Continuous Glucose Monitoring: A Major Advance in Blood Sugar Control

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Life in the trenches with type 1 diabetes is challenging.Unpredictable blood sugars can leave a person with diabetes (PWD)feeling frustrated and helpless. The acute toxic effects of abnormalblood sugars also contribute to depression, anxiety, irritability,and food cravings.

Every PWD knows that the primary goal in managing diabetes is tokeep blood sugar levels as close to normal as possible.Unfortunately, one of the "rewards" for those who work hard tocontrol their blood sugar is an increase in low blood sugar attacks,or hypoglycemia.

These occurrences can be frightening, embarrassing, anddangerous. Avoiding low blood sugar attacks generally means keepingblood sugars higher. But higher blood sugars bring with them theproverbial dark cloud of complications.

Advanced treatment programs, like those taught by Dr. RichardBernstein, have made relatively normal blood sugar levels attainableand much safer. Limiting total carbohydrate intake, matchingcarbohydrates with precise use of insulin, and frequent blood sugarmonitoring have all made it easier and safer to maintain normalsugar levels.

But no matter how motivated a person is or how well a diabetesprogram works, maintaining tight control of blood sugars always hasits teetering tightrope moments. And unexpected blood sugar spikesand drops feel like undeserved cheap shots. Every PWD has many timessaid in frustration: "What the hell is this and where did it comefrom!" after checking blood sugar levels.

Maintaining "normal" blood sugar levels requires a PWD to think andact like a pancreas. To achieve this, it's important to be able toreact appropriately to changing blood sugars before they reachabnormal ranges. High and low blood sugar levels do not show up outof nowhere. Abnormal outcomes are the product of transitions overtime.

Unless we can see these transitions and trends in progress, wecannot preempt and prevent abnormal blood sugars. Outside ofchecking blood sugars many times an hour, every hour of every dayand night, it has not been possible to track blood sugar levels,trends, and patterns at all times. Not having "in-time facts" aboutsugar trends and patterns has made it difficult to accurately playthe role of a pancreas.

But now continuous glucose monitoring (CGM) is making it possible. Acompany called Dexcom, Inc., of San Diego, California, has developeda monitoring system able to provide ongoing body sugar measurementswithout repeated finger or arm sticks. The system measures bodysugar levels every five minutes, twenty-four hours a day, andwirelessly sends the data to a pocket monitor. This adds up to 288blood sugar checks per day.

Dexcom's CGM system is set up to alert the wearer when blood sugarlevels rise above or drop below preset sugar-level limits. Thisenables the wearer to identify, preempt, and prevent undesirablehigh and low blood sugars. The CGM system provides a safety net thatprevents being blind-sided by low blood sugar hits and unexpectedhighs. This safety net is especially important for anyone whoexperiences hypoglycemia during sleep and for those at risk of lowreactions when driving a vehicle.

The wireless monitor has a screen that shows blood sugar trends on agraph over time, making it easy to see what is happening and wherethings are likely going. Thus, the CGM makes it much easier to makeaccurate adjustments and play the role of a pancreas.

Set-up and use of the CGM is easy once the process is learned. It isnot a completely non-invasive system. It requires the insertion of asmall and flexible piece of metal under the skin. The inserted metaland an attached sensor stick to the surface of the skin. The sensorinsert needs to be replaced weekly. The system also requirescalibration, involving at least two finger sticks per day.Calibration is required to maintain the accuracy of the sugarreadings.

The portion of the sensor under the skin is in contact withinterstitial fluid, not blood. Interstitial fluid sugar levelsadjust approximately fifteen minutes after changes have occurred inblood sugar levels. So there is a small delay in the real-timeaccuracy of the system. But this issue does not interfere with theuse of the Dexcom as a life-enhancing information tool and safetynet.

Dexcom's CGM system is the first generation of a relatively newtechnology, and new technologies always have room for improvement.One problem with the Dexcom system involves the low blood sugarwarning system. Because interstitial fluid sugar levels rise moreslowly than blood sugar levels, the low blood sugar warning systemis slow to adjust to corrections.

After appropriate correction for a low sugar is made, the lowblood sugar alarm on the meter continues to go off every fiveminutes until interstitial sugar levels normalize. This delay can beannoying, especially during the night, or can cause a person toover-compensate with dextrose or other blood sugar raising foods.

At some point in the future, the meter portion of the system willlikely shrink down to the size of a small watch. As the manufacturerrecoups its initial investment costs, hopefully the monthly costs ofreplacement supplies will go down enough to allow a majority of PWDsto use this technology. Currently, costs add up to around $240 permonth for supplies, on top of an initial $450 for the meter itself.

Besides a few fixable flaws, the overall technological design,accuracy, and function of this first generation system is quiteremarkable. The entire Dexcom system is designed and manufacturedwithin the USA. Kudos to the creative technologic design teams atDexcom.

Steven K. Gordon, ND, is a Naturopathic Physician who has hadtype 1 diabetes for over 25 years and has maintained an A1c of lessthan 5.5 % for the past ten years. Dr. Gordon has spent hisprofessional life studying the biological factors that promotequality of life and health, contrasting them with the factors thatcause aging, chronic disease, and diabetes. With his unique medicalperspective, Dr. Gordon utilizes treatment protocols thatre-establish and maximize health, body maintenance, and healingpotentials. It is his conviction that while prescription drugtreatments are essential for most people with diabetes, many othernon-drug biological and metabolic factors have equal importance inimproving health and preventing disease complications. When thesefactors are overlooked, quality of life, overall health andlong-term outcomes are less than optimal. Certain forms of diabetesare actually curable, while other more difficult forms can betreated in ways that improve quality of life at all levels in theshort and the very long-term. Diabetes, says Dr. Gordon, need not befeared.

Dr Gordon is in the process of finishing his first book,Understanding Metabolic and Blood Sugar Disorders – A HealthRestoration Guidebook, which is due out in early 2008.

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