staying on track headline

Intensive Diabetes

Management and Continuous

Glucose Monitoring

Intensive Diabetes Management and Continuous Glucose Monitoring

Technology has evolved a lot for people with type 1 diabetes, but is it right for you?

If you have type 1 diabetes or are the care partner of someone who does, you may have heard about continuous glucose monitoring (CGM) and intensive diabetes management. But it’s not always easy to know whether—or when—it’s the right time to use these diabetes treatment tools.

Here’s some information that may help you make the right decision for yourself or the person you care for along with your diabetes care teamDiabetes care teamYour diabetes care team may include: a primary care doctor, a diabetes and hormone doctor (endocrinologist), a registered nurse, a diabetes educator, a dietician, a heart doctor (cardiologist), a foot doctor (podiatrist), an eye doctor (ophthalmologist/optometrist), a kidney doctor (nephrologist), a dentist, a pharmacist, and a mental health professional.

How can CGM technology help?
cgm technology

In the 1970s, finger-stick blood sugarBlood sugarOr blood glucose. The main sugar (glucose) found in the blood, and the body’s main source of energy. monitoring was developed. Since then, it has become widely used for checking blood sugar.

More recently, the Food and Drug Administration (FDA) has approved real-time CGM. A CGM is a small sensor inserted under the skin that measures the fluid between cells called interstitial fluid. This measure is closely related to blood glucose, so it can be used to measure blood sugar levels. 

The benefits of CGM include:

  • CGM gives you an almost continuous readout of blood sugar levels, displaying them every 1 to 5 minutes. So, you can see whether blood sugar is rising or falling. You can’t tell this with a finger-stick reading since it is only a snapshot of your blood sugar level
  • Knowing which way blood sugar is going can be helpful. For instance, when trying to figure out if you (or the person you care for) need a snack before bedtime. If your blood sugar is where it should be, but is falling, then maybe a snack is a good idea to keep it from going too lowBut, if it’s going up, a snack is probably not needed or helpful
  • CGM has a built-in alarm warning that signals when blood sugar levels get too high or low. This helps people with diabetes find their way out of the danger zone. It may be really useful for those with low blood sugar unawareness. If you are thinking about trying tight controlTight controlIntensive insulin therapy is a treatment approach designed to keep your blood sugar levels closer to the levels of someone who doesn’t have diabetes. This treatment requires close monitoring of blood sugar levels and multiple doses of insulin., but are afraid of hypoglycemia, CGM may be especially helpful
  • CGM provides much more information than finger-stick readings alone. The detailed information CGM gives you about how blood sugar changes helps you figure out patterns, so you can fine-tune food choices and insulin InsulinA hormone made by the beta cells in the pancreas that helps sugar move from the blood into the cells. Insulin is also an injectable medicine that is used to treat diabetes by controlling the level of sugar in the blood.doses 
  • You'll know if you're meeting your "time-in-range" target. The ADA recommends that people using CGM stay within their recommended target range 70% of the time. So for most nonpregnant adults, that means 16.8 hours a day between 70 mg/dL and 180 mg/dL to keep A1C below 7%.

Here are some other things to remember about CGM: 

  • CGM does not replace finger-stick measurements. Finger-stick readings are more accurate than CGM readings and are needed to calibrate CGM measurements. And it is still necessary to confirm CGM readings with a finger stick before taking a bolusBolusBolus insulin (prandial or mealtime insulin) is an extra amount of insulin taken to cover an expected rise in blood sugar during or after a meal or snack. It can also be taken when blood sugar is high. of  fast‑acting insulin

  • CGM can be a constant reminder of diabetes. Instead of thinking about your diabetes mainly when checking blood sugar and taking insulin, new blood sugar measurements will be showing up every few minutes. While some people may find that reassuring, it can be too much information for others

piggy bank blue coin
  • CGM can be expensive, especially when it is not covered by insurance. Be sure to consult with your diabetes care team before making any changes to ensure that this is the right method for you or the person you care for 

What is intensive diabetes management?

The person with diabetes, care partner, and diabetes care team work together to safely keep blood sugar levels as close as possible to the level of someone without diabetes. This is referred to as “intensive diabetes management.” However, this type of control is not for everyone. People who have a high risk of low blood sugar may be advised by their doctors to aim for slightly higher goals.

The blood sugar goals recommended by the ADA for many nonpregnant adults are:

a1c blood sugar goals table

However, some doctors may set even lower blood sugar goals (such as an A1CA1CA test that gives you a picture of your average blood sugar level over the past 2 to 3 months. The results show how well your diabetes is being controlled. The A1C test does this by measuring the amount of sugar (glucose) that has attached to the hemoglobin in your red blood cells. More sugar (glucose) means a higher A1C. of less than 6.5%) for people with type 1 diabetes who are likely to achieve these goals without a major risk of low blood sugar or other negative effects. 

Intensive diabetes management for children and teenagers

Below are the goals for all pediatric age groups from the American Diabetes Association (ADA). A child’s or teen’s blood sugar goals may be higher or lower than these suggested goals. Consult with the diabetes care team to decide what is right for you or the person you care for. 

pediatric a1c blood sugar goals table

Intensive diabetes management means being strict

  • Checking blood sugar levels often (perhaps more often than you’re used to) and tracking the results

  • Closely following eating and physical activity plans and possibly tracking food and physical activity, too

  • Taking frequent doses of insulin by injection or through an insulin pump

Always do what your diabetes care team tells you

The benefits of intensive diabetes management need to be balanced against possible risks. These include low blood sugar (hypoglycemia) and potential weight gain. This type of control is not something that you or your care partner should try without the help and advice of a doctor. Talk to the diabetes care team about what makes sense for you or the person you care for. 


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