2021 - ES - CGM Pocket Guide
2021 - ES - CGM Pocket Guide
2021 - ES - CGM Pocket Guide
Continuous
Glucose
Monitoring
Connecting the Dots
Table of Contents
Getting Started................................................................. 1
Acknowledgments........................................................... 28
400
350
Glucose concentration (mg/dL)
300 Unnoticed
250 Highs
200
150
Target Area
100
50 Unnoticed
Lows
0
Time 9 11 1 3 5 7 9 11 1 3 5 7 9
am pm am
Where Levels
170
Are
8 ABOUT CGM
ABOUT CGM
THE SENSOR:
THE TRANSMITTER:
180
mg/dL
70
mg/dL
12 am 12 pm 12 am
180
mg/dL
70
mg/dL
12 am 12 pm 12 am
193
— High............................. 23%
— Low.................................4%
— Very Low.......................6%
350
95%
350
75%
50%
70 25%
54
5%
0
12 am 3 am 6 am 9 am 12 pm 3 pm 6 pm 9 pm 12 am
Getting Alerts
Many CGMs provide an audible beep or vibratory alarm
to alert you when you need to take action to correct your
glucose level. Alerts may happen when your glucose
result is:
Before breakfast
My Glucose Meg sees: Her fasting glucose is within the range advised by
My Glucose My Glucose My Glucose
Glucose In Range
160
2:30
higher than her normal readings. The trend arrow shows her
Glucose In Range
190
2:30 Glucose In Range
170
2:30 Glucose In Range
300
2:30
140
120
glucose is stable, indicating that the reading is not a cause for
180
170
160
150
250
200
100
concern. Meg decides to have a high protein breakfast, since
160 140 150
her glucose is normal but higher than usual. She takes her
My Glucose usual dose of insulin.
My Glucose My Glucose My Glucose
Glucose In Range 2:30 Glucose In Range 2:30 Glucose In Range 2:30 Glucose In Range 2:30
180
140
150
140
350
250
120
My Glucose Meg sees: Her glucose is within range for two hours after a
100
My Glucose
120
My Glucose
50
190
2:30
her glucose is falling slowly. Meg does nothing because her
Glucose In Range
170
2:30 Glucose In Range
300
2:30
180
170
glucose is currently in range. She knows glucose normally
160
150
250
200
160
rises after a meal, but then begins to fall as more time passes
140 150
after eating.
My Glucose My Glucose My Glucose
160
2:30
Before lunch
Glucose In Range
150
2:30 Glucose In Range
350
2:30
75 150 it is200
100 120 50
mg/dL mg/dL rising slowly. Since her glucose is high and increasing,
mg/dL
170
2:30
she takes enough insulin to cover the meal and a correction.*
Glucose In Range
300
2:30
160 250
150 200
140 150
150 350
A DAY IN THE LIFE WITH CGM
2:30
recommended range for 2 hours after beginning a meal, but
Glucose In Range
300
2:30
250
200
she does not take a correction dose of insulin, since her glucose
150
is falling. If she took a correction dose, the result could be
“insulin stacking” –or an overcorrection—that might bring on low
My Glucose My Glucose My Glucose My Glucose
Before exercise
250
150
50
140 120indicates130
arrow mg/dL 93 Since she knows exercise
it is falling slowly. mg/dL mg/dL mg/dL
180
can dramatically reduce her glucose levels, she decides to have
Glucose In Range 2:30 Glucose In Range
160
2:30 Glucose In Range
150
2:30 Glucose In Range
350
2:30
160
140
a serving of fruit with 15 grams of carbohydrates before
140
120
140
130
250
150
120
beginning her daily 30-minute walk. Meg also takes a snack
100 120 50
with her and resolves to check her CGM system during her
walk to make sure her glucose does not get too low (below 70 mg/dL).
If her CGM system indicates low glucose, or she gets an alert indicating
My Glucose My Glucose My Glucose
2:30 Glucose In Range 2:30 Glucose In Range 2:30 Glucose In Range 2:30
180
170
160
300
250
Before dinner
My Glucose
Meg sees: Her glucose is within range but falling significantly
My Glucose My Glucose
mg/dL 120 mg/dL 30130 93exercise. Since she plans to have dinner
minutes after mg/dL mg/dL
160
2:30
right away, she will reduce her usual pre-meal insulin dose to
Glucose In Range
150
2:30 Glucose In Range
350
2:30
140 My Glucose
keep her glucose levels in range. She will also check her
140 My Glucose 250
mg/dL 100
mg/dL
levels
120
mg/dL 50
170 300
160 250
150 200
140 150
Before bed
My Glucose
Meg sees: Her glucose is in the low normal range and is
My Glucose
0 mg/dL 130 mg/dL 93slowly, so she decides to have a snack with yogurt and
falling mg/dL
150
2:30
fruit before going to bed. She also makes sure she has turned
Glucose In Range
350
2:30
140
130
on her CGM system alert for hypoglycemia, since she knows
250
150
120
falling glucose at night can be dangerous.
50
I've had T1D for over 20 years For the first year of having
but have only been using CGM diabetes, I really just wanted it to
for about four years now and it's go away. I felt like having
been a complete game-changer. something connected was going
The constant monitoring helps to be a constant reminder of
me stay in control. The trend diabetes and I hated fingersticks
arrows and trend reports are because I was having to check so
also super helpful. At first, I many times a day. Now I look at
didn't try CGM because I felt like I my blood glucose using the CGM
was already in control and didn't data on my phone. Now, I get a
want something attached to me lot more data and understand a
all the time. But now, I can't lot more of what’s going on than I
imagine not having it and I wish I get from A1C. I just feel more in
knew how much better it could control with CGM, more time in
be with CGM. range and on track.
Considering CGM?
Things to Think About
CGM is only a tool to help you and your team see more clearly
what adjustments should be made to your diabetes medications
and/or insulin regimen.
Use the device reference chart and consider the answers to the
questions below to assess your needs. Be ready to discuss the
answers with your healthcare provider during your next visit.
28 ACKNOWLEDGEMENTS
Information from Our Partners:
Endocrine Society American Association of
endocrine.org Nurse Practitioners
aanp.org
American Academy of
Family Physicians American College of Physicians
aafp.org acponline.org
American Academy of PAs American Diabetes Association
aapa.org diabetes.org
Diabetes Leadership Edge Association of Diabetes Care &
Education Specialists
diabeteseducator.org
ISBN 978-1-936704-01-9
Connecting the dots
through collaboration