Complete guide to continuous glucose monitors (CGMs)

For diabetics, keeping your glucose level in the optimum range is very important – If you don’t, your diabetes can cause serious health complications.

To check their glucose level, many diabetics use a glucose meter (a.k.a. a glucometer). This involves regularly pricking your finger and feeding your blood into the meter – Blood glucose meters are cheap and easy to use, but some diabetics can find the need to prick their finger every time they want to get a reading draining and off-putting.

Another option is to use a continuous glucose monitor (CGM). These devices can help you easily monitor your body’s glucose level at all times, and without the need for finger pricks.

Here’s everything you need to continuous glucose monitors:

And if you’re interested in getting a flash or continuous glucose monitor (or you’ve been advised to get one by your doctor), you should know the key features and differences between the available continuous glucose monitoring devices in India:

And finally:

What is a continuous glucose monitor?

A continuous glucose monitor (commonly known as a CGM) constantly monitors your body’s glucose levels.

How does a continuous glucose monitor work? It works by placing a tiny sensor beneath your skin (often on your arm or abdomen). Every few minutes, the sensor measures your glucose levels. It then sends that information to an attached transmitter, which transmits it to a receiving device (such as a smartphone or even an insulin pump).

While a standard blood glucose monitor measures your body’s blood glucose level, a continuous glucose monitoring device is slightly different. A CGM measures interstitial glucose (the glucose stored in the fluid around your cells) – The reading you get from interstitial glucose is slightly delayed compared to blood glucose, but it closely follows the blood glucose level and is still a reliable measure.

With a continuous glucose monitoring system, you get access to many more glucose level readings than if you were using a blood glucose monitor. This can help you better understand your glucose levels, identify patterns, and learn how your body reacts to things like meals, exercise and daily medication.

As for who should use a continuous glucose monitor, continuous glucose monitoring devices provide the most benefit to people with type 1 diabetes. However, people with other types of diabetes (including type 2, LADA, and gestational diabetes) can also benefit from using a CGM.

Your doctor may advise you to get a continuous glucose monitoring system if you:

  • have blood glucose levels that are often too high or too low.
  • have hypoglycemia unawareness – (you’re unable to recognise the symptoms of low blood sugar).
  • require intensive insulin therapy.
  • need strict glucose management due to gestational diabetes.

You may have also heard the term ‘flash glucose monitor’. This term is sometimes used when referring to a continuous glucose monitor, and vice versa. However, there is a difference.

  • Continuous glucose monitors – take readings every few minutes and instantly transmit them to a monitoring device (such as a smartphone or insulin pump).
  • Flash glucose monitors – also take readings every few minutes, but don’t transmit them instantly. Instead, they store the records in the sensor until you scan it with a reader device. When the sensor is scanned, all the records transfer in bulk.

While a flash glucose monitor and a continuous glucose monitor work slightly differently, they still achieve the same goal. This means that diabetics can usually choose between them based on their needs and key considerations.

What are the benefits of using a flash or continuous glucose monitor?

Research has shown that using a continuous glucose monitor can help diabetics improve their control over their glucose levels and reduce the risk of hypoglycemia.

Using a continuous glucose device or flash glucose monitor gives many benefits. You can:

  • see fluctuations and patterns in your glucose levels – By understanding how your body reacts to things like activity, nutrition, stress, illness, and exercise, you can make adjustments and avoid glucose levels that are too high or too low.
  • have greater control over your insulin injections – With more detailed records of your glucose levels you can tailor your insulin injections, and may be able to take smaller doses more regularly (fine-tuning your diabetes care).
  • reduce the frequency of hypoglycemic events – If your CGM identifies that your glucose levels are dropping too fast you can take action sooner, and may be able to avoid going too low.
  • enhance your medical treatment plan – By providing your doctor with more detailed records of your glucose levels, you can help them evaluate your treatment plan and work out what’s right for you.
  • improve your HbA1c levels – With more data and better control over your glucose levels, you can enjoy glucose levels that are more consistently correct. This can help improve your HbA1c levels.
  • enjoy a better quality of life – By using a continuous glucose monitoring system (or flash glucose monitor) you can have a better understanding of your diabetes and won’t need to do finger-prick testing as often. This can help relieve pain and stress, improving your quality of life.

What flash and continuous glucose monitors are available in India?

Both flash glucose monitors and continuous glucose monitors can be of great help to a diabetic.

However, before you buy one, you need to identify what the availability is like for flash glucose monitors and continuous glucose monitoring devices in India. This helps ensure that when you buy your CGM you’re getting a product that is locally supported and easy to maintain and update – It’s also important to understand how much does a continuous glucose monitor cost.

The two most widely available flash and continuous glucose monitoring devices in India are:

Other popular options include Dexcom G6 and Eversense, but these CGMs aren’t currently available in India.

The FreeStyle Libre

The FreeStyle Libre by Abbott. A flash glucose monitor designed for use by diabetics.

What is the FreeStyle Libre?

The FreeStyle Libre is a flash glucose monitoring device manufactured by Abbott Laboratories. It was launched in 2015 as a flash glucose monitoring device that can link to a mobile phone or a tablet.

Abbott’s FreeStyle Libre is mainly intended to help type 1 diabetics, but some type 2, LADA (latent autoimmune diabetes in adults), and gestational diabetics also prefer it – This is thanks to its non-prick technology, convenience, and the increased protection any diabetic using the FreeStyle Libre has against hypoglycemia.

Since the FreeStyle Libre CGM’s launch, it’s been one of the market leaders. Abbott intends to frequently upgrade the FreeStyle Libre system, improving its ability to provide accurate readings of glucose levels – The next generation of the FreeStyle Libre is the FreeStyle Libre 2, but this isn’t available yet in India.

The FreeStyle Libre system is made up of 2 parts:

  • The FreeStyle Libre Sensor
  • The FreeStyle Libre Reader

How does the FreeStyle Libre work?

The Abbott FreeStyle Libre system monitors glucose levels throughout the day – This happens automatically, at regular intervals.

The readings are stored in the FreeStyle Libre Sensor, and when you scan the sensor with the FreeStyle Libre Reader (a hand-held monitor) get sent to the Reader. The readings can also be synced with your smartphone.

How do you maintain the FreeStyle Libre?

Almost all continuous or flash glucose monitors require some maintenance – The FreeStyle Libre is no exception.

When applying the FreeStyle Libre Sensor, you need to place it on a clean area on the back of the upper arm, that doesn’t have any scars, rashes or tattoos. The sensor needs to be removed after a few days – The maximum length of time you can keep the FreeStyle Libre Sensor on your skin is 14 days.

Some people find the adhesive on the FreeStyle Libre Sensor wears off over time. If you find it’s not lasting long enough you can apply sports tape over the sensor to help keep it in place, or patches made specifically for the FreeStyle Libre.

Applying the FreeStyle Libre Sensor is simple and typically painless. The removal process is also easy – A little pull and it comes off.

When reapplying a new sensor, you should place it on a new part of your skin – Avoid reapplying it in the exact same place.

Once the FreeStyle Libre Sensor is applied, you can sync it with your smartphone (or your guardian/partner’s smartphone).

Key features and pros of the FreeStyle Libre

The FreeStyle Libre has many features that have made it a popular choice of flash glucose monitor, especially for people in the South East Asia region.

  1. Lightweight – The FreeStyle Libre Sensor weighs just 5 grams.
  2. Long battery life – The FreeStyle Libre system works for 14 days on one charge.
  3. Water resistant – The FreeStyle Libre Sensor is IP27 waterproof, meaning it can handle being in 1 metre of water for up to 30 minutes.
  4. Suitable operating conditions – The FreeStyle Libre system can operate between 10-45 °C and 10-90% humidity. This makes it very suitable for use in India.
  5. Up to 8 hours of data collection – The FreeStyle Libre Sensor can store up to 8 hours of data. As long as you take a reading every 8 hours, you’ll be able to build up a 24-hour picture of your glucose levels.
  6. Flexible sensor range – The FreeStyle Libre Reader can take readings from the sensor between 1cm-4cm, even through clothing.
  7. Fast Measuring Time – The FreeStyle Libre Sensor can take instant measures of your glucose level, providing readings within 1 second.
  8. Wide Measuring Range – The FreeStyle Libre Sensor can measure glucose levels from 20-500 mmol/L.
  9. Ease of use – The FreeStyle Libre CGM is very easy to apply and use. It comes with clear instructions, and Abbott has a lot of information on its website about how to apply the FreeStyle Libre Sensor and how to use the FreeStyle Libre Reader.
  10. Ease of connectivity – The FreeStyle Libre system easily syncs with smartphones or tablets using the LibreLinkUp app.
  11. Wide age range – The FreeStyle Libre is approved for people aged 4 and older.
  12. Alerts – The FreeStyle Libre 2 (not yet available in India) can send alerts to connected smartphones, helping prevent hypoglycemia.
  13. Availability – The FreeStyle Libre is readily available in India.
  14. Data records – The FreeStyle Libre system allows you to extract, print and share your data. This can help you easily share it with your doctor in whichever format they prefer. The data records also let you see trends in your glucose levels, helping you manage and reduce fluctuations.
  15. Easy replacement & repair – The FreeStyle Libre system is officially supported in India as ‘FreeStyle Libre India’; repairs and replacements are easy and fast to arrange.

Cons of the FreeStyle Libre

The Abbott FreeStyle Libre system does have some drawbacks that may make it a little unsuitable for some people.

  • No warranty – When you buy the FreeStyle Libre Sensor it doesn’t come with a warranty, so if it’s damaged you  need to buy a new one.
  • Less accurate than a glucose monitor – The FreeStyle Libre Sensor readings aren’t as accurate as the readings you’d get from a conventional glucose monitor. This is because the FreeStyle Libre Sensor takes readings from interstitial fluid, while a glucose monitor takes readings from your blood; there is a slight delay between interstitial fluid glucose levels and blood glucose levels.
  • 8 hour data storage – The FreeStyle Libre Sensor can only store your blood glucose readings for 8 hours, so if you don’t scan it with your Reader within 8 hours each time you can get gaps in your data.
  • No alerts – The FreeStyle Libre can’t send alerts, letting you know if your glucose level is getting too low or too high (the FreeStyle Libre 2 can do this, but isn’t available yet in India)
  • Irritation to wear – Using a FreeStyle Libre Sensor requires some thought and management. Not all clothes will be suitable to wear while you have the FreeStyle Libre Sensor applied to your skin, and some people don’t want to openly share that they’re diabetic.
  • Leaves spots on skin – If you apply the FreeStyle Libre Sensor in the same area, again and again, it can lead to spots on your skin.
  • Security block – The FreeStyle Libre Sensor will get picked up on security scans at airports and other security checkpoints. This means you may need to inform security staff and carry information about the sensor when travelling.
  • Maintenance – The FreeStyle Libre Sensor must be changed every 14 days, so may not be suitable for people with busy lifestyles.

How much does the FreeStyle Libre cost?

The FreeStyle Libre typically costs between ₹5,500 to ₹10,500, depending on offers and seasonal sales. This price makes it ‘affordable’ for the middle class.

Buying additional sensors or patches can add additional costs, with sensors costing around ₹5,000.

Where can you get the FreeStyle Libre?

The FreeStyle Libre is available throughout India, and there are a few ways you can buy it:

  1. Directly from the FreeStyle Libre website.
  2. Online shopping portals such as Amazon, Flipkart, etc.
  3. Local pharmacies.

It’s a good idea to get advice from your doctor before you buy a FreeStyle Libre, but you can easily buy it without a referral or prescription from your doctor.

BUY A Freestyle libre

The Guardian Connect

The Guardian Connect by Medtronic. A flash glucose monitor designed for use by diabetics.

What is the Guardian Connect?

The Guardian Connect Smart CGM is a continuous glucose monitoring device developed and manufactured by Medtronic, a global leader in healthcare technology. It was first launched in 2018, following 2 years of rigorous regulatory checks, and is designed to follow the latest advances in mobile technology.

Like with Abbott’s FreeStyle Libre, it’s mainly intended for type 1 diabetics, but some type 2, LADA and gestational diabetics also find it beneficial and like using it.

The Guardian Connect tracks real-time trends in your sugar levels and can send alerts to your mobile device if your blood glucose level is decreasing or increasing too quickly, or predicted to. It is the only CGM device available with customisable predictive alerts. Like the FreeStyle Libre, it’s also a device that continues to evolve and get upgraded, with Medtronic regularly releasing newer versions.

The Guardian Connect Smart CGM system is made up of 2 parts:

  • A sensor (called the Enlite)
  • The Guardian Connect transmitter

How does Guardian Connect work?

Guardian Connect consists of a sensor and a transmitter working together. The sensor is placed on your skin, either on your arms, abdomen, or buttocks. It’s in constant contact with your interstitial fluid (the fluid between the cells) and takes its glucose readings from these. Readings are taken every 5 minutes and sent to the transmitter, which is connected to the sensor.

The transmitter uses Bluetooth technology to send readings, alerts and other data to your mobile device.

The Guardian Connect can optionally also be connected to an insulin pump (Medtronic’s MiniMed), making it a popular choice for diabetics who want to create a ‘closed loop’ system – A setup where your CGM and insulin pump work together like an artificial pancreas, automatically monitoring and controlling your blood glucose levels.

How do you maintain a Guardian Connect?

Similar to the FreeStyle Libre, the Guardian Connect requires some maintenance.

When applying the Guardian Connect sensor, you also need to apply it to a clean area of skin. While the FreeStyle Libre needs to be placed on your forearm or lower belly, the Guardian Connect has been approved for more areas – You can place it on your arms, abdomen or buttocks.

The Guardian Connect sensor can be worn for 7 days. A fully charged transmitter will last at least 6 days.

To get accurate results, you need to calibrate your sensor at least twice a day, or when you receive an alert on your mobile device.

Key features and pros of Guardian Connect

The Guardian Connect has several features that make it a popular choice of continuous glucose monitor, especially for diabetics in India.

  1. Continuous glucose monitoring – The Guardian Connect automatically measures your blood glucose levels every 5 minutes.
  2. Small and discreet – The Guardian Connect is relatively small, can be placed discreetly on your skin, and is easy to set up.
  3. Mobile first design – The Guardian Connect is designed with mobile device technology in mind, developed to send readings and alerts to your phone.
  4. Good transmitting range – The Guardian Connect transmitter can send readings and alerts to your phone within 6 metres.
  5. Predictive technology – The Guardian Connect is the only CGM able to make predictions about your blood glucose levels.
  6. Customisable predictions – The Guardian Connect’s predictive alerts can be customised to your preference, with settings available anywhere between 10 minutes to 60 minutes.
  7. Customisable alerts – The Guardian Connect allows you to adjust alert volume and mute alerts, with the option to customise settings based on day or night periods. You can set high alarms as high as 22.2 mmol/L and low alarms as low as 2.2 mmol/L.
  8. Interactive reporting – The Guardian Connect has an event marker feature that lets you record important events (such as when you took an insulin injection, when you ate, when you exercised, etc.). This helps you understand how your blood glucose levels change based on your lifestyle.
  9. User-friendly reports – The Guardian Connect app has easy-to-read reports showing you information like daily glucose trends. This can help you understand patterns in your blood glucose levels.
  10. Optional closed loop – The Guardian Connect is the only continuous glucose monitor in India which can be combined with an insulin pump to create a closed loop system (effectively working automatically as an artificial pancreas)
  11. Water resistant – The Guardian Connect can handle being in 2.5 metres of water for up to 30 minutes.
  12. 1-Year warranty – The Guardian Connect transmitter comes with a 12-month warranty. During this time it will have transmitted more than 100,000 readings to your mobile device.
  13. Personalised support – Medtronic provides 24/7 support for Guardian Connect, ensuring peace of mind for you and your loved ones.
  14. Networked care – With the Guardian Connect CareLink diabetes management software, you can collect and share blood glucose readings from your Guardian Connect. This allows you to provide easy access for your doctor and family. You can also set up alerts through automatic text messages, keeping them informed about unusual blood glucose readings.

Cons of the Guardian Connect

The Guardian Connect does have some drawbacks that may make it a little unsuitable for some people.

  • Not fully Android compatible – The Guardian Connect Smart CGM system is not compatible with all mobile devices. Guardian Connect compatible devices include those with an iOS operating system and a few android devices (mostly Samsung, Huawei, Sony and LG).
  • Not suitable for young children – The Guardian Connect can only be used by people aged 14 years and above.
  • Less accurate than a glucose monitor – Like the FreeStyle Libre, the Guardian Connect’s readings also aren’t as accurate as the readings you’d get from a conventional glucose monitor. This is again because the Guardian Connect takes readings from interstitial fluid, while a glucose monitor takes readings from your blood; there is a slight delay between interstitial fluid glucose levels and blood glucose levels.
  • Shorter sensor lifespan – While other CGM sensors last between 10 to 14 days, the Guardian Connect sensors only last 6 days.
  • Requires regular calibration – The sensor has a long warm-up time (2 hours) and needs to be calibrated at least every 12 hours. For more accurate results, you need to calibrate it every 6 hours. If you don’t calibrate the sensor, your blood glucose data will not be recorded.

How much does the Guardian Connect cost?

Compared to Abbott’s FreeStyle Libre and some other CGM devices, the Guardian Connect CGM price is higher. The cost of the transmitter is around ₹50,000, and the transmitter will last about a year.

Additional sensors also come at an additional price, costing between ₹3,000 to ₹3,500. As Guardian Connect sensors only last 6 days, while other CGM sensors last 10 to 14 days, this also makes the Guardian Connect slightly more expensive.

This makes the Medtronic Guardian Connect price annually to be around ₹2,40,000.

This price makes it prohibitive for many diabetics in India.

Where can you get the Guardian Connect?

The Guardian Connect is available throughout India, and there are a few ways you can buy it:

  • Directly from the official Medtronic Diabetes India website.
  • By phone, on the Medtronic toll-free number – 1800 209 6777.

It’s a good idea to consult your doctor and get their advice before you get a continuous glucose monitor, but you don’t need a referral or prescription to get the Guardian Connect Smart CGM.

Comparing CGMs

How do the FreeStyle Libre and Guardian Connect directly compare?

FreeStyle Libre Guardian Connect
Flash or Continuous Flash – Stores up to 8 hours of readings in the sensor, until scanned and transferred to the Reader Continuous – Transfers readings in real-time to a receiving device (such as a smartphone or insulin pump)
Frequency of readings Every 1 minute Every 5 minutes
Sensor warm-up time 1 hour 2 hours
Sensor lifetime 14 days 7 days
Reader battery life 7 days N/A
Transmitter battery life N/A 6 days
Transmitter lifetime N/A 1 year
Additional maintenance N/A Requires calibration at least once every 12 hours (and for more accurate results, recommended at least once every 6 hours)
Smartphone compatibility Apple iOS + Google Android OS (with compatible smartphones) Apple iOS + Google Android OS (with compatible smartphones)
Alarm capability No Yes
Approved placement areas Upper arm Arm, Abdomen, Buttock
Sensor size 35mm x 35mm x 5mm 19mm x 11mm x 10mm
Water resistance Up to 1m for 30 minutes Up to 2.5m for 30 minutes
Initial cost Initial purchase of sensor and reader - ₹5,500 to ₹10,500 (depending on sales) Transmitter - ₹50,000 per year
Sensor cost Additional Sensors - ₹5,000 per sensor every 14 days Additional Sensors - ₹3,000 to ₹3,500 per sensor every 6 days
TOTAL cost ₹1,30,000 per year ₹2,40,000 per year
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