Overcoming Some of the Challenges of Monitoring CGMs for Young Diabetes Patients: Tips for Safer and More Reliable Blood Sugar Monitoring
by IDS Director of Exercise Physiology, Teen/Young Adult Specialist, Kathryn Gentile Alvarez
I work with families all over the world, and one of the most significant challenges they face is the reliability of continuous glucose monitors (CGMs).
For many, especially parents of young children with type 1 diabetes, CGMs are a source of constant frustration and worry. As much as we rely on them for better management, these devices often fall short in crucial ways, and for my younger patients, this can be a serious barrier to achieving optimal outcomes.
Issues with CGMs:
CGMs don't always stay on for the intended duration, and their readings can be wildly inaccurate—sometimes too high, sometimes too low. This is particularly concerning when the device is linked to an automated insulin delivery system that is actively adjusting insulin based on these readings. For young children who can't always express how they feel, or who may not wake up to out-of-range blood sugars, the risks are terrifying. Caregivers are left in a constant state of anxiety, unsure whether the device is helping or hindering their child's safety.
What makes this situation even more frustrating is how difficult it is to obtain replacements when CGMs fail. Some companies even limit the number of replacements families can receive, leaving many to cover the cost out of pocket—sometimes thousands of dollars—just to ensure they have a working monitor.
While some may argue that we should be grateful for CGMs since we once managed without them, the reality is that these devices are far from perfect. The dangers are clear when a CGM reports a reading of 365 mg/dL while the true blood sugar is actually 43 mg/dL (a true story from one of my 5-year-old patients). It's a reminder that while these devices are invaluable, they are not infallible.
Tips for Reading Continuous Glucose Monitors (CGMs)
Get a 2nd Opinion:
So, what can you do? If you're ever in doubt about a CGM reading, I recommend using a blood glucose meter for confirmation. A key indicator that something may be off with the CGM is when you see erratic or large swings in readings. It's also important to observe your child for signs of hypoglycemia—such as a change in behavior (e.g., seeking comfort, asking for food, becoming shaky or tearful), changes in skin color, or sudden irritability. If you notice discrepancies, calibrate the CGM once blood glucose levels stabilize.
Hydrate:
Additionally, make sure both you and your child are staying well hydrated, as dehydration can affect CGM accuracy. Placing the CGM in an area less prone to compression (such as the abdomen) can help reduce the likelihood of sensor errors.
Advocate:
Above all, continue advocating for better technology. We are grateful for the progress CGMs have brought to diabetes management, but there is still significant room for improvement to make these devices more reliable and safer for all users—especially for our youngest patients.
