Helping patients succeed with continuous glucose monitoring

In this article:

• The CGM boom
• Counseling patients with CGMs
• Understanding results
• Other resources

In this article

• The CGM boom
• Counseling patients with CGMs
• Understanding results
• Other resources

Continuous glucose monitors (CGMs) have changed how patients manage diabetes for the better. However, that doesn’t stop many from showing up at the pharmacy feeling a little lost with their new tech. While these small sensors can help track blood sugar around the clock, many patients might have trouble making sense of all that data and getting the most out of their CGMs. Pharmacists can step in as guides to give advice on the most common concerns and offer support.

The CGM boom: What it means for your patients

CGMs are now a go-to for many people with diabetes. And with good reason, as many patients prefer not to keep pricking their fingers multiple times a day just to check their glucose. Around 40% to 50% of people with Type 1 diabetes use CGMs, and more research is showing benefits for Type 2 diabetes as well.

CGMs can give real-time data on glucose levels, helping patients make smarter daily choices. They’ve been shown to help lower A1c levels and promote healthy behaviors in patients with diabetes, such as eating a balanced diet and regularly exercising. 

With the ability to see blood sugar on their smartphones, patients may find it more convenient to track their levels. Over-the-counter CGMs are also becoming available, making the tech more accessible. Prescription models, however, tend to last longer and may offer more advanced tracking features.

Counseling points for patients who use a CGM 

Patients may need help with applying the sensor, reading their device, and figuring out insurance or other costs. Focusing on these areas can help patients get the most out of their CGMs.

1. Applying the sensor and rotating sites

Applying the sensor in the right spot can ensure it’s placed comfortably while being accurate. Walk patients through cleaning the spot with alcohol and letting it dry. 

Sensors need to be placed on spots with enough fat, such as the back of the upper arm, abdomen, or thigh, depending on the device. Patients should avoid lotions or oils so the sensor stays put for the whole wear period.

2. Explaining the warm-up period

Most CGMs don’t start reading glucose levels right away. Remind patients that, after applying the sensor, there’s usually a “warm-up” period where the device adjusts and gets ready to give accurate numbers. This can take anywhere from one to two hours, depending on the device: 

• FreeStyle Libre 2 and 3: About 60 minutes 
• Dexcom G6: Around 2 hours 
• Dexcom G7: About 30 minutes 
• Medtronic Guardian Sensor 3: About 2 hours 

Let patients know they won’t get readings during this time, and that’s normal. Some sensors, like the Dexcom G6 and G7, don’t require fingerstick calibrations. Others, such as the Guardian Sensor 3, may need regular calibrations to stay accurate. Make sure patients know if their device needs calibration and how often to do it.

3. Getting comfortable with readings and alerts

CGM readings come from interstitial fluid, not blood, so there can be a bit of a lag (maybe 10 to 15 minutes). Patients need to know this so they don’t get startled if the numbers look off. 

You might consider taking time to set up alerts with patients. If there are too many alarms, it may get bothersome, and patients might just quit using the device. Start with broader ranges, then narrow them as patients get used to things. 

4. Managing technical problems

Technical hiccups are part of the CGM experience. If patients know what to expect, they’re more likely to maintain adherence when something goes wrong. Common technical problems and fixes include: 

• Lost signal: Move closer to the receiver or check your phone connection
• Compression lows: Sometimes lying on the sensor can give a false low 
• Sensor errors: If readings are always off, swap the sensor 
• Adhesive failures: Suggest medical tape or patches to keep it in place

5. Providing rules for daily use

CGMs are typically built to last through daily life activities. Most are waterproof, so patients can swim or shower without worry. They can work out, sleep, and go about their day pretty much as usual. 

Make sure patients know when to use finger sticks. If they see an unusually high or low, especially in the first few days with a new sensor, they should double-check with a fingerstick test before treating.

6. Breaking down costs and insurance coverage

Insurance coverage for CGMs can vary and is sometimes a headache for patients. Most plans pay for CGMs if someone has Type 1 diabetes or uses multiple daily insulin shots. Prior authorization is often needed, with some plans only covering certain brands. 

Pharmacists can help patients figure out their costs upfront. SingleCare offers savings on prescription CGMs. Plus, manufacturers sometimes offer assistance or discount programs, so it can be helpful for people without good insurance to look into these. 

7. Understanding privacy and data security

Many CGMs can send data to apps or shared cloud platforms. That way, patients and sometimes their doctors or caregivers can track glucose trends over time. However, this can also raise concerns about privacy and who can see their data.

Most CGMs, including Dexcom, Libre, and Medtronic systems, have sharing features. For example:

• Dexcom Share lets users send real-time readings to up to 10 people through the Dexcom Follow app.
• LibreLinkUp lets caregivers see updates from a FreeStyle Libre user.
• Medtronic CareLink uploads CGM and pump data for remote provider access.

Let patients know these features are optional. They should choose what data to share and with whom. It’s also a good idea to explain how to adjust privacy settings in the app. If patients are worried about data safety, encourage them to use secure passwords and update their apps regularly to stay protected.

Helping patients understand their results

CGM data can feel like information overload. Emphasize that the value of a CGM is in tracking patterns over time, not just reacting to individual highs or lows. Teach patients to look at daily trends, such as:

• What times of day their blood sugar tends to rise or fall
• Whether meals or activities consistently trigger spikes or dips
• How long it takes for their blood sugar to return to target after eating

Point them toward the device’s “time in range” or average glucose summaries, which may be easier to understand than line-by-line readings. For example, a patient consistently spending 70% or more of the day within their target range is doing well, even if a few numbers seem off.

Help patients reframe unexpected highs or lows as learning opportunities, not failures. A spike after a new food or workout can be useful information, not a reason to be upset.

Encourage patients to follow up with a healthcare provider

As a pharmacist, you might be the first person a patient goes to about CGM-related questions. While you may be able to answer many questions, some problems need support from their provider. Encourage patients to schedule a visit with their diabetes care provider, especially if:

• They’re seeing unexplained highs or lows that may require lab tests to check for other causes
• They may need an adjustment to insulin doses or other diabetes medications
• They’re not using insulin but have concerning trends
• Their A1c results don’t align with their CGM trends, which might need a full clinical review
• They’re showing signs of diabetic complications, like numbness in their feet, vision changes, or slow-healing wounds
• They’re experiencing mental health changes (stress, depression, or anxiety) that can affect how they manage glucose levels and may need behavioral support

Remind patients that providers can often download CGM data directly from the app or through cloud-based platforms (e.g., Dexcom Clarity, LibreView), which can help make appointments more productive. Reassure them that reviewing CGM trends with their healthcare provider is one of the best ways to adjust their treatment plan.

Other resources for patients

There are many resources out there to help support and guide patients who use CGMs. Pharmacists can show patients different organizations and tools that can make it easier to stick with a CGM:

• Manufacturer support: Many brands have tutorials, helplines, and mobile app walkthroughs (e.g., Dexcom’s “G6 and G7 Start Here” guide, Abbott’s LibreView resources).
• Community groups: Organizations like Beyond Type 1 or Diabetes Daily may provide articles for education and forums to get support from others.
• Apps: Some CGMs sync with digital tools like Apple Health, MySugr, or Glooko, which can help with meal tracking or analyzing glucose trends.

CGM manufacturers usually release instruction sheets and short videos to walk people through the steps of how to use the devices, but the information can still be overwhelming. Fortunately, pharmacists can point people to the right resources for help.

The American Diabetes Association (ADA) keeps a set of CGM resources to help healthcare providers make the right recommendations. These include free courses, clinical guidelines, and case studies to stay current and better support patients.