Ask a diabetes nurse educator

A Continuous Glucose Monitor (CGM) is a small device you wear, usually on the back of your arm. A CGM tracks your glucose levels all the time and sends the results to an app on your phone via Bluetooth. You can also use a special device called a ‘reader’ instead of a mobile phone if your phone is incompatible or you would prefer not to use a mobile.

A CGM records your glucose levels continuously instead of single readings like a finger-prick check. For many people, this leads to better awareness and understanding of the personal factors that affect glucose levels and supports better diabetes management. It can also predict your glucose levels for the next few hours. This appears as upward, downward or straight ‘trend arrows’. The ‘trend arrows’ can be helpful to avoid hypoglycaemia during high-risk activities such as driving. For example, if someone saw a glucose level of 5mmol/L with an ‘upward arrow’, this would indicate it is safe to drive. Alternatively, if someone saw a glucose level of 5mmo/L and a ‘downward arrow’ before driving, they would be prompted to eat some carbohydrate before driving.

CGM is not necessary for everyone with diabetes, and not everyone benefits from constant monitoring. In fact, some people find constant information about their glucose levels to be overwhelming. CGMs are most often used for people living with type 1 diabetes as they can help people make decisions about how much insulin to take and help prevent potentially life-threatening ‘hypos’ (low blood glucose level under 4mmol/L).

CGMs can also be used by people with type 2 diabetes, particularly for those who:

• Take insulin or sulphonylureas medications which can cause hypos
• Have regular hypos and cannot feel when they are happening
• Want to lower their HbA1c, but don’t know where to make changes
• Want to better understand how food, exercise, stress and sleep affect glucose levels
• Avoid finger prick checking
• Want to feel more engaged and informed about their glucose levels

However, some people feel the benefits are not worth the cost and the hassle of wearing the device all the time.

Some key facts about CGMs:

• CGM measures glucose in the fluid around the body’s cells (called interstitial fluid) rather than directly in the bloodstream, so there can be a slight delay between blood glucose changes and the CGM reading.
• If you take insulin or sulphonylurea tablets (such as gliclazide or glipizide) and your symptoms don’t match the sensor reading, it is still recommended to confirm your reading with a finger prick.
• CGM gives 24/7 glucose monitoring but having constant access to glucose data may increase anxiety for some people. Your diabetes educator can help you use your CGM effectively and minimise anxiety around it.
• You can share the glucose data with your family, friends, or health professionals. Some people feel reassured that another person can help notify them when they may need to act on their glucose levels.
• In Australia, subsidy for CGM is only available for people with type 1 diabetes, not for those with type 2 diabetes.
• CGMs last for 10-15 days and can be expensive to replace. However, some people still find it beneficial to wear a CGM a few times each year to understand their glucose patterns and whether their current medication and lifestyle routine is working.

A CGM can be a helpful tool in managing diabetes. However, there are pros and cons to wearing these devices. Seek advice from your diabetes educator of healthcare team for advice on whether you may benefit from trialling a CGM.

Author: Riby Kuriachan – Diabetes Nurse Educator at Diabetes Victoria

Stress is a feeling that we experience when faced with a challenging situation. The event that leads to the stress is called a stressor. This can be physical, like an injury or illness. Or it can be mental, such as problems in our personal life, or a fear of something.

When we are stressed, our body responds with the “fight or flight” mechanism. This is our body’s way of preparing us either to fight the stressor or run away from it. During this response, the body releases stress hormones like cortisol, glucagon and adrenalin.

Our body needs more oxygen and glucose to fight or flee. These hormones increase our heart rate, blood pressure and breathing so that our body can pump blood to our muscles faster, providing them with more oxygen.

Stress hormones also stimulate the liver to release stored glucose. Additionally, they make our body less sensitive to insulin – in other words they increase insulin resistance. As a result, the blood glucose levels rise to give enough energy for the body to fight or flee.

This response made perfect sense in our ancestors’ life when most stress was physical. If an animal was chasing them, they had to either run for their lives or fight back. However, in modern life most stress is mental which can’t be managed by fighting or running away.

The “fight or flight” response happens to everyone but does not cause significant problems with glucose levels for people without diabetes. In people with diabetes the pancreas may not produce enough insulin to move this extra glucose to the cells effectively. This can lead to high blood glucose levels.

Managing stress

The first step is to identify the stressor. Managing diabetes itself can be stressful for many people and there may also be stressors that are not related to diabetes. Sometimes identifying the stressors can be more challenging than managing them.

Two key ways of dealing with stress are:

1. Change the situation when you can; or
2. Change your response.

Here is an example.

Stressor: Managing diabetes medications, following healthy eating guidelines, meal planning and achieving recommended physical activity goals.

Change the situation

Possible approaches include:

• Using medication aids like a Webster pack to organise medication.
• Speak with your healthcare team to simplify your medication regimen.
• Work with a dietitian to develop a realistic meal plan.
• Work with an exercise physiologist to create a safe and practical exercise plan.

Change your response.

Some suggestions include:

• Stay calm where you can and take diabetes management one step at a time.
• Focus on small and gradual dietary change.
• Start slowly and build up on your activities.
• Seeking support from your health care team if you are overwhelmed.
• Believe in yourself and avoid negative self-talk such as “I can’t manage my diabetes.”.

Some practical tips to reduce stress:

• Exercise regularly
• Do activities that you enjoy e.g. gardening, knitting
• Try to learn new activities
• Spend time with your loved ones
• Get quality sleep
• Practice relaxation techniques like yoga, meditation and deep breathing
• Seek help from a health professional when needed.

Managing stress is not about being perfect – it’s about learning what keeps you going!

Author: Riby Kuriachan – Diabetes Nurse Educator at Diabetes Victoria