[Opening Music]

AMBER: Good morning. JILL: Good morning. AMBER: I'm Amber Healy. JILL: Hi, I'm Jill. AMBER: Nice to meet you. JILL: Nice to meet you. AMBER: I'm a diabetologist. And, uh, I hear from Dr. Gwilym that you have interest in, um, other ways to monitor your blood sugar. 

JILL: I do. Um, I get a little nervous about pricking my finger mm-hmm. And using the glucometer and I've heard that there are other options out there and so I wanted to come learn about those. AMBER: Yeah. They're a nice option. Um, we refer to 'em as continuous Glucose monitoring systems, which is long for the CGMS if you've heard that. Sometimes people just refer to them as a sensor. JILL: Mm-hmm. AMBER: It's a, it's a patch that you would wear on the back of your arm most generally. And there's a little filament that goes under the skin and it measures the fluid and the tissues under your arm and it, uh, gives you an estimate about where your blood sugar's running. Every five minutes, you get a lot more data than with a finger stick. JILL: Oh Yeah. So do they hurt? 

AMBER: They can be a little painful when you place them because they're, that filament goes under the skin and it'll pinch a little. But after that, most people don't even notice that they're there until it's time to remove them. And then it's, since they're sticky on the back mm-hmm. It can be painful, like removing a bandaid. 

JILL: I hope you don't mind, I brought my notebook. I like to take notes so I can refer back to what we've talked about. AMBER: That's perfect. I love when patients take notes and keep track of their own journeys. JILL: So what I understand is with the CGM, it's not actually looking at the blood, but the fluid under the skin. AMBER: Yeah. It's the fluids in the tissues. Um, what they found is that the glucose and the capillaries underneath where those tissues are is very similar to what your blood sugar would run. JILL: Interesting. So I get a lot more readings in a day. AMBER: Yes. JILL: So it's easier to see trends and see how my body reacts to food and activity. 

AMBER: That's why I really like them for patients is because instead of adding more medication, sometimes uh, with wearing this you get more data. 'cause the finger stick is just a snapshot in time. And some people they only check once, maybe three times a day. Some people don't check at all. Uh, and this providing up to 290 or so readings a day with the every 5 minutes, uh, does allow for the trend. So, you know, people can see which foods affect their body because not everybody's the same. JILL: Sure. AMBER: You can see what activities affect your body or if you're stressed, uh, you know, sometimes people, they're sugar grow up and they're stressed or in times of illness it will affect how blood sugar runs and even if someone sleeps poorly, they might have higher blood sugar and it will be information that they can use to change some of their habits and have a bigger impact on their glucose control. 

JILL: Yeah. So it sounds to me like I, as the patient would get a much better idea of, um, what I maybe my, maybe what my next meal should look like or you know, maybe the fact that I should get up and take a little walk or drink water or, or sounds like it would help me make decisions just day to day. AMBER: Absolutely, absolutely. JILL: So I work outside a lot and I get sweaty. AMBER: Mm-hmm. JILL: Um, do patients have problems with them sticking on? AMBER: That can be, uh, an issue for some patients. It really is dependent on the patient, but we have some different strategies to help keep them on. So one of the more basic strategies that the companies have put out is simply watching the area of soap and water. 'cause it'll get the oils out of the skin. JILL: Mm-hmm. AMBER: And that can make it stick better. Uh, other people need to prep with like skin tack wipes or mastisol, which makes the area more sticky before they place the sensor. And then if those ideas don't work as well, there's also overlay patches that are available that you can put over it to help increase the duration. 'Cause waiting 10 to 14 days to change something can be a while, especially if you're sweaty and working outside. 

JILL: Right, right. Um, but it sounds like some of these issues are easily things that could be worked around. What are some pros and cons of using A CGM versus glucometer? AMBER: So the pros are you get more information. So that means that you have more data at your disposal for your day-to-day life. JILL: Mm-hmm. AMBER: The other nice thing is we can connect you to the clinic and if you're having an issue, you can call in and say, Hey, I'm having an issue. We can pull a report, take a look and help make more meaningful medication adjustments to you based on that profile on what's going on. JILL: Wow. That seems really convenient for you and me. AMBER: Oh, it's nice because we don't even- people don't even have to physically come in for that. JILL: Oh, I really like that. What are some cons? 

AMBER: Some of the cons are the 15 minute delay. What the sugar's reading up here on the device is what's about 15 minutes behind. So if you're treating for low blood sugar, it's important to still do a finger stick. We usually recommend that you recheck in 15 minutes. Well, if this hasn't caught up, you run the risk of overtreating and bouncing between like a low of 50 or 60 and going up to 300 because it hasn't shown you that your numbers are going up. So that's one time where you still want the finger stick for backup. AMBER: The other thing is accuracy can vary sometimes between sensors, sometimes in people. And if your symptoms don't match what it's showing you, like say it's telling you you're 400 and you're not thirsty, you're not sleepy, you drink, this isn't how I feel when I'm high. You might wanna recheck with a- a finger stick and then calibrate it because it might not be as accurate for you at that point in time. JILL: I'm really interested in these. Do you have one, have one we could look at? 

AMBER: Yeah, I do. Uh, there's a couple of different brands, but the one I happen to have in office today is the Dexcom. And I know this is gonna look intimidating, but it is smaller than this. This is the device that is used to place it. So when you actually open it up and take a look on the on inside, you can see it is much smaller. JILL: Oh Yeah. Good thing I wore my glasses, I wouldn't even be able to see that little thing. AMBER: You know, that filament is actually what reads this particular model has what we call a, you know, they all have a warmup period. This model has a 30 minute warmup period and that's the time it takes that filament to get saturated and start giving you readings. JILL: Mm-hmm. So talk me through how this works. 

AMBER: So first we need to decide, are you going to have a receiver, which would be a separate device that you carry with you? Or would you like to use an app on your phone? JILL: Uh, the phone does sound convenient. AMBER: Okay. So we would wanna download the app to your phone. We would go into either, um, the Google Play store or the app store, depending on if you have an Android or an iPhone. JILL: Mm-hmm. AMBER: And we'll download that app. Then it'd be the Dexcom G7 app for this. Now other brands have their own apps. JILL: Sure. AMBER: The other thing we wanna do is get you connected to the clinic after we've got that part set up is you can wear this, what's recommended is the back of your arm. JILL: Okay. AMBER: Uh, some sensors can go on the belly and some of them are approved for the upper part of the buttock. JILL: Mm-hmm. AMBER: But most people wear them on the back of their arm and that's where most of them have been studied. JILL: Mm-hmm. AMBER: So we would go and put it on the back of your arm JILL: Mm-hmm. AMBER: After we've cleaned off the area, of course. JILL: Mm-hmm. AMBER: And then once we have it where we want it, you've got this button here on the side and you would push this button. 

JILL: Mm-hmm. AMBER: And that'll spring this forward and it'll stick. JILL: Okay. AMBER: And it will put that filament under the skin. And after that's on there, you wanna push around on all the adhesive and on the middle of it to make sure that this really sticks really well onto your skin, because that'll be less of that chance of it sliding off when you sweat too. JILL: Gotcha. AMBER: And then, um, after you have it in place, you're gonna pair it with, in your case, your phone app JILL: Mm-hmm. AMBER: Where you're prompted and you'll put the number that is on the side. JILL: Okay. AMBER: In there. And then they actually provide a little overlay patch in this one. JILL: Mm-hmm. AMBER: And you're gonna put that over the top of it. JILL: Okay. AMBER: And then you'll wait your 30 minutes before it starts giving you readings on your phone. 

JILL: Nice. And you made that look like I could easily just do it myself. I don't need my kid or my husband there to help me with it. AMBER: No JILL: I can do it all alone. AMBER: Most people can do it on their own. JILL: I do like to be independent with my care. So this seems like it'll work AMBER: So it'll be a great Yeah. JILL: Yeah. I- I really do think I'm interested, how would I go about getting a CGM? AMBER: Most insurances, it's a pharmacy benefit and we would just send a prescription into your pharmacy. JILL: This all sounds really great. I can't wait to go back and talk to my healthcare provider to see if I can get started on a CGM. Thank you so much. AMBER: Absolutely. JILL: That real time data just seems so beneficial. AMBER: Oh, it is. It definitely is. 

[Closing Music]