Living with type 2 diabetes requires constant vigilance and meticulous management of blood glucose levels, but advances in technology are making the task easier, helping patients maintain their health. Those advances include much-improved implantable continuous glucose monitors (iCGM). First introduced 40 years ago, the devices have been refined and updated dozens of times in the past 10 years.
Unlike traditional glucose monitoring methods that involve intermittent finger stick tests, these implantable devices offer an increasingly seamless, automated approach. The device is typically placed just under the skin, ensuring a direct and accurate measurement of glucose levels.
The device is comprised of a small sensor, transmitter and receiver. The sensor, implanted under the skin, continuously measures glucose levels in the interstitial fluid, or the space between the cells. The transmitter sends the data wirelessly to a receiver or compatible smart device. Users can access real-time glucose readings and trends, allowing for more efficient diabetes management.
“It’s really a remarkable device,” said Dr. Denise Tonner of Ocean Blue Medical. “The device [now] is only about a quarter inch long and about the size of a hair. You insert it on your arm or abdomen and the interstitial glucose can be extrapolated through a mathematical formula into blood sugar or glucose.
“These sensors are constantly monitoring your blood glucose so once you have one on, you can pull up the app and look at your sugars in real time. You can watch the sugar go up and down. The sensors are reading every minute to five minutes, depending on which brand you have. They send the information to your phone or reader and give you an arrow telling you which direction you are going. Let’s say you have a normal blood sugar reading of about 100 but it has a straight downward arrow. That indicates your blood sugar is dropping really fast, and even though you are good now you may not be in 20 minutes.
“For people with diabetes on insulin, it’s so important to know the trends. The sensor gives you the number but also what direction you are moving on a real-time basis. This helps the diabetic determine their treatment because a lot of diabetics will change their insulin dose depending on what they are going to eat and what their glucose is.”
The device is waterproof and can be left on for 10-to-14 days, after which it will be replaced with a new one.
“Even non-diabetics are utilizing these sensors to help control their weight,” Dr. Tonner said.
“It’s a very useful tool for anyone who wants to see what is happening with their blood sugar in response to what they are eating. You look at the glucose spikes on the monitor and think of every spike as a big boost of insulin coming out of your pancreas, trying to get that sugar down. Because insulin is the food storage hormone, every time you see a spike, that insulin’s going to store everything you just ate. Your goal when you are using the sensor is not to have spikes and to try and keep it a smooth even line.
“Even if you are eating healthy fruits, that fructose is fruit sugar and still makes your pancreas spit out that insulin. If you are eating concentrated fruit sugar, put some protein and fat in it – like a little bit of peanut butter or cheese – to blunt that big spike of insulin.
You can’t feel that, but if you have a sensor you can see it. I advise my patients not to eat fruit alone. That is the downfall for many trying to lose weight.”
The iCGMs generate immediate alerts when glucose levels deviate from the target range, enabling timely interventions to prevent hypo (low) or hyper (high) glycemia.
“All of the sensors have alarms you can adjust to a specific sugar level,” Dr. Tonner continued. “It also has an alarm to alert you if you’re dropping or rising very rapidly. You might not have noticed the arrow, so it gives you an auditory alarm or vibration that allows you to make a correction when you are entering a danger zone. It can even be programed to alert a family member as well. Hypoglycemia or low sugar can come on very quickly and the patient doesn’t always feel the low. It can be a matter of moments before they pass out.
Having that early warning is a sense of peace of mind for the patient.
“Wearables have changed everything. We are even able to pair a sensor with an insulin pump, so they talk to each other for patients who have insulin pumps. The sensor and the pump then control the insulin 24/7. The holy grail for diabetes care is to get a closed loop where the patient doesn’t have to do anything or push any buttons.”
The latest continuous glucose monitors are available by prescription for both diabetic and non-diabetic people. Anyone who takes insulin for diabetes will generally have it covered by insurance but for those wanting to simply monitor their glucose levels effortlessly and review the trends, it will be an out-of-pocket cost of about $100 a month.
The integration of implantable continuous glucose monitors marks a significant advancement in diabetes care. By providing continuous real-time glucose monitoring, these devices empower individuals with diabetes to take proactive control of their health. The continuous nature of the monitoring eliminates the need for constant manual checking, providing individuals with diabetes greater freedom and peace of mind in their daily lives.
Dr. Denise Tonner worked for 30 years in busy endocrinology practices before opening Ocean Blue Medical, her private primary care and endocrinologist concierge practice in 2022.
She received her medical degree from the University of North Dakota School of Medicine. She completed her residency in Internal Medicine and fellowship in Endocrinology, Diabetes and Metabolism at the University of Iowa Hospitals and Clinics.
Ocean Blue Medical is located at 908 East Causeway Blvd., Vero Beach; call 772-360-4973 to schedule an appointment.
