Diabetes Care: How Tech Can Help You Manage

Content independently created by WebMD and supported by our partners. Learn More

Serena Valentine, 41, has been pricking her finger at least four times a day for more than 20 years. She knows exactly where to poke for the least amount of pain. "On the side, not on the tip or fingerprint area, because that's where all the nerve endings are," she says.

The Houston mom and community health worker, who's also legally blind, found relief using a continuous glucose monitor (CGM).

"All I have to do is scan the sensor with my phone," she says. "I can check it at any time, and no one knows what I'm doing. They might think I'm just scratching my arm."

Like nearly 40 million Americans, Valentine has type 2 diabetes. She manages her condition with weekly semaglutide shots, daily antidiabetic medication, regular exercise, and nutritious eating.

Technology gives her even more control over her condition.

An app on her phone provides real-time updates on when her blood sugar levels go

out of range and shows how her body responds to changes in diet and lifestyle.

"With the CGM, I don't have to prick myself over and over again," she says. "Oh my gosh, I love it."

The Houston mom and community health worker, who's also legally blind, found relief using a continuous glucose monitor (CGM).

"All I have to do is scan the sensor with my phone," she says. "I can check it at any time, and no one knows what I'm doing. They might think I'm just scratching my arm."

Like nearly 40 million Americans, Valentine has type 2 diabetes. She manages her condition with weekly semaglutide shots, daily antidiabetic medication, regular exercise, and nutritious eating.

Technology gives her even more control over her condition.

An app on her phone provides real-time updates on when her blood sugar levels go out of range and shows how her body responds to changes in diet and lifestyle.

"With the CGM, I don't have to prick myself over and over again," she says. "Oh my gosh, I love it."

Advances in Diabetes Technology:
Who Benefits?

The first CGM hit the market in 1999. Insulin pumps were approved for commercial use 20 years before that.

Diabetes technology has evolved quite a bit since then, says Shubham Agarwal, MD, an endocrinologist and assistant professor at the University of Nebraska Medical Center who has a special interest in diabetes tech.

For example, CGMs can measure blood sugar levels in real time now, and sensors are more accurate than they used to be. Modern insulin pumps link directly to CGMs, Agarwal says, operating mostly in the background with little input from the user and less risk of low blood sugar, compared to older models.

CGMs and automated insulin delivery systems are safer and easier to use than past devices. What's more, people who use technological tools (including mobile apps and telehealth services) to manage their diabetes are more likely to have better blood sugar control, less diabetes distress, and an improved quality of life.

Having healthy glucose levels also lessens the chances you'll have future diabetes-related health problems, Agarwal says, like the kind that cause serious damage to your eyes, kidneys, or nerves and raise your odds of heart and blood vessel problems.

There's overwhelming data that shows diabetes technology improves glycemic control for people who use insulin. This largely includes folks with type 1 diabetes and about 10% of those with type 2 diabetes. But these advances also benefit those with diabetes who don't use insulin.

"Technology gives more power to people with diabetes," says Agarwal. "They're more empowered to understand what they're doing in their daily lives (that affects their blood sugar) and how they could change things around to see results."

The first CGM hit the market in 1999. Insulin pumps were approved for commercial use 20 years before that.

Diabetes Devices That Fit Your Lifestyle

Continuous Glucose Monitors:
Who Should Get One?

Of all the technologies available to help manage diabetes, the CGM is probably the "single most important intervention," says Patricia Peter, MD, an endocrinologist at the Yale Diabetes Center.

CGMs often alert people with diabetes and their doctors about rising blood sugar levels that may go unnoticed with less frequent checks, she says. This can signal that your current dose of insulin or oral agents aren't working well.

When people reach out to their clinic, the care team can review blood sugar data to make changes to treatment between visits, says Peter. In other words, "We can make changes quicker," she says.

Peter also sees how instant feedback from CGMs promotes healthy habits. "Many of my patients with type 2 diabetes tell me that CGMs give them insight into the foods they should or shouldn't be eating," she says.

CGMs also use machine-learning algorithms (computer models that solve problems) to predict future blood sugar levels based on past glucose readings. You can use this extra data to guide your nutritional choices or help you adjust your insulin or medication doses based on what the CGM tells you about where your blood sugar is headed. "And that's information you don't get from finger sticks," says Peter.

Of all the technologies available to help manage diabetes, the CGM is probably the "single most important intervention," says Patricia Peter, MD, an endocrinologist at the Yale Diabetes Center.

When people reach out to their clinic, the care team can review blood sugar data to make changes to treatment between visits, says Peter. In other words, "We can make changes quicker," she says.

Continuous Glucose Monitor Basics

There are different ways to check your glucose levels. If you go to the doctor, they may test blood from a vein in your arm. An at-home meter also measures blood glucose, but the fingerstick method takes from smaller blood vessels called capillaries.

A CGM, on the other hand, measures the sugar levels in your interstitial fluid—the fluid surrounding your cells. Glucose reaches this space after traveling through your bloodstream and leaking out of your vessels, which is why CGM readings can differ from finger stick readings.

There's also a type of CGM that works with an implantable sensor. A health professional has to put in and remove this device. These sensors can last for months, but they're not used as often as the kind you can change out yourself.

There are two categories of CGMs:

Personal CGM. These are CGMs that you buy and keep. Most personal CGMs are only available with a prescription from your doctor, but you can buy one FDA-approved biosensor (Stelo made by Dexcom) over the counter.

Professional CGM. Your doctor may loan you a CGM. You wear it for a short period of time, usually 1-2 weeks. This option might be right for you if you don't want to wear a CGM all the time or your health insurance won't pay for one.

Benefits of a Continuous Glucose Monitor: Is It Right for You?

Research shows mixed results on whether using a CGM does much to lower A1c levels (your blood sugar average over 3 months) in people with type 2 diabetes who don't use insulin.

Valentine credits her CGM with helping her gain control over her glycemic variability - the daily ups and downs of blood sugar that can also impact your long-term health.

Here are some reasons to talk to your doctor about using a CGM:

Research shows mixed results on whether using a CGM does much to lower A1c levels (your blood sugar average over 3 months) in people with type 2 diabetes who don't use insulin.

Valentine credits her CGM with helping her gain control over her glycemic variability - the daily ups and downs of blood sugar that can also impact your long-term health.

Here are some reasons to talk to your doctor about using a CGM:

Even if your doctor prescribes you a CGM, there's no guarantee that your insurance will cover it. This is a common barrier for people in Valentine's situation - you have type 2 diabetes and don't use insulin and are covered by Medicaid, the state-run health insurer for people on disability or who have a low income.

"My insurance company stopped paying for the CGM, saying it wasn't a medical necessity," says Valentine. "But I'm telling them I'm legally blind and I'm tired of poking myself. Can you please just give me the CGM?

Valentine's-new endocrinologist gave her a Freestyle Libre 3 CGM sensor to use in the meantime. The device attaches to the back of her arm and checks her glucose every minute. The results go straight to her smartphone without the need to scan the sensor. Her doctor also linked his system to her account so that he can check on her blood sugars. "I didn't even know they could do that," says Valentine.

She'll need to replace her sensor every 14 days but she has a prescription for refills so she can continue using it. Valentine is hopeful Medicare will cover the CGM this time since the request came from her endocrinologist. The original issue involved her primary care doctor.

If something similar happens to you, ask your doctor to challenge the decision. Ask for a peer-to-peer review, if possible. This usually means an endocrinologist (or other diabetes specialist) will explain why you need a CGM and why insurance should cover it.

"I do believe that the best move was to get an endocrinologist," says Valentine.

For more resources, visit the "continuous glucose monitor" advocacy page of the American Diabetes Association.

Use Insulin? Consider These Tools

Cheryl Barry, RN, MS, is a certified diabetes care and education specialist (CDCES) at UMass Memorial Medical Center in Worcester, MA. She helps people with diabetes understand how to manage their condition from "soup to nuts," including how technology can simplify their care.

If you're on insulin, she might ask you questions such as:

Here are some of the most common insulin delivery devices she recommends:

If you're on insulin, she might ask you questions such as:

Here are some of the most common insulin delivery devices she recommends:

Smart insulin pen. Not only does this app-friendly tool deliver preloaded insulin with just a few clicks, it automatically tracks your doses. This lowers the chances you'll miss a dose or take too much.

For example, Barry says, it's common to see high blood sugar and give yourself another dose of insulin on top of your previous one (called insulin stacking). This can lead to low blood sugar due to the active insulin still in your body.

A smart pen can help prevent insulin stacking because it knows how long your previous dose should last. It calculates the amount you really need by noting the "insulin on board," says Barry.

Other benefits of a smart insulin pen include that it can:

A smart insulin pen could be a good fit for you if you use insulin-to-carb ratios (how much fast-acting insulin you need based on your carb intake) and correction factors (how much insulin you need to get your blood sugar in your target range).

If all that math seems overwhelming, you can enter your glucose levels and the carbs you're eating into the smart pen app. "It'll do the calculations for you," says Barry.

Insulin pump. If you need multiple insulin doses each day, your doctor might suggest you try an insulin pump. These small devices can be an option whether you have type 1 or type 2 diabetes.

You can set it to give you a steady dose of insulin all day and night (basal insulin), and you can also give yourself an extra dose (bolus insulin) when you eat to manage blood sugar spikes. Your doctor or diabetes educator will teach you how to use one.

The American Diabetes Association offers a consumer guide that'll help you compare different insulin pumps. But when Barry meets someone who's considering one, she'll ask questions such as:

Automated insulin delivery systems. This is also called a closed-loop system or an artificial pancreas.

The FDA recently approved the first ever automated insulin delivery device for adults with type 2 diabetes. It's called the Omnipod 5. The connected system decides whether to raise, lower, or pause your insulin dose every 5 minutes.

If you told Barry that you absolutely don't want an insulin pump with a tube, "then we might go with the Omnipod," she says.

Tools to Track Food and Exercise

There are at least 100,000 health-related apps out there, with around 1,500 of those focused directly on diabetes management. While no app replaces education from a health professional, they can be useful tools for lifestyle support.

"The one our nutritionists always recommend is MyFitnessPal," says Peter. This gives you the option to track carbs, calories, and exercise. In the app, you can also customize weight loss goals and connect with a larger diabetes community for support.

Mobile apps are an add-on to your diabetes management, not a replacement for medical care. In general, you can use these tools to:

Valentine doesn't use tech to track her meals. "I have a really good memory," she says. But she does take advantage of the fitness features on the Apple Health app on her iPhone, which also gives her the option to add her blood glucose by day, time, and meal when she wants to.

In case of emergency, anyone can swipe the Medical ID option on her phone to access information about her diabetes, other health conditions, and what medications she takes, even when her phone is locked.

"I also have an Apple Watch to track my sleep, which I'm trying to focus on these days," she says. "I use it in connection with my phone to track my heart rate, steps, and when I'm working out."

Tech to Connect With Your Care Team

The COVID-19 pandemic marked the beginning of a new era in telehealth services, says Peter, when people started connecting with their doctors electronically in ways they hadn't before.

The most common way people still do that is through MyChart, she says. This is a secure communication system for health professionals and patients.

"It's a nice way to get feedback and make treatment changes in between scheduled visits," says Peter.

While urgent problems like very low blood sugar or new symptoms always warrant a phone call, says Peter, it's typically a good idea to message your doctor before your next visit if you notice blood sugar ups and downs that signal your treatment might not be working.

Often, you can link data from your CGM, smart insulin pen, or insulin pump directly to your doctor's office for remote monitoring. Ask your diabetes care team if that's possible and what steps you need to take to set up the connection.

Once your doctor has access to the app or website that stores your information, they won't check your blood sugar levels or insulin dosing information all the time. But they should give you general guidelines for where your glucose levels should be and when to nudge them to look at your numbers.

As a diabetes educator, Barry encourages people who use technology like CGMs to be proactive and to reach out early on when they notice two or more blood sugar lows in a week or consistent highs.

"I always tell patients we get their data in real time, but I don't look at it unless you tell me too," she says. "And if you're running high for the last 2 months, don't wait another 3 or 4 months to see your provider. Let us know so we can make changes."

Reviewed by Brunilda Nazario, MD on September 10, 2024

Sources

SOURCES:

Serena Valentine, executive director, CORE initiative; diabetes advocate, Houston.

Patricia Peter, MD, assistant professor of medicine (endocrinology), Yale School of Medicine; endocrinologist, Yale Diabetes Center, New Haven, CT.

Cheryl Barry, RN, MS, CDCES, UMass Memorial Medical Center, Worcester, MA.

Shubham Agarwal, MD, assistant professor, University of Nebraska Medical Center, Omaha, NE.

Therapeutic Advances in Endocrinology and Metabolism: "Improving patient self-care using diabetes technologies."

Journal of Diabetes Science and Technology: "Continuous Glucose Monitoring Devices: Past, Present, and Future Focus on the History and Evolution of Technological Innovation."

World Journal of Diabetes: "Impact of technology use in type 2 diabetes distress: A systematic review."

Clinical Diabetes: "Patient Perspectives on the Benefits and Challenges of Diabetes and Digital Technology," "Use of Diabetes-Related Applications and Digital Health Tools by People With Diabetes and Their Health Care Providers."

Mayo Clinic: "Blood sugar testing: Why, when and how."

American Diabetes Association: "Type 2 and Blood Glucose Checks," "Diabetes and Technology," "Continuous Glucose Monitors," "What is a smart insulin pen?" "Consumer Guide: Insulin Pumps,"

JAMA Internal Medicine: "Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings - A Randomized Trial."

Diabetes Technology & Therapeutics: "Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring."

Cleveland Clinic: "What is continuous glucose monitoring (CGM)?"

Northwestern Medicine: "How Do Continuous Glucose Monitoring Systems (CGMS) Work? And Should You Get One?"

National Institute of Diabetes and Digestive and Kidney Diseases: "Continuous Glucose Monitoring."

FDA: "FDA Clears First Over-the-Counter Continuous Glucose Monitor."

American Academy of Family Physicians; "Continuous Glucose Monitoring (CGM)."

Diabetes Care and Education (Academy of Nutrition and Dietetics): "Advanced Insulin Management: Using Insulin-to-Carb Ratios and Correction Factors."

Endocrine Connections: "The changing landscape of automatic insulin delivery in the management of type 1 diabetes." Omnipod.com: "Omnipod 5 Type 2 Indication FAQs."

Diabetes Care: "Safety and Efficacy of the Omnipod 5 Automated Insulin Delivery System in Adults With Type 2 Diabetes: From Injections to Hybrid Closed-Loop Therapy."

Diabetes Therapy: "Smartphone-Based Technology in Diabetes Management."

Telehealth.HHS.gov: "How can I use telehealth for diabetes care?" "What are different types of telehealth?"