that keeps them awake at night – with money being the obvious concern. In fact is sleep is disturbed a person is quite likely to only sleep for four hours.

PatientTalk.Org conducted this interview about sleep and diabetes with TV’s Dr Rob Hicks just before Easter!

We kicked off with asking Rob to tell us a bit about the connection between sleep and diabetes. He replied “The connection is that if you’re suffering with a problem with sleep and so for example you’re not getting enough sleep that there is a link with an increased risk of developing type two diabetes and that’s two fold, one is because people who do not get enough sleep tend to gain weight and that’s often because actually when we are tired we eat more comfort food and we are less active and there’s also been some research recently suggesting for people who are not getting enough sleep on a regular basis this effects just how effective insulin is , it increases something called insulin resistance which is felt to be the most main reason for type two diabetes so this is one of the many reason why we should take a good night’s sleep very seriously indeed. ”


Turning to the prevention of diabetes he shared “Well the important thing about a good night sleep is obviously the following day if you haven’t had a good night’s sleep you feel really tired , not only loss concentration pool but also productivity is likely to be bad but also you switch to move too eating more comfort food which tend to be high in calories and high in saturated fat, your less likely to be active you’re more likely to drink alcohol, that piles on the pounds in weight and the major risk factor for type two Diabetes is gaining weight. ”

Of course a good nights sleep is important for those who have already been diagnosed with diabetes. “A good night’s sleep is good for everybody whether they have got diabetes or not because one of the problems is with not getting a good night’s sleep and certainly the Dunelm sleep survey has highlighted this is that people who are left tired the following day they are more likely to be irritable, they are more likely to adopt unhealthy lifestyles habits that increase blood pressure that increase cholesterol , we know that those factors increase the risk of not just diabetes but also of heart attacks and strokes but also it increases the risk of stress and anxiety and when we are felling stressed again we don’t follow healthy practises so if we want to get the best out of the day look after our emotional and physical well being then it’s very very important to have a good night’s sleep. ”

You can find out about ways of getting more and better sleep to help fight insomnia at our previous blog! Please follow this link http://patienttalk.org/insomnia-busting-some-great-tips-to-help-you-get-more-and-better-sleep/.