Continuous Glucose Monitoring

Continuous Glucose Monitoring (CGM) is a method that tracks glucose levels throughout the day and night. This technology uses a small sensor inserted under the skin to measure glucose levels in the interstitial fluid. The sensor transmits data to a display device, which may be a separate receiver, smartphone, or insulin pump. CGM provides information about glucose trends, allowing for better management of diabetes and reducing the need for frequent fingerstick tests.

Dr Donovan Tay

Senior Consultant Endocrinologist

Dr Ben Ng

Senior Consultant Endocrinologist

Indications for Continuous Glucose Monitoring

The following conditions and situations may necessitate the use of continuous glucose monitoring.

Type 1 Diabetes

Individuals with Type 1 diabetes often benefit from CGM, as it helps track glucose fluctuations that occur with insulin therapy. The real-time data assists in making informed decisions about insulin dosing.
Type 2 Diabetes with Insulin Therapy

Patients with Type 2 diabetes who require multiple daily insulin injections can use CGM to monitor their glucose response to insulin. This monitoring helps prevent both high and low glucose episodes.
Gestational Diabetes

Pregnant women with diabetes may use CGM to maintain tight glucose control during pregnancy. The continuous data supports adjustments in diet and medication to protect maternal and foetal health.
Hypoglycaemia Unawareness

Patients who do not experience symptoms when their blood glucose drops dangerously low may use CGM with alert features. The device can notify users when glucose levels fall below a preset threshold.

Benefits of Continuous Glucose Monitoring

Continuous glucose monitoring offers several advantages for individuals managing diabetes.

Real-time Glucose Data

CGM provides glucose readings every few minutes, allowing users to see current levels and trends. This frequency of data helps users make timely adjustments to their diabetes management.

Trend Analysis

The system displays directional arrows indicating whether glucose levels are stable, rising, or falling. These trend indicators help users predict and prevent potential high or low glucose events.

Reduced Fingerstick Testing

While not eliminating the need for blood glucose testing entirely, CGM reduces the frequency of fingerstick tests. This reduction decreases discomfort and increases convenience for users.

Nighttime Monitoring

CGM continues to track glucose levels during sleep, alerting users to nocturnal hypoglycaemia or hyperglycaemia. This overnight monitoring provides safety and peace of mind for users.

Pattern Recognition

Data collected over time reveals patterns in glucose response to meals, activity, stress, and medication. These patterns help your doctor make more informed treatment recommendations.

Types of Continuous Glucose Monitoring Systems

Real-time CGM: These systems display glucose readings continuously and update every few minutes. Real-time CGM includes customisable alerts for high or low glucose levels, allowing for immediate intervention when needed.
Intermittently Scanned CGM: Also known as flash glucose monitoring, this system requires the user to scan the sensor with a reader to get current glucose readings. The sensor stores data between scans and provides trend information when read, offering a more affordable option with fewer alerts.
CGM Linked to Insulin Pumps: These systems are part of an Automated Insulin Delivery (AID) or “closed-loop” system, where the continuous glucose monitor (CGM) works together with an insulin pump to automatically adjust insulin delivery based on real-time glucose readings. The system primarily modifies the basal insulin rate in response to rising or falling glucose levels, and some advanced models are also capable of delivering automatic correction boluses. By continuously adapting insulin delivery to the body’s needs, these systems help to reduce glucose variability and significantly improve time spent in the target glucose range, enhancing both safety and overall diabetes control.

CGM System Implementation Process

Medical Evaluation

The process begins with a comprehensive evaluation to determine if CGM is appropriate. This assessment includes reviewing medical history, current diabetes management, and treatment goals.
Sensor Insertion

The CGM sensor is applied to the body, typically on the abdomen or back of the arm. Using an applicator device, a tiny flexible filament is inserted just under the skin to measure glucose in the interstitial fluid.
Device Pairing

The transmitter is paired with a receiver, smartphone app, or insulin pump that displays the glucose data. This pairing process establishes the wireless connection needed for data transmission.
Training Session

Patients receive instruction on sensor insertion, device operation, data interpretation, and troubleshooting common issues. This education ensures users can effectively manage their CGM system and utilise the data to improve their diabetes care.

Preparing for Your CGM Appointment

Before your CGM appointment, gather information about your current diabetes management, including blood glucose logs, medication list, and any specific concerns you wish to discuss. Wear loose-fitting clothing that allows easy access to potential sensor placement areas, such as the abdomen or back of the arm. Bring a list of questions you may have about the device and how to interpret the data it provides.

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CGM Usage Considerations

Skin irritation or allergic reactions to sensor adhesives can occur at insertion sites, though alternative adhesives or skin barriers may help mitigate these issues. Sensors occasionally provide inaccurate readings due to technical failures or physiological factors such as pressure on the sensor or dehydration. Some patients experience mild discomfort during sensor insertion or while wearing the device, though most adapt to the sensation over time.

Frequently Asked Questions

How accurate are CGM readings compared to fingerstick tests?

CGM systems measure glucose in interstitial fluid rather than blood, which creates a natural time lag of about 5-15 minutes. Most current systems achieve accuracy within 10-15% of laboratory blood glucose values under normal conditions.

Can I swim or shower with my CGM sensor?

Most modern CGM sensors are water-resistant and can withstand short periods of water exposure, such as showering. Swimming capabilities vary by manufacturer, with specific depth and duration limitations outlined in product documentation.

How do exercise and physical activity affect CGM readings?

Physical activity can impact sensor accuracy due to changes in blood flow and interstitial fluid glucose dynamics. Some users observe a lag in CGM response during rapid glucose changes associated with exercise, and pressure on the sensor site during activities may temporarily affect readings.

Can I travel with my CGM system?

CGM systems can be taken through airport security scanners, though some manufacturers recommend requesting manual screening to avoid potential equipment issues. When travelling across time zones, device settings may need adjustment, and carrying backup supplies is recommended for extended trips.

Dr Ben Ng

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr Ben Ng provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, obesity, and a range of other metabolic and endocrine conditions.

Adj Asst Professor Dr Ben Ng Jen Min graduated from the Queens University of Belfast Northern Ireland, United Kingdom (UK).
He completed his postgraduate training with the certificate of completion of training (CCT) from the Royal College of Physicians (UK) with dual accreditation in diabetes and endocrinology and in general internal medicine.
In 2010, he was awarded an MD with honours by the University of Hull, UK, in recognition for his research in diabetes mellitus

Dr Donovan Tay

Senior Consultant Endocrinologist

As a senior consultant endocrinologist with over 20 years of clinical experience, Dr. Donovan Tay provides comprehensive care for patients managing various endocrine conditions. His expertise includes the diagnosis and treatment of diabetes, thyroid disorders, osteoporosis, and a range of other metabolic and endocrine conditions.

Dr. Donovan Tay graduated from the National University of Singapore (NUS) and obtained his membership in the Royal College of Physicians (UK), Master of Medicine (NUS), and Master of Clinical Investigation (NUS).
After completing training in endocrinology, he was conferred as a Fellow of the Academy of Medicine, Singapore (FAMS).
He further specialised in endocrinology with a fellowship at the prestigious Columbia University Medical Centre in New York City.

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