Continuous Glucose Monitoring for Children: A Parent's Guide

One of the most difficult parts of diabetes management is keeping track of blood glucose levels as the day progresses. Traditionally, this was done using a blood glucose meter and test strips that require pin-pricking a finger for a drop of blood, sometimes several times a day.

Aside from the repetitive nature of this task, the physical pain associated with it could become a hurdle to many people with diabetes looking to keep their condition under control. This is especially true for young children, as it can be detrimental to their adherence to their diabetes care regimen.

As a parent, it should be relieving to know there’s an alternative available: a continuous glucose monitoring system. Here’s a complete guide on CGM for children and what caregivers should know before using this diabetes technology.

The first component of a CGM device is the sensor. For example, it’s a part of the device inserted under the skin, in the abdominal area, or on the back of the arm. It’s used to detect the glucose level in the interstitial fluid (the plasma present between body tissues).

CGM sensors can either be disposable or implantable. Disposable sensors are inserted like a regular needle into the fatty layer under the skin. They’re kept in place for several days or weeks using adhesive tape.

Implantable sensors are fluorescence-based and usually implanted into the body to last for several months, with current iterations lasting about 6 months.

Current continuous glucose monitoring devices rely on different types of receivers to interpret and display the data they provide. The most common type is a smartphone app that receives information from the sensor about blood glucose values and displays them as numbers and charts.

Another type of receiver is a dedicated device that scans and reads the data provided by the sensor, although this type is falling out of favour thanks to the ease of use of smartphone apps.

The receiver can also be an insulin pump that connects with the CGM directly and responds to its readings by releasing or withholding insulin in high or low blood glucose cases. This closed-loop system is also called an “artificial pancreas” because it mimics how the body controls insulin secretion.

Most display devices, other than insulin pumps, can alarm the patient or their caregiver if their blood glucose is too high or too low. This is indispensable when trying to manage a child’s diabetes regimen since many children can’t recognize the symptoms of hyper or hypoglycemia.

The transmitter is a part of the continuous glucose monitor that connects the sensor with the receiver, which you can use to read the blood glucose data. It’s a small but highly sensitive part of the device.

The transmitter usually constantly sends the data to the receiver for implantable sensors. The transmitter stores the data for disposable sensors until scanned with the receiving device.

Continuous glucose monitors aren’t all the same. Depending on what type of hardware and software they use, they require different levels of involvement from the patient, their parents, or other caregivers. CGM types include:

Real-time CGMs use an implantable transmitter that continuously updates the patient’s blood sugar levels on the CGM smartphone application. These require no input from the patient or their caregiver.

This type is preferable for young children who aren’t as capable of staying still to get their CGM scanned. It’s also the only option to connect to an insulin pump in a closed-loop system to achieve better glycemic control.

• Continuous data transmission that doesn’t require input from the patient
• The gathered data can be directly shared with the patient’s healthcare team
• Alarms and alerts for hyper and hypoglycemia to avoid dangerous fluctuations in blood sugar

• Can be prohibitively expensive outside of insurance coverage
• The alarm function can be embarrassing and ostracizing, especially for young children

Unlike real-time CGMs, the intermittently scanned variety is a simpler device. It requires a disposable sensor to be placed in an area with adequate fat padding, like the abdomen or the back of the arm. The sensor can then be scanned by a separate display device that reads the blood sugar levels on it and stores it for a few days.

• A simpler solution that requires very few setup steps, including “wearing” the sensor
• Much less expensive than real-time CGMs, and most insurance plans cover it
• Data can also be shared with family, caregivers, and the patient’s healthcare providers

• Doesn’t offer any alarms or alerts, which can be dangerous if the patient’s parents forget to scan it for prolonged periods.
• Requires patience and standing still to scan, which can be challenging for young children
• Cannot be recalibrated if the sensor shows inaccurate blood glucose values.

Now that you know what continuous glucose monitoring is realistically like, here are the potential benefits your child can see after including a CGM in their diabetes management regimen:

According to a study done on children and teenagers recently diagnosed with type 1 diabetes, incorporating continuous glucose monitors as part of the diabetes treatment led to better health outcomes in the short and long runs.

The study showed that kids who used the CGMs immediately after being diagnosed had better control over the HbA1c levels than children who started using CGMs a month after diagnosis.

Using CGMs, especially the real-time variety that offers alerts when blood glucose levels are out of the target range, can make dangerously high or low blood sugar a rare occurrence. That’s mostly the result of improved awareness and positive family behavioural intervention (FBI).

Diabetic children are less likely to suffer unwanted spikes after eating a carb-rich meal or hypoglycemia after running around the yard or playing a soccer match if their CGM alerts them beforehand.

Most young patients, especially those not yet old enough to control their insulin therapy, require constant surveillance from their parents or caregivers. Using a CGM allows young children a certain level of freedom to “be kids” and explore the world independently.

It also allows parents to have some ease of mind when it comes to allowing their children to go on field trips, spend time at their friends’ houses, or participate in other group activities, even without using an insulin pump.

As long as the child is aware enough to ask for help when the alarm goes off or self-administer insulin using a pen or a jet injector, they’re good to go!

This is one of the most important benefits of continuous blood glucose monitoring for young children. Having easy access to readings allows parents and caregivers to keep track of their glucose levels without the finger prick of traditional blood glucose meters.

Most young children show some degree of needle phobia, and using a lancet several times a day can make their diabetes management regimen more complicated than necessary. Embracing this new diabetes technology allows children and their parents more control with fewer physical and emotional repercussions.

This revolutionary technology may have changed the way we view diabetes management. However, CGM has its drawbacks, especially in treating pediatric diabetes, which include:

Some young children might experience pain and discomfort when the sensor for a CGM is inserted. It can also cause uneasiness for some children, who might not enjoy having the sensor out where they might get it caught on clothing.

Real-time CGMs might benefit from alerting the patient or their caregivers of potential hyper or hypoglycemic episodes, but the alarms aren’t always welcome. They might sound off during class or a test, which might add to the feelings of stress children usually feel in these settings.

Parents might also find the alerts less helpful and more confusing and anxiety-inducing. That’s especially true if the CGM gives false alarms or has a hard time monitoring rapidly changing blood sugar levels.

Unfortunately, some children don’t understand how to handle differences among their school or playground peers. Unwanted attention, bullying, or ostracization due to wearing the CGM sensor can be detrimental to the child’s mental well-being and can cause feelings of isolation and resentment.

Of course, parents and other caregivers shouldn’t base their choices for their child’s healthcare on the reaction of their peers. However, young children might be more dismayed by these unwanted remarks than older children and teenagers, so the parents' support is more crucial.

Some parents and caregivers might struggle with setting up and understanding the data provided by the CGM, causing them to incorrectly “treat” their child or ignore important alerts.

The most important role here belongs to the diabetes care team that the parents are working with, where they should explain -in layman’s terms- what each component does and the correct way to use it. Any questions they might have about remote monitoring and CGM use should be answered in detail.

Managing type 1 diabetes isn’t a walk in the park for parents who just had their child diagnosed with a life-long illness. Although using this advanced technology should -in theory- make it easier, sometimes it serves as a constant reminder that their child needs extra attention and care to live a somehow normal life.

As a parent, if you find the monetary investment and the initial learning curve not that big of a deal, then CGM use might make your child’s treatment journey much less challenging.

That said, if your child is comfortable with their current monitoring system and would find it disruptive to adapt to a new one, maybe you should wait until they’re a little older to introduce a CGM to their diabetes care routine.

Pediatric diabetes care stands to benefit from technological advancements like the continuous glucose monitor.

Aside from allowing children a better chance at self-monitoring and their parents less anxiety, they also help their diabetes care team gather more information about their condition. Children with needle phobia also find CGMs less difficult to use than traditional glucose meters that require finger pricking.

Pairing a CGM with an insulin pump or a needle-free insulin jet injector, like InsuJet, can help children adhere to their diabetes management routine better, providing better health outcomes in the long run.