Those trendy continuous glucose monitors? I’ve been wearing it for over a decade. Here’s what I learned

A woman slowly rises from a hot tub—her long, wet hair glistening in the sunlight, a beautiful sunrise in front of her—and a continuous glucose monitor completely centered on the back of his flawless right arm.

This is a scene from an ad for one of those trendy continuous glucose monitors (also known as a CGM) that just popped up on my social feed.

It doesn’t even remotely resemble my life with a CGM-and I need to know what life is like. I’ve been a type 1 diabetic for a quarter of a century, since I was 12. And I’ve worn a variety of CGM products for over a decade, from relatively large sensors that “g -staples” in my stomach to pill-sized sensors that were implanted. under the skin of my upper arm.

And let me tell you, it’s not a glamorous life.

In the latest wearable health trend, technology manufacturers have developed to help diabetics—by warning of potentially fatal high and low glucose episodes—now marketing their products to non-diabetics. Their pitch: A sensor inserted between the layers of the skin via a spring-loaded needle will provide insights into metabolism that can lead to changes in fOOD and exercise.

Don’t get me wrong—I am very grateful for CGM technology. It’s grown tremendously over the past few years, from an anxiety-inducing nuisance that often sets off false alarms, to a truly life-saving technology that almost always reliably warns me of what’s coming. high and low glucose levels.

But I don’t look like a model. After years of shooting a CGM up the back of my upper arm (as well as injecting insulin and inserting insulin pump and pod infusion sites there), mine is damaged and bruised— until sometimes I ask if I am safe at home.

And a long soak in a hot tub? That’s a no-go (or a “proceed with extreme caution”) for me, as someone who needs a CGM medically. Diabetics are warned to be extra careful in hot tubs, as the heat can be a factor hypoglycemic without knowing which suppresses the usual warning signs of low blood sugar levels, such as shakiness and sweating.

You’d expect my CGM to alert me to a low glucose episode but—as I’ve learned firsthand from tests in long, hot baths—they tend to stop reading once submerged in for a while. (I spend more time silencing “lost signal” alarms than actually relaxing.)

If you’re relying on readings from your CGM, be wary of long hours in the water – that’s a lesson I’ve learned from over a decade of wearing a CGM. Here are some others.

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1. CGMs do not measure blood sugar.

Yes, you read that right. And yes, many people say the wrong—even some of the so-called “pros.” CGMs do not measure blood glucose levels. They measure glucose in the interstitial fluid, between the tissue layers. Glucose tends to flow from the blood vessels into the tissue surrounding them. The level of glucose in the interstitial fluid is similar to the level of glucose in the blood, but it lags by a good 15 minutes or more.

In a non-diabetic, lag is no different. For a diabetic, this can mean a delay in the alert of low glucose levels and, thus, treatment.

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2. Diet and exercise aren’t the only factors that affect your glucose levels.

CGMs are marketed to non-diabetics as a tool that allows them to observe the effect of foods on their glucose levels. But many other factors can affect levels, from illness and certain medications to stress, lack of sleep, and menstrual cycles. I once went to a controversial meeting with my son’s school with a relatively normal blood glucose level, and was upset—and had a reading in the 400s. (The meeting was awkward, to say the least.)

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3. Sensors are easy to wear for a week or two—and harder to wear for longer than that.

Some companies sell CGMs to non-diabetics as a temporary inconvenience. Wear a sensor for two weeks and have data on how food affects your glucose levels valid for a whole year, they said.
But such a scenario does not apply to diabetics, especially those with hypoglycemic unawareness.

The longer one has diabetes, the greater the chance of developing the condition, a type of neuropathy that makes CGM a daily necessity. Don’t get me wrong—I am very thankful for my CGM. But apparently my arms were damaged—as was my stomach, when I used to wear them there all the time.

(Regular CGM users are advised to rotate “sites” whenever they can—arms, legs, abdomen, upper buttocks—to preserve “real estate.” Historically, however, some CGMs are only approved for abdominal use or upper buttocks, the latter of which cannot be reached without assistance. And, not all sites are good for all diabetics.)

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4. CGMs can ease the “cognitive burden” of diabetics—but they may have the opposite effect for non-diabetics.

It is estimated that type 1 diabetics can make the environment 180 health-related decisions a day in an effort to monitor glucose and ketone levels. The medical term for this: “cognitive stress.”

When I was young, my dad would sometimes sit down on a Saturday morning and monitor my glucose levels with a traditional blood-based monitor, so I could get more sleep. Wearing a CGM is just like having that level of help—but better, and all the time. This allows me to shift more of my focus elsewhere, knowing that there is an eye on things. It helps shoulder that mental burden.

For non-diabetics, however, CGMs can have the opposite effect. Unless you have hypoglycemia, pre-diabetes, or another health condition that puts you at risk for high or low blood glucose levels, you may find that a sensor triggers a stress test. state of information overload. As someone who has no issues maintaining healthy oxygen saturation or blood pressure levels, I can’t imagine being presented with a constant flow of such data (and trying to process and interpret relatively small differences). Honestly, such a “tool” would probably send my anxiety through the roof—and I have to wonder if CGMs do at least for some non-diabetics.

5. Not everyone has equal access to this potentially life-saving technology—and that’s a problem.

Insulin, insulin pumps, and now CGMs—add them to the list of expensive medications that diabetics need but can’t always afford. For diabetics—especially type 1s—the mental burden is one thing, but so is the financial burden.

But there is a documented lack of access to CGMs among racial and ethnic “minorities” that cannot be explained by socioeconomic status alone. According to a study published this year in medical journals Diabetes Care, The use of diabetes technology such as insulin pumps and CGMs was more than 20% lower among black patients compared to white patients. And according to a 2021 study in a similar journalless than one-third of Black youth have access to insulin pumps and CGMs, while nearly three-quarters of white patients do (40% of Hispanic patients have access).

Among the reasons: provider bias, systemic racism, and (understandable) distrust of the medical system, the authors of the latter study speculated.

For non-diabetics using CGMs, my message is this: Enjoy the new gadget—even though the insertion can be very painful, which takes some of the fun out of it. Use the data to improve your health, if you can. And if you find it’s not all you hoped for, consider donating your unused, unexpired CGM sensor to a charity like Insulin For Lifewhich distributes supplies to diabetics in developing countries.

The device that annoys and frustrates you can save a diabetic’s life.

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