Intensive Diabetes Management And CGM | Cornerstones4Care®

Intensive Diabetes Management and Continuous Glucose Monitoring (CGM)

If you have type 1 diabetes or are the caregiver of someone with type 1 diabetes, you might be familiar with the terms “intensive diabetes management” and “continuous glucose monitoring” (CGM). But it’s not always easy to know whether—or when—it’s the right time to use these diabetes treatment tools. Here’s some information that, along with the diabetes care team, could help you make the right decision for yourself or the person you care for.

How can CGM technology help?

Blood sugar monitoring technology for type 1 diabetes continues to advance. In the 1970s, finger-stick blood sugar monitoring was developed and since then it has been the standard for checking blood sugar. However, more recently the Food and Drug Administration (FDA) has begun to approve real-time continuous glucose monitoring devices. A continuous glucose monitor (CGM) is a small sensor inserted under the skin that measures the fluid between cells called interstitial fluid. This measure is closely related to blood glucose, so it can be used to measure blood sugar levels.

What are the positives and negatives of CGM?

CGM has its upsides and downsides. Here are the benefits:

  • CGM gives you an almost continuous readout of blood sugar levels, displaying them at 1- and 5-minute intervals, so it’s possible to tell whether blood sugar is rising or falling. You can’t tell this with a finger-stick reading since it is only a snapshot of blood sugar levels—you would need multiple finger-stick readings to determine this 
  • Knowing which way blood sugar is going can be helpful, for instance, when trying to figure out if you (or the person you care for) need a snack before bedtime. If your blood sugar is where it should be, but is falling, then maybe a snack is a good idea to keep it from going too low. But, if it’s going up, a snack is probably not necessary or helpful
  • CGM has a built-in alarm warning that signals when blood sugar levels get too high or low. This helps people with diabetes find their way out of the danger zone and is especially useful for those with low blood sugar unawareness. If you are thinking about trying tight control, but are afraid of hypoglycemia, CGM may be especially helpful
  • CGM provides much more information than finger-stick readings alone. The detailed information CGM gives you about blood sugar fluctuations helps you figure out blood sugar patterns, so you can fine-tune food choices and insulin doses

Here are some things to remember about CGM:

  • CGM does not replace finger-stick measurements. Finger-stick readings are more accurate han CGM readings and it is still necessary to confirm CGM readings with a finger stick before taking a bolus of fast-acting insulin
  • CGM can be a constant reminder of diabetes. Instead of thinking about your diabetes mainly when checking blood sugar and taking insulin, new blood sugar measurements will be showing up every few minutes. While some people may find that reassuring, it can be too much information for others
  • CGM can be expensive, especially when it is not covered by insurance

Be sure to consult with your diabetes care team before making any changes to ensure that this is the right method for you or the person you care for. 

What is “intensive diabetes management?"

The person with diabetes, caregiver, and diabetes care team work together to safely keep blood sugar levels as close as possible to the level of someone without diabetes. This is referred to as “intensive diabetes management.” However, this type of control is not for everyone and people who have a high risk of low blood sugar may be advised by their health care providers to aim for slightly higher goals.

The blood sugar goals recommended by the ADA for most adults are: 

 A1C 

 Less than 7% 

Before meals

80 to 130 mg/dL

 2 hours after starting a meal 

 Less than 180 mg/dL 

 

However, some health care providers may set even lower blood sugar goals (such as an A1C of less than 6.5%) for people with type 1 diabetes who are likely to achieve these goals without a major risk of low blood sugar or other negative effects. 

Intensive diabetes management for children and teenagers

While many health care providers advise that kids should be at least 13 years old to try intensive diabetes management, others have used this goal for children as young as 7. 

Below are the goals for all pediatric age groups from the American Diabetes Association (ADA); but a child or teen’s blood sugar goals may be higher or lower than these suggested goals. Consult with the diabetes care team to determine what is right for you or the person you care for.

A1C

Less than 7.5%

 Before meals 

 Between 90 and 130 mg/dL

 At bedtime/overnight 

 Between 90 and 150 mg/dL 

 

Intensive diabetes management

Intensive diabetes management means following a strict regimen that includes: 

  • Checking blood sugar levels often (perhaps more often than you’re used to) and tracking the results 
  • Closely following eating and physical activity plans and possibly tracking food and physical activity, too 
  • Taking frequent doses of insulin by injection or through an insulin pump 

Always follow the recommendations of the diabetes care team. 

The benefits of intensive diabetes management need to be balanced against possible risks, such as low blood sugar (hypoglycemia) and the potential for weight gain. This type of control is not something that you or your caregiver should attempt without the help and advice of a health care professional. Talk to the diabetes care team about what makes sense for you or the person you care for.

Getting Used to Blood Sugar Checks

If you have recently been diagnosed with type 1 diabetes, or your doctor has recommended more frequent checks, it can be hard to get used to checking so often. But you can do it! We can help.

Get The Support You Need

The Cornerstones4Care® Diabetes Health Coach is a useful tool for people who are newly diagnosed with type 1 diabetes and is always there to help you build healthy habits and skills. Get online coaching sessions, inspirational videos, tools, and progress trackers, as well as helpful tips and reminders.