“Diabetes”

Prairie Doc Perspective Week of October 20th, 2024
“Diabetes”
By Kelly Evans-Hullinger, MD FACP
The saying goes, “newer isn’t always better,” and while I typically tend to agree with that, newer might be better when it comes to glucose monitoring technology. In recent years we have seen rapid development and uptake of new types of glucometers, leaving fewer and fewer patients with diabetes using the old standby fingerstick method of blood sugar monitoring.
Let me be clear: not every patient with diabetes needs a fancy new continuous glucometer (CGM). The cost might be higher, and there is certainly more data to sort through with a continuous glucometer. So who stands to benefit the most?
The most compelling reason to upgrade to a CGM would be a tendency to get low blood sugars (hypoglycemia), especially if that patient does not get any symptoms or awareness of that. Hypoglycemia can be very dangerous, causing loss of consciousness, seizures, and coma. A CGM can detect a pattern of dropping sugar levels and alarm to a patient’s (or their loved one’s) device as a signal to preempt a possibly dangerous episode of low blood sugar. Patients at highest risk of this are those on insulin, elderly patients, and those with more complicated or challenging diabetes.
Other reasons for patients to pursue a CGM might vary. Often in patients with poorly controlled diabetes, the data collected by a CGM can aid decision making on changes to medication, diet, and exercise at the right times of day. Some patients just truly hate pricking their fingertips, and using a CGM gives them information they can’t otherwise obtain if avoiding fingersticks.
I can think of numerous patients in my own practice whose diabetes was poorly controlled, started using a CGM, then returned to clinic with major improvement in their control as manifested by their hemoglobin A1c lab, even without any changes to their medications. I attribute this to the unavoidable real time feedback a CGM gives, which probably motivates patients to change behavior in diet and exercise in ways that are hard to achieve otherwise.
Continuous glucometers aren’t for everyone; some patients have excellent control of their diabetes and no hypoglycemia without this technology, in which case it probably isn’t necessary. In patients who do pursue their use, it is important to work with a clinician who can help interpret the data the CGM provides and adjust treatment accordingly. In short, talk to your endocrinologist or primary care provider if you think a CGM might be for you.
Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust.