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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

What did your breakfast just do to your blood sugar? Continuous glucose monitoring can ‘empower’ the diabetic and non-diabetic alike, experts say

University of Washington diabetes expert Dr. Irl B. Hirsch shares the latest information and research on diabetes management using Continuous Glucose Monitoring technology during the lecture “Beyond the Stick: The Future of Diabetes with Continuous Glucose Monitoring” on Tuesday at Gonzaga University’s Hemmingson Center.  (COLIN MULVANY/THE SPOKESMAN-REVIEW)

Monitoring of the body’s blood sugar is essential to the treatment of diabetes. But getting effective glucose readings has long been a challenge, according to UW Medicines Diabetes Institute professor Irl Hirsch.

The Seattle-based doctor charted through the history of glucose monitoring in a lecture and panel for Spokane’s UW School of Medicine students on Thursday.

More than 133 million Americans have diabetes or prediabetes, and many of them use insulin to treat their condition. Insulin is a hormone that regulates a body’s use of sugar.

Continuous glucose monitoring devices are a sensor just under the skin that constantly checks glucose levels throughout the day. The monitors serve as a tool to help diabetes patients track blood sugar levels in addition to fingersticks.

Hirsch told the crowd of doctors-in-training there was “no reason to wait” to use a CGM for diabetes patients.

“If you are on insulin, you should be on a CGM,” he said.

As an over-the-counter CGM was approved by the FDA last year, Hirsch also encourages those who are not diabetic to use the device, even for a short period.

“People with pre-diabetes and even people without diabetes like to wear these to see what happens to their glucose after certain things they eat or after their exercise,” he said.

In the panel discussion, Providence diabetes management nurse Anneke Van Sloten called the device “empowering” for those who want to understand what happens inside their bodies.

“A CGM allows patients to problem solve on their own. Know what blood sugar does when having cereal one day and then eggs the next. And look at the difference,” she said.

University of Washington School of Medicine professor Carol Wysham called the devices “essential” to knowing what doses of insulin a diabetic patient needs.

“Putting it on, you learn about what goes on in the body when they eat high-carbohydrate meals or they exercise. It makes a huge difference in their ability to self-manage their diabetes,” she said.

The ability to monitor the blood sugar of diabetic patients was not so comprehensive not that long ago. In Hirsch’s history of glucose monitoring, he said there were doubts blood sugar levels had an impact on patients as recently as the early 1990s.

“I remember prescribing a glucose meter and literally the next day the patient’s primary care physician called to yell at me about prescribing this expensive device that hurt the patient. Claiming that it made no difference at all. There was this big push to not know what one’s blood sugar was,” he said.

Part of that hesitance comes from the history of glucose monitoring, which was often unreliable or invasive to the patient. The first glucose monitors came in the 1940s when a “horrible, cumbersome” device was invented, Hirsch said.

“You had to put a blue pill into a test tube with the urine and water and then a white pill was placed underneath it. Then you put a match to it and burned it and you would measure the glucose by the color it would change into,” Hirsch said. “It was a shot in the dark when all you had was urine. The urine was really not helpful at all when we look back on it; it took years to develop the evidence for the fingerstick glucose testing.”

In the 1980s, a method of glucose monitoring was invented to check blood sugar by pricking a finger. This was more accurate and could be done at home, but was invasive to the patient who might have to prick their finger multiple times a day.

It was not until 1993 when it was conclusively proven that glucose control treated diabetes. Before that, such treatment was often controversial.

“When I was at the University of Missouri, we would use the finger sticks to help us decide what insulin to give. But then when I went to Miami, that wasn’t the case,” Hirsch said.

Wysham said she could “remember all those fights” to use glucose monitoring and get it covered by insurance.

“I had nurses tell me that it’s just not accurate,” she said.

By the late 1990s, continuous glucose monitoring was invented, and it has become less invasive over the years. Hirsch is participating in research on a completely noninvasive CGM with Israeli researchers.

Those efforts have been slowed by the war in Gaza, but he hopes to resume research soon.