CGMs have enabled people without type 1 and type 2 diabetes to be exposed to the world of blood glucose levels and time in range. But is that a good thing?

Our in-depth article explores the advantages and disadvantages of CGMs for people with and without diabetes and how this technology is being integrated into wider health and lifestyle management.

What are CGMs?

CGMs are devices that continuously track blood glucose levels through the body’s interstitial fluid.

This provides a dynamic, real-time view of blood sugar patterns throughout the day and night.

CGMs typically comprise a small sensor inserted under the skin and a transmitter that sends the data to a monitor or smartphone. Some CGMS have displays that show blood glucose information in real time.

• FreeStyle Libre 2: update enables use as a continuous glucose monitor
• CGM Sensors: How They Work, Sensor Placement and Care

Advantages of CGMs

In the evolving landscape of diabetes technology, CGMs have transformed how people with type 1 diabetes in particular manage their blood glucose levels.

Improved blood glucose control

CGMs provide real-time feedback and trends which enable individuals to manage their blood glucose levels more effectively.

Peeople are able to see the impact certain foods, exercise, stress and medications can have on their blood sugar levels.

CGMs also allow people to see how long their blood glucose levels are in range.

This can lead to significant improvements in blood glucose control and thereby reducing the risk of diabetes-related complications.

Hypo and hyperglycemia prevention

By alerting users to sudden drops or spikes in glucose levels, CGMs can help prevent severe hypoglycemia (low blood sugar) and persistent hyperglycemia (high blood sugar) which are common challenges for people with diabetes.

Alerts can be set to notify people on when they are getting close to going hypo or hyper.

• Hypoglycemia (low blood glucose levels)
• What is a Hypo: Hypo Causes, Symptoms and Treatment

Reduced need for fingerstick testing

CGMs can decrease or sometimes eliminate the need for traditional blood glucose testing via finger pricks, offering a less invasive and more convenient monitoring method.

Closed-loop insulin delivery systems

Also known as the “artificial pancreas” closed-loop insulin delivery systems continuously monitor blood glucose levels and automatically adjust insulin delivery in real time.

This significantly reduces the burden of constant monitoring and manual insulin adjustment, improving glycemic control and reducing the risk of both hypoglycemia and hyperglycemia.

• Artificial Pancreas: Hybrid closed-loop system gets NHS green light
• Artificial pancreas improves blood sugar control in young children with type 1 diabetes

Are there advantages for people without diabetes?

It has become commonplace to hear of people without diabetes using CGMs.

Athletes and sports enthusiasts are increasingly turning to CGMs as a tool to optimise performance and recovery.

For athletes, maintaining optimal blood glucose levels is crucial for sustained energy, endurance, and performance.

CGMs are used as a window into how their bodies respond to various types of training, the impact of stress, and the effect of their diet on glucose levels.

Real-time data allows athletes to fine-tune their nutrition and training regimes, ensuring that they are fueling their bodies appropriately before, during, and after exercise to maintain energy levels and accelerate recovery.

By avoiding the peaks and troughs of blood glucose levels, athletes can potentially reduce the risk of energy dips and improve their overall metabolic efficiency.

The adoption of CGMs by sports people highlights a broader trend of leveraging health technology not only for disease management but also for enhancing physical performance and wellbeing.

For people without diabetes, CGMs can provide fascinating insights into how their diet, exercise, and stress levels affect their blood sugar levels, enabling more informed lifestyle choices.

• What should my blood sugar levels be?
• Time in Range

For example, feeling tired after meals, a condition often referred to as postprandial somnolence or the “food coma” can sometimes be linked to fluctuations in blood glucose levels. High blood glucose following a meal can trigger this sensation of fatigue as the body works harder to manage and utilise the excess sugar.

CGMs can be used as a useful tool in this context by offering real-time insights into how specific foods and meal compositions impact glucose levels.

CGMs can also serve as a tool for preventive health and help to avoid the onset of type 2 diabetes and other metabolic conditions.

Disadvantages of CGMs

While CGMs are innovative devices that have transformed diabetes management, there are several disadvantages that have been noted.

Cost

CGMs can be expensive.

Skin irritation

Some users may experience skin irritation from the adhesive used to hold the CGM’s sensor in place.

Additionally, having a device attached to the body continuously can be uncomfortable for some.

Accuracy

While CGM technology has improved significantly, discrepancies can still occur, especially in the case of rapid glucose changes. Users must be prepared to verify readings with fingerstick tests if needed.

Reliance on software

A number of software issues have rendered CGMs useless for people with diabetes. These issues have highlighted reliance on software and Internet-enabled technologies.

• Omnipod 5 insulin system reports decimal point glitch
• FreeStyle LibreLink app update glitch sparks alarm among Apple users

Should people without diabetes use CGMs?

CGMs offer novel insights into blood glucose management and their use in people without diabetes comes with specific challenges and considerations.

Unnecessary anxiety

While data is always useful to make better decisions, when CGMs are used by people without diabetes it can cause unnecessary anxiety or an obsession with numbers.

Continuous access to glucose data can lead some individuals to fixate on minor fluctuations in their blood sugar levels.

In the context of an individual without diabetes, these may be within a normal range and not a cause for concern. Hyper-awareness can contribute to stress and anxiety, which ironically, can themselves impact glucose levels.

Misinterpretation

The wealth of data provided by CGMs can be both a blessing and a curse.

For those without a medical background or thorough understanding of metabolism, there is a significant risk of misinterpreting the data.

Physiological responses to food, exercise, and stress can cause variations in glucose levels that are normal but might be perceived as problematic.

Misinterpretation could lead to unnecessary dietary restrictions or lifestyle changes.

Overreliance on technology

CGMs can make it easy to become over-reliant on technology for health and lifestyle decisions.

The immediate feedback loop provided by CGMs might lead some people to trust the technology more than their own bodily signals, such as hunger, fullness, and fatigue.

Over-reliance on technology can detract from developing intuitive eating practices and listening to the body’s natural cues.

As with any health technology, it’s essential for individuals to consult healthcare professionals to determine if CGMs are a suitable option for their personal health and lifestyle needs.

What is Time in Range?

Time in Range is the percentage of time a person’s blood glucose levels are within a specified target range.

Typically, this would be between 4 mmol/L and 10 mmol/L, or whatever targets you have agreed with your healthcare team.

The goal with managing diabetes is to maximise the “time in range” and to minimise high and low sugar levels.

By doing this, blood glucose levels remain stable and this can reduce the risk of short-term and long-term health complications.

• Blood Sugar Level Ranges
• How To Test Your Blood Glucose
• How To Inject Insulin

How to calculate Time in Range?

To calculate Time in Range from your blood glucose readings manually, follow these steps:

1. Define your target blood glucose range
2. Collect your blood glucose readings – either from your CGM or blood glucose meter
3. Count how many readings fall within your defined target glucose range during the period you are analysing
4. Calculate the percentage of time in the target range using the formula, expressed as a percentage of the total monitoring time

Time in Range (%) = [Number of readings within target range / Total number of readings] * 100

For example, if you have 288 readings in a 24-hour period (assuming most CGM devices record a reading every 5 minutes), and 230 of these readings are within the target range, the calculation would be:

Time in Range (%) = [230 / 288] * 100 = 79%

Typical Time in Range targets are for people with diabetes, based on guidelines and clinical recommendations:

References: American Diabetes Association (ADA) Standards of Medical Care in Diabetes (2023); International Consensus on Time in Range (2019); Advanced Technologies & Treatments for Diabetes (ATTD) Consensus Report (2019).

Why Time in Range matters?

Time in Range gives a far more detailed understanding of blood glucose control compared to the traditional HbA1c test.

HbA1c tests give you an average glucose level over 90 days but fail to reveal daily blood glucose fluctuations, or the frequency of highs and lows.

Time in Range gives a comprehensive view of a person’s daily blood glucose control.

It shows how diet, physical activity, and medications influence blood sugar levels.

This detailed understanding is essential in preventing the rollercoaster-like effects of fluctuating blood glucose levels and help to reduce the risk of both hypoglycemia and hyperglycemia.

For people with diabetes, an HbA1c level of 48mmol/mol (6.5%) or below is considered ideal. This equates to having a time in range of 80%.  

The clinical importance of Time in Range

Research has shown that a higher Time in Range, that is, spending more time with your blood glucose levels between your target thresholds, is linked to a reduced risk of diabetes complications.

Time in Range is becoming a key endpoint in clinical trials evaluating new diabetes therapies, highlighting its importance as a predictor of treatment efficacy and patient outcomes.

Monitoring Time in Range

While monitoring Time in Range may seem cumbersome, it’s actually very simple.

Continuous glucose monitors (CGMs) and systems such as the Freestyle Libre 2 provide real-time blood glucose readings allowing you to track fluctuations throughout the day and night.

This continuous stream of data allows you and your healthcare team to assess your blood glucose control accurately.

Most CGMs come with apps that show your Time in Range.

• Buy a Freestyle Libre 2
• FreeStyle Libre 2: update enables use as a continuous glucose monitor
• How do CGM sensors work?

What’s more, the data that comes from your CGM can also help you to identify trends, such as times of day when blood sugar levels are most volatile, guiding more precise guidance on how to optimise blood glucose management.

Using Time in Range data

Time in Range data has several practical applications:

• It enables you to make more informed treatment decisions
• It enables your healthcare provider to design tailored interventions like medication dosages, dietary plans, and exercise regimens according to your unique biology
• Maintaining Time in Range can significantly reduce the risk of diabetes-related complications
• Time in Range empowers people with immediate feedback on their choices and develops a more engaged, proactive approach to health

Alongside HbA1c, Time in Range gives you an effective way of understanding your state of diabetes control.

Hypoglycemia occurs when blood glucose levels fall below 4 mmol/L (72mg/dL).

Whilst many of us do think of diabetes as being a problem of high blood sugar levels, the medication some people with diabetes take can also cause their sugar levels to go

too low

and this can become dangerous.

What is hypoglycemia?

Hypoglycemia occurs when the level of glucose present in the blood falls below a set point:

• 
  Below 4 mmol/L
  
  (72mg/dL)

Being aware of the early signs of hypoglycemia will allow you to treat your low blood glucose levels quickly – in order to bring them back into the normal range.

It is also recommended to make close friends and family aware of the signs of hypoglycemia in case you fail to recognise the symptoms.

What are the symptoms of hypoglycemia?

The main symptoms associated with hypoglycemia are:

• Sweating
• 
  Fatigue
• Feeling dizzy

Symptoms of hypoglycemia can also include:

• Being pale
• Feeling weak
• 
  Feeling hungry
• A higher heart rate than usual
• 
  Blurred vision
• Confusion
• Convulsions
• Loss of consciousness
• 
  And in extreme cases, coma

Who is at risk of hypos?

Whilst low blood sugar can happen to anyone, dangerously low blood sugar can occur in people who take the following medication:

• 
  Insulin
• 
  Sulphopnylureas
  (such as glibenclamide, gliclazide, glipizide, glimepiride, tolbutamide)
• 
  Prandial glucose regulators
  (such as repaglinide, nateglinide)

If you are not sure whether your diabetes medication can cause hypos, read the patient information leaflet that comes with each of your medications or ask your doctor.

It is important to know whether your diabetes medication puts you at risk of hypos.

What are the causes of hypoglycemia?

Whilst medication is the main factor involved in hypoglycemia within people with diabetes, a number of other factors can increase the risk of hypos occurring.

Factors linked to a greater risk of hypos include:

• Too high a dose of medication (
  
  insulin
  or hypo causing tablets)
• Delayed meals
• 
  Exercise
• 
  Alcohol

You can take steps to minimise the risk of these factors causing hypos.

How is hypoglycemia diagnosed?

Hypoglycemia is detected by measuring blood sugar levels with a glucose meter. Any

blood glucose level below 4.0 mmol/L

indicates that the individual has hypoglycemia. Urine tests do not detect hypoglycemia.

If taking a blood test is not possible or would take too much time, it may be better to treat the hypo straight away.

How do I treat hypoglycemia?

A mild case of hypoglycemia can be treated through eating or drinking 15-20g of fast acting carbohydrate such as

glucose tablets, sweets, sugary fizzy drinks or fruit juice.

Some people with diabetes may also need to take 15-20g of slower acting carbohydrate if the next meal is not due.

A blood test should be taken after 15-20 minutes to check whether blood glucose levels have recovered. Severe hypoglycemia may require an ambulance, for example if loss of consciousness occurs or a seizure persists for more than 5 minutes.

Severe hypos can be treated with glucagon if a

glucagon injection kit
is available and in date.

• Read more detail on
  
  how to treat hypoglycemia

How serious is hypoglycemia?

Hypoglycemic episodes can range from mild to severe.

Mild hypoglycemia can usually be treated by the individual and are to be expected to some degree in people on insulin. Mild hypos are not associated with significant long term health problems unless they are occurring very regularly or for long periods of time.

Severe hypoglycemia, however, will require treatment from someone else and may require an ambulance. Severe hypos can lead to immediate danger if not treated immediately. Whilst rare, severe hypos can potentially lead to coma and death.

• What is
  
  dead in bed syndrome
  ?

Do symptoms always occur before hypoglycemia?

Most people experience some warnings before the onset of hypoglycemia. However, some diabetics may experience little or no warning before the onset of sudden or severe hypoglycemia.

An impaired ability to spot the signs of hypoglycemia is known as loss of hypo awareness (or

hypo unawareness
).

Preventing hypoglycemia

The key to preventing hypos is understanding why hypos occur and then taking actions to stop this happening. If you know that a hypo is likely to occur soon, carbohydrate can be taken to raise sugar levels and prevent the hypo.

If your doctor is happy for you to adjust your medication doses, you can also lower your dose during or following certain activities (eg exercise or after having alcohol) to prevent a hypo occurring.

Testing blood sugar levels
regularly can help you to understand when your sugar levels are dropping too low.

Your diabetes health team can help you with making changes to your diabetes management.

Are hypos catching you without warning?

Join the Hypo Awareness Program for a comprehensive guide towards recovering your hypo awareness »

A hypo (hypoglycemia) is triggered when blood sugar levels fall under 4 mmol/L.

Too much insulin or too little food can spark a hypo.

This guide details what

hypoglycemia
is, how to recognise hypo symptoms, and what to do when you or your child is suffering from a hypo (hypoglycemia).

What are the symptoms of hypo?

Symptoms of hypoglycemia vary from person to person, but people with diabetes should learn to recognise their own signs in order to treat the hypo as quickly as possible.

Some of the most

common symptoms
of a hypo include:

• Feeling dizzy
• 
  Feeling hungry
• A change in mood
• Feeling sweaty
• Trembling
• Finding it hard to concentrate

What to do if you think you/your child is having a hypo?

If you, or your child, may be having a hypo, it’s often worth checking

blood sugar levels
as soon as the symptoms are noticed.

However, if testing could delay treating the hypo by more than a minute or two, it is better to treat the hypo immediately and test as soon after as you can.

Someone I know is having a hypo, what should I do?

If someone with diabetes is having a hypo and is conscious, they should initially treat a hypo with 15-20g of fast acting sugary food or drink, such as:

• 5 glucose tablets
• 150 to 200ml of a sugary fizzy drink (eg full sugar cola or lemonade)
• 4 to 5 sugar lumps or teaspoons of sugar
• 150 to 200ml of fruit juice

The priority is to bring blood glucose levels back up to normal as quickly as possible.

Chocolate can be used if little else is available. However, note that the fat in chocolate slows down how quickly the sugar gets broken down, so use sugary foods without fat in where possible.

If someone is unconscious or has a seizure this is a severe hypo. Read more on the symptoms and

treatment of a severe hypo

So in the case of serious hypo what should be done?

• The patient should be put into recovery position
• Emergency services should be contacted
• Glucagon should be given as advised

What does glucagon do to a hypo patient?

Glucagon causes blood glucose levels to rise within 10-60 minutes after an injection. Following glucagons, standard instant hypo treatment (glucose tablets, Lucozade, fizzy drinks). Vomiting may occur during the first hour of glucagon injection.

How much glucagon should be given to hypo patients?

Standard glucagon dose is:

• Half a vial – 0.5mg
  
  (Children younger than 8 years)
• Full vial – 1mg)
  
  (Children 8 years and above)

Directions for use should be included with the product or your

healthcare professional
should be able to advise you.

The prefilled

syringe
should be injected into the glucagon vial, this should then be shaken until contents dissolve, the solution should then be drawn into the syringe with all air removed.

The technique for injection is to inject about ¼ inch into the outer thigh at an angle of 90 degrees.

In the UK, the National Health Service (NHS) does not permit people with type 2 diabetes who are not treated with insulin access to diabetes test strips on prescription unless doctors state a legitimate reason or benefit for a particular patient.

The reasons for this approach may be due to the

cost to the NHS
of providing test strips and the fact that there are no available resources to offer education on blood glucose testing to individuals with

type 2 diabetes

However, there is now a bank of evidence that structured Self-Monitoring of Blood Glucose (SMBG) can have positive effects on people with non-insulin dependent type 2 diabetes, including helping them to better understand their condition,

reduce their HbA1c levels, and improve their diabetes control.

Support is vital

Blood glucose meters are available to buy from pharmacies both online and on the high street. But research suggests that SMBG is only of significant benefit to a person’s

diabetes management
or overall health if they are supported with guidance on how to test, when to test and what to do with their results.

Research has concluded that should an individual test under the right circumstances with support and expert guidance, they can significantly improve their health.

How and when to test?

In order to get the maximum benefit of

testing blood glucose, studies have shown that it needs to be done in a structured, systematic way, one which provides information which can be useful in monitoring a person’s diabetes and also in providing specific feedback.

SMBG should not be conducted at random or too frequently – tests require fingers to be pricked to draw some blood and lots of tests within a short space of time cannot only make fingers quite sore but the information could be overwhelming so health benefits may be missed.

If you have type 2 diabetes and are interested in structured testing of blood glucose, make sure you consult your GP first.

Support and guidance from your doctor and diabetes care team will be needed in order to discover the true health potential of

blood glucose
testing.

For example, results and information from your structured testing could be used to help them make better and more informed decisions for your personal diabetes care plan.

Is SMBG worth it?

According to the research – yes it is! In 2009, the peer-reviewed medical journal Diabetes Care reported that structured blood glucose testing can help individuals with type 2 diabetes:

• Improve control of their blood glucose levels

• 
  See what effect different foods and drinks have on glucose levels, thus allowing them to make informed diet and lifestyle choices
• 
  Reduce HbA1c
  and the subsequent chances of
  
  developing diabetes-related complications, such as heart disease and stroke, retinopathy, neuropathy, and symptoms of depression.

Studies have shown that a 1% improvement in HbA1c in people with

type 1
or type 2 diabetes slashes their risk of:

• 
  Cataracts
  by 16%
• 
  Heart failure
  by 19%
• 
  Diabetic nephropathy
  (kidney disease),
  
  retinopathy
  (eye disease), and
  
  neuropathy
  (nerve damage) by 25%.

By empowering individuals with type 2 diabetes to achieve better blood glucose control through structured testing, evidence has also shown that individuals will experience a significant improvement in their overall quality of life.

Would it save the NHS money?

Official health figures show that type 2 diabetes

costs the NHS over £11.8 billion, with over £8 billion going towards inpatient care.

By testing blood glucose levels and subsequently lowering HbA1c, diabetes specialists and health experts believe the huge cost to the NHS could be significantly reduced.

Glucose intolerance is an umbrella term for metabolic conditions which result in higher than normal blood glucose levels – hyperglycemia.

Western lifestyles have seen glucose intolerance become more common year on year.

What conditions are denoted by glucose intolerance?

Conditions which can be considered as glucose intolerance include:

• 
  Impaired fasting glucose
• 
  Impaired glucose tolerance
• 
  Pre-diabetes
• 
  Type 2 diabetes

What is glucose intolerance?

Glucose intolerance includes anyone with either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).

With the World Health Organisation’s definitions for IFG and IGT, glucose intolerance is defined as:


^[46]

• A
  
  fasting blood glucose level
  
  of above 6.0 mmol/L or
• A
  
  blood glucose level
  
  of over 7.8 mmol/L 2 hours after consuming 75g of glucose.

Symptoms of glucose intolerance

The symptoms of glucose intolerance match those of type 2 diabetes:

• 
  Feeling very thirsty
• Dry mouth
• 
  Extreme tiredness
• 
  Blurred vision
• Drowsiness
• 
  Frequent need to urinate
• 
  Loss of muscle mass

The NHS states that not everyone will get these symptoms and symptoms may not be so severe.

Glucose intolerance test

A number of tests can be used to diagnose forms of glucose intolerance.

Test performed to diagnose glucose intolerance include:

• 
  Fasting plasma glucose test
• 
  Oral glucose tolerance test
  (OGTT)

Treatment for glucose intolerance

Treatments for glucose intolerance will either require lifestyle changes or a combination of lifestyle changes and

anti-diabetic medication

Lifestyle changes involve taking part in regular physical activity, aiming to lose weight, if appropriate, and cutting down on smoking and alcohol as necessary.

If medication is advised, most people will start on a drug, taken in tablet form, called

metformin

Some people may need to take additional or alternative medication.

Product:

Keynote, Keynote Pro

Manufacturer:

Wavesense

Wavesense manufacture and sell a range of blood glucose meters, each of which is designed to help people with diabetes to better manage their condition.

Wavesense Range of Meters

The Wavesense range of meters includes:

• KeyNote
• KeyNote Pro
• Presto
• 
  Jazz
  
• Jazz Wireless

Each of the meters support new technology, giving people with diabetes a wide choice.

The WaveSense technology is a suite of patented biosensor technologies that employ a concept termed

Dynamic Electrochemistry

to prodive accurate blood glucose readings.

Wavesense meters are produced by AgeMatrix who are a company based in Oxon.

Wavesense Blood Glucose Meters Technical Information

Key Features

• Key Features
• No Coding Required
• Large, backlit digits
• Glucose variability calculation

Performance Features

• As fast as 1-2-3® (In some conditions, test may take as long as 12 seconds)
• 0.5 µL blood sample size
• Alternate site testing
• Easy-to-handle test strips
• End-fill strip instantly fills

Safety Features

• Units safety lock
• Automatic marking of control solution
• Non-slip rubber grips and feet

Data Management Features

• Mealtime tagging
• Pre/Post mealtime averages
• Daily Digest
• 7 User-settable alarms
• Zero-Click software
• 1,865 test memory

How does a CGM sensor work?

Continuous glucose monitors measure the glucose in your interstitial fluid – a thin layer of fluid which surrounds the body’s cells and provides them with nutrients.

For people with diabetes, monitoring your glucose levels at all times can make all the difference when it comes to controlling your glucose levels and avoiding blood sugar spikes.

A CGM is typically placed on the back of your upper arm, where it is most safe from knocks as you go about your daily life.

If you’ve just received your first CGM and need help applying the sensor, or you’ve been having trouble making your sensor stay on, below is a step-by-step guide on sensor placement and adhesion.

Finding the right CGM sensor application site

Most sensors are placed on the back of the upper arm, where it’s less likely to brush against things such as doorways, although some sensors can also be applied to your abdomen, thigh, buttocks or back.

If you’re unsure where to put your sensor, check the information booklet that came with your device, or consult your doctor.

You must avoid using body lotions or creams on the area as this can interfere with readings and impair the sensor’s adhesion.

Select a smooth area of skin free from birthmarks, stretch marks, scars or lumps at least one inch away from where you would usually inject your insulin.

Preparing your skin

When cleaning the area where you plan to place your sensor, ensure you use a non-moisturising fragrance-free soap. Instead, a moisture-free alcohol wipe that doesn’t contain ingredients such as glycerol can be used to clean the skin.

Try to let your skin air dry before applying the sensor.

Depending on your skin type, you may have to spend a little extra time ensuring the skin is ready for the sensor to be applied. While this can be inconvenient, it can significantly improve the sensor’s adhesion, meaning it will last for longer.

Extra steps for your skin type

If you have oily skin, lotions, soaps, shampoos and hair conditioners can leave an oily residue on your skin, compromising how well the sensor sticks to your skin.

After following the steps above to ensure a clean sensor site, use an alcohol wipe to remove an excess oily residue from your skin.

For hairy skin, simply shaving the area until it is free from excess hair will help the sensor stay in place.

Applying your CGM sensor

Most sensors are applied to the skin the same way. However, there might be some differences between brands.

The steps below are a broader guide to sensor application – always consult the information booklet which came with your device for the exact instructions.

• Remove the lid from your new sensor and push it into the sensor applicator. Most sensors will have a guide (usually a mark or line) that indicates the sensor and applicator are aligned correctly.
• With the skin area prepared, place the loaded applicator over the application site. Push firmly until the sensor is in place. Afterwards, remove the applicator by carefully pulling it away.
• With the sensor attached to your skin, ensure it is secure by gently running your finger across its edge.

Caring for your sensor

It’s almost inevitable that one of your sensors will accidentally fall off at some point, whether that’s due to it catching on tight clothing or getting knocked on furniture. However, you can take some extra steps to try and keep your sensor in place.

Be wary of furniture – particularly the edges, doorways and even car seatbelts.

Loose clothing will allow your sensor to breathe and make it harder to get caught on tight clothes.

Avoid touching your sensor unnecessarily, and be careful around children curious about your device.

When drying off after showering or swimming, avoid catching or pulling the sensor on your towel.

Picking the right sensor

If you’re not sure what CGM to get, we have reviews of some of the most popular devices used by people with diabetes.

Head over and read CGM guides to read reviews and for further information on CGMs, or check out the blood glucose monitoring forum to find out what other community members are saying.

Product:

VerioPro

Manufacturer:

LifeScan

Test Strips:

Verio Pro Test Strips

The OneTouch VerioPro is a diabetes blood glucose meter that not only records and stores your results but that also helps to make sense of them by spotting trends in blood glucose levels.

The meter will be of particular interest to those with Type 1 or Type 2 diabetes who manage their own insulin and are at a higher risk of

hypoglycemia

Test strips for the Verio Pro require a very small blood sample size of 0.4 microlitres.

Results are blood plasma equivalent and, thanks to its GlucoFilter technology, the Verio Pro has been found to be one of the most accurate

blood glucose meters

available.

A meter that spots blood glucose trends for you

To help you maintain the best blood glucose levels, the Verio Pro features an on board high and low blood sugar patterns tool which enables the meter itself to detect trends and notify the user as soon as a pattern of

low blood sugar levels

is identified.

Identify trends

When such a trend is spotted, the user can view details of when they’ve been going low (or high) on previous days.

Store up to 750 results

The VerioPro can:

• Store 750 test results
• Provides a useful set of averages of 7, 14, 30 and 90 days
• Add pre-meal, post-meal,
  
  fasting
  
  and before bed tags to results to organise and help analyse results

For further analysis of blood sugar trends, results can be uploaded to your computer by data cable and viewed using the One Touch Zoom Pro Data Management System. The software offers a useful array of different tables, charts and graphs which can be printed out as a report to show your doctor.

OneTouch Verio Pro: Practicality

Like many of the glucose meters in the OneTouch range, the meter is very easy to set up and use. The Verio Pro comes with a compact and convenient carry case, which allows the user to perform a test without having to take all the kit out separately.

The meter is helpful when it comes to testing in the dark as it has a backlit screen and a strip port light.

As well as only needing small drop of blood, the test strips are also self-coding so no worrying about calibration with each new pot of test strips.

Summary

The OneTouch Verio Pro is a reliable, practical and accurate blood glucose monitor.

The small blood sample size will mean less squeezing of fingers and successful tests the vast majority of times. The high and low tool will be particularly useful for people who lead fast moving lives and those who worry about hypoglycemia.

OneTouch Verio Pro best features

• Instant notifications of high and low blood sugar trends
• Unsurpassed accuracy
• Very small blood sample size
• A range of averages, going up to 90 days

Verio Pro specifications and technical information

• 
  Strips:
  
  OneTouch Verio Pro blood glucose test strips (available on prescription)
• 
  Batteries:
  
  2 x standard AAA alkaline batteries
• 
  Data:
  
  OneTouch Zoom Pro Data Management System
• 
  Compatibility:
  
  Compatible with Windows 7, Windows XP (SP2 or above) and Windows Vista
• 
  Support:
  
  In the UK, call 0800 121 200 and in Ireland 1800 535 676

Product:

CareSens N POP

Manufacturer:

Spirit Healthcare

Test Strips:

CareSens N test strips

The CareSens N POP offers a smaller meter than the CareSens N, whilst boasting a greater range of features, including a larger memory and a greater range of averages to view.

The meter has two buttons to select and scroll through results and features. The one disadvantage is that there is no back button so you can only scroll one way through results and averages.

The CareSens N POP meets the

ISO standards

for blood glucose meter accuracy achieving 99.5% of results within the accuracy primary accuracy guidelines.

CareSens N POP features

• Small and compact
• LCD backlit screen allows testing at night
• Pre- and post-meal markers for tests
• Reminders: 4 alarms (3 timed and 1 post meal)
• Hypoglycemia alert
• Allows data transfer to computer

Blood glucose result data can be transferred using a USB data available, on request, from Spirit Healthcare. Results can then be monitored by downloading the CareSens PC Care software from the CareSens website.

Technical information

• Blood sample size: 0.5 microlitres
• Time to result: 5 seconds
• Memory: 1,000 results
• Averages: 1, 7, 14, 30 and 90 day averages given for pre-meal, post-meal and all results
• Batteries: Two 3.0 V lithium CR2032
  
  Battery Life: 1,000 tests
• Dimensions: 95 x 33 x 19 mm
• Weight: 41g
• Measurement range: 1.1 to 33.3 mmol/L
• Haematocrit range: 15 – 65%

Operating ranges

• Temperature: 5 – 50°C
• Relative humidity: 10 – 90%

Product:

Personal A1c

Manufacturer:

Abnova

The Personal A1c Diabetes HbA1c Rapid Test Kit allows people to test whether they have sugar levels in a diabetic range.

It will show whether your

HbA1c level

is either:

• 48 mmol/mol (6.5%) or greater
• Or below this figure

The test may therefore be useful for people that want to know whether their HbA1c is in a healthier range.

In the UK, diabetes tests are provided by your GP and so if you need to check for diabetes, it is important you see your GP.

If you wish to test your HbA1c at homen, you are free to do so but the test by the doctors should take priority and will be more accurate. An

HbA1c test

from the doctors can also show you if your HbA1c is in the prediabetic range, which is something that the Personal A1c test cannot.

How the test works

The test provides all the tools you need to perform the test at home. The test can be prepared and completed within 15 minutes.

Take a while to read and understand the instructions before proceeding.

A single-use lancing device is included which allows you to draw blood. The blood is drawn into a dropper-like device and then mixed with a solution.

The solution is then applied to a specific area of the testing device.

If the ambient temperature is below a certain level, a heat pad is provided which, when activated, stimulates a chemical reaction that gently warms the pad. The testing device can be placed on the pad to achieve the necessary temperature.

The test requires a waiting time of between 10 and 15 minutes.

What we found when using the kit

The instructions were well laid out but a couple of the steps could have been a touch clearer.

The long, blue lancet cap on the lancing device simply needs to be twisted off.

The heat pad requires a small metal oval to be fully folded over to activate the reaction that causes the heat pad to warm up.

The lancing device is single-use only and one of our staff members didn’t managed to draw blood on the first attempt and therefore had to use their own lancing device to draw blood.

The results were in line with what our users, with

type 1 diabetes

, were expecting given their recent HbA1c results from their doctors and their recent level of control.

Product:

A1cNow

Manufacturer:

PTS Diagnostics

A1cNow is a home testing kit for HbA1c. The test requires a drop of blood and allows you to get a good reading of your HbA1c level within a few minutes.

The kit allows you to get an up to date HbA1c reading between the official

HbA1c tests

from your healthcare team.

The A1cNow kit should not be used, however, as a replacement for the tests you get from your health team.

Summary

Overall, the test was swift, easy and provides a very clear, useful result.

• The process was quick
• The kit has been designed to make things easy.
• Result given as a numerical figure is very useful.
• The instructions are fairly clear and simple but rely on the user’s intuition to correctly interpret the images and a little more wording could help to improve clarity.

Getting set up

The design of the kit made the set-up fairly easy. The instructions are image based than word based. Whilst the images well laid out, they rely on people’s intuition to make sure they open the right pouch in the right order. It is important that the cartridge pack is not opened too early.

Our user had no problem with setting up but felt that some additional words to accompany the images might have helped.

Lancing device

The lancing device worked as intended. It requires a fairly solid push into the finger. This might perturb some people that are squeamish about finger prick tests, however, our user didn’t have an issue with this.

Blood collection

The lancing device worked as intended and the blood collection tool is well designed.

The part of the process that presented a small issue for our user was that the instructions could have been a little clearer in the use of the blood uptake tool. Our user missed that the blood uptake tool needed to be held horizontally rather than vertically to draw blood.

Reagent mixing and sample application

The reagent mixing and sample application parts of the process were clear and very easy to carry out with minimal fuss.

The meter provides a five-minute countdown on screen after the sample is applied. The user noted that this was useful.

Result

The result is given in numerical form which is very handy. The result remains on screen for up to an hour which should provide more than enough time to note it down.

The result received by our user was in line with their level of control.

Summary

Overall, the user was very impressed with the product and would have no hesitation using it again.

If you are someone that wants to obtain an HbA1c reading in between your official HbA1c tests, the A1cNow presents a good option.

Product:

OneTouch Ultra2

Manufacturer:

LifeScan

Test Strips:

OneTouch Ultra Test Strips

The Lifescan OneTouch Ultra 2 Blood Glucose Meter is designed for good diabetes management.

The meter is easy to use but has been surpassed by modern meters, such as the

OneTouch Verio

and

OneTouch Verio IQ

which require a better range of features and provide greater accuracy.

The OneTouch Ultra2 is based on the widely-used OneTouch Ultra.

After more testing feedback from doctors, nurses and patients, and latest technology – the OneTouch Ultra2 Meter provides all the information necessary to help

manage diabetes

better.

LifeScan OneTouch Ultra2 Contents

The Ultra2 box includes:

• Meter (with batteries installed)
• Guidebook
• OneTouch Ultra test strips
• OneTouch UltraSoft lancing device
• Lancets

Benefits of the OneTouch Ultra2

• Fast test time – 5 Seconds
• End fill test strip automatically draws in blood
• Test on forearm, palm or finger
• Large display with backlight
• Data port for transferring data to computer
• No cleaning necessary
• Customer Service Helpline
• Three-year warranty

Technical specifications

• Blood sample size: 1 microlitre
• Time for result: 5 seconds
• Memory: 500 test results
• Averages: 7, 14 and 30 days
• Battery: One replaceable 3.0 Volt CR 2032 lithium battery
• Dimensions: 79 x 57 x 23 mm
• Weight: 43g including batteries
• Measurement range: 1.1 to 33.3 mmol/L
• Haematocrit: 30 – 55%

Operating conditions

• Temperature: 6° – 44°C (43 – 111°F)
• Relative humidity: 10 – 90%
• Altitude: 3, 048 m

The LifeScan OneTouch Ultra2 previously boasted a fast test time, small sample size, a three year warranty and customer service helpline, with no cleaning necessary.

As stated above, more modern meters now provide improved features.

Product:

GlucoMen Visio

Manufacturer:

Menarini

Test Strips:

GlucoMen Visio Test Strips

The GlucoMen Visio, when it was released, was one of the

smallest blood test meters

available, weighing just 39g and is 8cm tall, 2cm deep and 6.5cm wide.

The GlucoMen Visio has been superceded by modern meters, such as the

GlucoMen GM

which offers improved features and accuracy.

Readings in 10 seconds

The GlucoMen Visio gives a reading after 10 seconds, and up to 250 results are automatically stored.

Date and time details and you can use the meter to see averages of readings over a 14 or 30-day period.

GlucoMen Visio test strips

The GlucoMen Visio Sensor

test strips

With the GlucoMen Visio the reaction required to give a blood reading does not start until the correct amount of blood has been added.

You can add a second drop of blood direction to the strip already in use until the reaction starts.

Most other blood test meters tell you to load a new strip and you might need to do another finger-prick, too.

GlucoMen Visio Technical Information

• Blood sample size: 0.8 microlitres
• Time to result: 10 seconds
• Measurement range: 1.1 to 33.3 mmol/L
• Memory: 250 test results
• Averages: 14 and 30 days
• Battery: One 3V lithium battery (CR2032 or DL2032)
• Battery life: Approximately 1000 tests
• Dimensions: 80 x 65 x 16 mm
• Weight: 39g
• Software: GlucoLog Software

The Microdot+ is one of a number of blood glucose meters that GPs love as it is proven to be an accurate meter as well as one which takes low cost blood glucose test strips.

The meter takes a relatively long time, by modern standards, to produce a result (10 seconds), and only provides an average of 14 days.

However, the meter does provide the basic features needed for regularly testing and recording blood glucose results.

The meter includes a test strip eject button to prevent handling the blood from the end of the used test strip and there are 4 alarms which can be set as reminders to do blood glucose tests.

The Microdot+ supports

alternate site testing

and meets the ISO standards for

blood glucose meter accuracy

Technical specifications

• Blood sample size: 0.6 microlitres
• Time for result: 10 seconds
• Memory: 500 results
• Averages: 14 days
• Battery: One 3V lithium battery (CR2032)
• Battery life: 1,500 tests
• Dimensions: 80 x 64 x 15 mm
• Weight: 58g (including battery)
• Measurement range: 1.1-29.2 mmol/L
• Haematocrit: 25-55%

Operating range:

• Temperature: 10° – 40°C
• Relative humidity: 10-90%

Product:

Bayer Didget

Manufacturer:

Ascensia Diabetes Care

Technology:

No Coding, Connects to Nintendo DS

Test Strips:

Contour Test Strips

Bayer’s Didget meter was developed in conjunction with Paul Wessel who is the father of a child with type 1 diabetes.

He realized that his so, Luke, was constantly losing his

blood glucose meter

but could always find his Nintendo Game Boy.

Plug it into a Nintendo

Paul left his job in 2000 to found Guidance Interactive Healthcare, which, with support from Nintendo, developed a product that would better help his son manage his diabetes.

Bayer has worked with Paul, who is now a

Ascensia Diabetes Care

employee, to develop the Didget.

This is a first-of-its-kind blood glucose meter that connects directly to Nintendo D and Nintendo D Lite gaming systems.

The idea being that

children

can be encouraged to make more of an effort to manage their diabetes by being rewarded for adhering to good testing habits.

Ready to do tests straight out of the box, it has a 5-second test time and requires only a small 0.6 μL blood sample and features Bayer’s No Coding technology.

Strips

:

The Didget meter uses

Contour

Test Strips, available on prescription. PIP Code 304-0279, GMS Code 81537.

Access to


Bayer’s Didget World is an exclusive web community for children with diabetes.

Technical specifications

• Blood sample size: 0.6 microlitres
• Time to result: 5 seconds
• Measurement range: 1.1-33.3 mmol/L
• Memory
  
  :
  
  480 test results
• Averages: 7, 14 and 30 day averages
• Battery: Memory: 480 test results
• Battery rating: 220 mAh
• Battery life: Approcimately 1,000 tests or 1 year of average use
• Dimensions: 95 x 77 x 21 mm
• Weight: 76g
• Operating temperature range: 5°–45°C
• Humidity: 10-93% relative humidity

Product:

Continuous Glucose Monitoring system

Manufacturer:

Medtronic

Medtronic’s Paradigm REAL-Time Insulin Pump (522/722) was the world’s first with built in CGM functionality.

Medtronic’s Guardian REAL-Time Continuous Glucose Monitoring System is a stand-alone monitor and wireless Minilink transmitter that can be used by any diabetes patient wanting to get a better insight into their

glucose

trends.

The sensors read the
interstitial fluid
readings (known as ISIGs), giving a glucose reading which can be used to adjust insulin doses and to glean a greater insight into any individual’s own body rhythms.

Recording glucose every 10 seconds

All Medtronic’s devices use the same sensor, which records glucose data every 10 seconds and transmits the average reading to update the monitor every 5 minutes.

In this way it is possible for you to see if your body’s sugar levels are moving up, or moving down.

As you can set alarms on the system, it means that you should be able to get advance notice of a

lowering blood sugar

so that you can take action and hopefully avert a hypo.

CGM isn’t cheap!

These are currently very expensive items at around £50 per sensor, each one of which should last about six days.

Generally access through the
NHS
is only for those with relatively severe hypos but as technology and access improves these are likely to become much more common place along with

insulin pump

therapy.

More information

• Call
  Medtronic on 01923 205167

Product:

Guardian REAL-Time

Manufacturer:

Medtronic

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Technology:

 

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The Guardian REAL-Time system is a stand alone continuous glucose monitoring (CGM) system, from Medtronic, that is designed to be used by people on multiple daily injection therapy.

The Guardian REAL-Time monitor resembles a similar appearance to Medtronic’s MiniMed Paradigm Veo insulin pump but is a little bulky compared with CGM recivers such as the

Dexcom G4 Platinum

or the

Abbott FreeStyle Navigator II

As with other CGMs, the Guardian REAL-Time system is composed of three main elements, a glucose sensor that is attached to the body, a transmitter to attach to the sensor and a monitor that receives data wirelessly from the transmitter.

If you are o, or considering going onto, a Medtronic pump, note that Medtronic pumps include direct integration with Medtronic’s CGM sensors and transmitters and may present a better oiption for you than having a separate CGM system.

Calibration

Calibration of the CGM is made easier if you use, or switch to using, the Bayer Contour NEXT Link blood glucose meter which communicates wirelessly with the Guardian REAL-Time system.

Technical specifications

Monitor

• Dimensions: 51 x 81 x 20 mm
• Monitor weight: Approximately 79 grams (with battery installed)
• Battery: Standard 1.5 V AAA alkaline battery (Energizer brand recommended)
• Communicator range with transmitter: 1.8 m
• Communicator range with blood glucose meter: 1.2 m

MiniLink

• Battery life: 14 days of continuous glucose monitoring

MiniLink charger

• Charger: Completes 40 typical charging operations using a new AAA battery

Product:

FreeStyle Libre

Manufacturer:

Abbott

The Abbott FreeStyle Libre has come as an entirely new concept in glucose monitoring by providing much greater data than blood glucose testing whilst being more affordable than

continuous glucose monitors

(CGM).

The FreeStyle Libre provides ‘flash glucose monitoring’ with glucose readings provided by scanning a sensor rather than pricking your finger.
.

What are the benefits of FreeStyle Libre?

Due to way the Libre works, there are a number of benefits:

• Reduced need to take so many
  
  blood glucose tests
  
• Provides graphs of how your sugar levels have been varying – in a similar way to how a CGM does.
• Scanning the sensor shows how much your results are trending upwards or downwards.
• More affordable than a CGM
• Sensor is waterproof in up to 1m of metre for 30 minutes

How the FreeStyle Libre works

The FreeStyle Libre works by having a small round sensor applied to your arm.

The sensor is a round disc, 5mm high and 35mm diameter, making it roughly the size of a £2 coin.

The sensor is applied to the skin with a handheld applicator and then lasts for 14 days. Most people that were used in patient trials of the Libre rated the application of the sensor as being painless.

Within the 14 days of usage, the sensor allows you to scan the sensor with the handset which sends data of your sugar levels over the previous 8 hours to the Libre system’s handset.

When you scan, you therefore get not just a glucose reading, as you would with a

blood glucose meter

, but can also see whether your sugar levels are starting to go up, down or are stable.

How much does the FreeStyle Libre cost?

At the time of writing, the FreeStyle Libre is available at the following prices direct from Abbott’s FreeStyle Libre website:

• 
  Starter Pack
  
  – reader plus two 14 day sensors: £159.95
• 
  FreeStyle Libre Reader:
  
  £57.95
• 
  FreeStyle Libre Sensor:
  
  £57.95

Power in the data

The data provided by the FreeStyle Libre is the largely same as the data provided by a CGM, just so long as you ensure you take a scan at least once every 8 hours.

The one feature that CGMs have that the FreeStyle Libre most notably lacks is that it cannot alert you when

glucose levels are going too low

However, the much lower price tag for the Libre means that some people will not be put off buying the Libre despite lacking the alerts.

In terms of hypos, particularly over night ones, the fact that the Libre allows you to review graphs of your sugar levels whilst you’ve been asleep means that you can see that if your sugar levels have been trending low over night and can make changes to

minimise the risk of future nocturnal hypos

Glucose levels

Note that the sensor provides a glucose level reading not by measuring the level of glucose in the blood but the level of glucose in

interstitial fluid

, fluid in the body which acts as a reservoir of nutrients, including glucose, for your body’s cells. This is the same method of measuring sugar levels that continuous glucose monitors use.

Whilst the sugar levels provided by readings from interstitial fluid are largely a close match for blood sugar readings, there will sometimes be differences. The differences should not be large but may be significant at lower levels. For this reason, it is advisable to carry out some blood glucose tests during the day to check for accuracy and to do a blood test if you think you may be hypo.

Technical specifications (reader)

• Radio frequency: 13.56 MHz
• Data port: Micro USB
• Blood glucose measurement range: 1.1 to 27.8 mmol/L
• Blood ketone measurement range: 0.0 to 8.0 mmol/L
• Battery: 1 lithium-ion rechargeable battery
• Battery life: 7 days typical usage between charging
• Service life: 3 years of typical use
• Dimensions: 95 x 60 x 16 mm
• Weight: 65 g

Operating and storage ranges

• Operating temperature: 10° to 45°C
• Storage temperature: -20° to 60°C
• Altitude: -381 m (-1,250 ft) to 3,048 m (10,000 ft)

Technical specifications (sensors)

• Memory: 8 hours (32 readings)
• Sensor life: Up to 14 days
• Battery: 1 silver oxide battery (lasts the life of the sensor)
• Dimensions: 35 mm diameter and 5 mm height
• Weight: 5 g

Operating and storage ranges

• Operating temperature: 10° to 45°C
• Storage temperature: 4° to 30°C
• Relative humidity: 10-90% (non-condensing)
• Altitude: -381 m (-1,250 ft) to 3048 m (10,000 ft)
• Water resistance: IP27: Can withstand immersion into 1m (3 ft) of water for up to 30 mins

Product:

FreeStyle Navigator II

Manufacturer:

Abbott

The FreeStyle Navigator II is the successor to Abbott’s FreeStyle Navigator CGM.

The FreeStyle Navigator II features a transmitter (the part you wear on the skin) that is just over 3 by 3 cm and 1 cm deep.

The receiver, which displays the glucose levels, includes a colour screen and range of additional features and alarms to help you monitor your glucose levels.

Features

• Colour screen receiver
• 30m transmission range
• New result every minute
• Trend arrows – showing whether levels are stable, falling/rising or rapidly falling/rising
• Customisable target range
• 5 day sensor life

Sensors

Sensors for the FreeStyle Navigator II are less expensive than the sensors for Abbott’s FreeStyle Libre flash monitoring system, however, each sensor lasts 5 days compared to the 14 day usage available from the FreeStyle Libre sensors.

The sensor insertion device allows the sensors to be added to areas, such as the back of the arm.

Calibration

Calibration should be performed at 1, 2, 10, 24 and 72 hours after sensor insertion to ensure accuracy and functionality. The FreeStyle Navigator II will alert you when a calibration test is required.

Data transfer

Data can be transferred onto a PC via mini USB cable.

However, at time of writing, Abbott’s FreeStyle CoPilot software is not as yet compatible with computer running Windows 8 or Mac operating systems.

Technical specifications

Sensor:

• Measurement range: 1.1 to 27.8 mmol/l
• Sensor life: Up to 5 days
• Operating temperature of sensor: 25°to 40° C

Transmitter:

• Size: 32 x 31 x 11 mm
• Weight: ? (including battery)
• Batteries: One lithium CR2032 coin cell battery
• Battery life: Up to 1 year of normal use
• Wireless range: Up to 3 m
• Waterproof: IPX7 Suitable for water use up to 45 minutes in a depth of 1 m

Receiver:

• Size: 96 x 61 x 16 mm
• Weight: ? (with 2 AAA batteries)
• Data memory: 60 days of normal use
• Batteries: One rechargeable 4.1 V lithium-ion battery
• Battery life: Up to 3 days of normal use
• Test strips: FreeStyle Lite
• Hematocrit: 15 to 65%
• Humidity range: 10% to 93% (non-condensing)

System operating and storage conditions

• Operating temperature: 4°to 40° C
• Storage temperature of system: -10°to 45° C
• Storage temperature of sensor: 3°to 30° C
• Storage temperature of test strips: 4°to 30° C
• Storage temperature of control solution: 2°to 30° C
• Operating and storage altitude: Sea level to 3,048 m