Diabetes In Real-Time

For decades our approach to managing diabetes was reactive. Now, with real-time technology, a shift to proactive treatment improves caregiving.

Helpful Highlights

  • Hypoglycemia (low blood sugar) may not be obvious in older adults and can cause serious problems.

  • While blood glucose monitors (BGM) are still used and still valuable, continuous glucose monitoring (CGM) has revolutionized diabetes care.

  • Real-time and predictive glycemic data now allow us to be wholly proactive, getting ahead of blood sugar, rather than reactive and constantly chasing it.

  • Medicare and Medicaid expanded CGM coverage in March 2023.

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Symptom awareness

Symptoms of blood sugar that is too high or too low can range from mild to severe in older adults. Therefore, symptoms of hypoglycemia (low blood sugar) – fatigue, weakness, dizziness, shaking, confusion – may not be as pronounced. Likewise, symptoms may be considered “typical” for them or written off as a “bad day” and ignored. This is especially true if your loved one has other chronic conditions in addition to diabetes.

Always ask how your loved one is feeling, particularly addressing subtle signs like sleep problems, toileting issues, changes in appetite, and altered thinking or mood.

Hypoglycemia (low blood sugar) can contribute to problems with thinking and reasoning, resulting in poor decision-making. Poor judgment can put your loved one at risk for injury, even during routine tasks. Hypoglycemia can also contribute to falls, due to sudden and unpredictable onset or increase in weakness or dizziness.

With the technology available today, we no longer have to spend our time chasing blood sugar to correct it. Continuous glucose monitoring (CGM)*, for example, has moved way beyond blood glucose monitoring (BGM) – the fingerstick machines of old. CGM now provides both real-time and predictive glycemic data and helps us fully understand the relationship between food, activity, and medication.

  • Real-time: Blood sugar readings are transmitted 24 hours a day, providing detailed information about levels, trends, and patterns. Readings are available anytime at a glance on a handheld receiver or directly on a smart device (phone, tablet). Data can help pinpoint how and when certain foods, activities, and medications are affecting glucose levels.

  • Predictive: Data is displayed with trend arrows that provide cues about glycemic activity and the direction (up, down, or steady) blood sugar is trending.* The system can also alert you and your loved one anywhere from 10-60 minutes before a high or low occurs, giving you ample time to prepare and intervene.

*To benefit from CGM systems and trend arrows, you and your loved one must be instructed on how to correctly read them and act on the cues provided. Learning what each trend arrow indicates and how to react to them, such as with medication adjustment, change in activity level, or efforts to prevent hypoglycemia, is essential. Education and instruction should be conducted with a qualified healthcare professional.

Caregiver benefit

As a caregiver, you can connect your smart device to your loved one’s CGM! This allows you to enhance your overall care, as well as offers peace of mind regarding their blood sugar level maintenance.

Real-time data allows you to see how certain foods affect blood sugar following snacks and meals, essentially advising you and your loved one of what food should be avoided, or eaten sparingly, and what foods can be eaten more regularly or in greater amounts.

Similarly, with activity and exercise, you can see how much and what types of activities and exercises work best for your loved one and when. For example, you may find that walking after a big meal can help keep blood sugar from soaring and using the trends and patterns data, you can even determine how long the walk should last for the best results. CGM can help your loved one to be more active overall, at any time of day, because of its predictive rise and fall ability.

You can also see the direct effects of medications, noting when they have their peak effect and how much they affect blood sugar. Such data can also lend guidance to your loved one’s provider if medication adjustments are needed and help with developing and updating your loved one’s customized treatment plan.

RESOURCES

American Diabetes Association

American Diabetes Association. (2021). Health equity and diabetes technology: A study of access to continuous glucose monitors by payer and race executive summary (white paper). American Diabetes Association. Link

Eichorst, B. (2023, July 24). Personal communication. ADA VP of Healthcare Programs.

Lawton, J., Blackburn, M., Allen, J., Campbell, F., Elleri, D., Leelarathna, L., et al. (2018). Patients’ and caregivers’ experiences of using continuous glucose monitoring to support diabetes self-management: Qualitative study. BMC Endocrine Disorders, 18(1), 12. DOI: 10.1186/s12902-018-0239-1

Marcus, Y., Eldor, R., Yaron, M., Shaklai, S., Ish-Shalom, M., Shefer, G., et al. (2020). Improving blood glucose level predictability using machine learning. Diabetes and Metabolism Research Review, 36(8), e3348. DOI: 10.1002/dmrr.3348

Miller, E.M. (2020). Using continuous glucose monitoring in clinical practice. American Diabetes Association: Clinical Diabetes, 38(5), 429-438. doi: 10.2337/cd20-0043

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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