Imagine trying to follow a secret recipe that changes every hour—now, add a room full of kids, a chemistry test, and lunchtime chaos. Welcome to the daily balancing act of students with diabetes. Constant vigilance and close monitoring are not just important - they are life-saving, which is why continuous glucose monitors (CGMs) stand out as a beacon of progress, transforming diabetes management, making it less intrusive and more effective while providing real-time insights and data to school nurses responsible for the care and support of students with diabetes at school. According to the T1D Exchange Registry, over 50% of children with type 1 diabetes under 18 use CGMs, and the number is growing as the technology becomes more accessible. 

Understanding CGMs

Continuous glucose monitors consist of three basic components:

• A sensor attached to a small, flexible cannula inserted just beneath the skin.
• A low-profile, wearable transmitter is attached to the sensor and sits on top of the skin.
• A compatible receiver or other device that displays the glucose readings and trends.

CGMs measure glucose levels in the interstitial fluid and convert these readings into estimated blood glucose levels every few minutes. Depending on the device, sensor glucose levels can lag behind blood glucose values by 5-10 minutes. This doesn't mean the sensor isn't accurate, but variations may occur during rapid glucose fluctuations and bodily interactions. 

The Transformative Impact

Evidence underscores the efficacy of CGMs in improving glycemic control and reducing the incidence of hypoglycemic and hyperglycemic episodes. This is particularly pertinent for the school setting, where fluctuations in glucose levels can not only be a significant health concern but also impact a student's cognitive function, behavior, and overall academic performance. The technology also utilizes trend arrows, which allow for proactive care and management, remote monitoring by school nurses, other caregivers, and parents, and, in some cases, even pairing with certain insulin pumps for automatic insulin delivery. 

Practical Guidance for Supporting Students

Implementing CGM technology in a school environment involves several practical considerations.

• Education and Training: Seek out training opportunities and collaborate with diabetes educators to ensure comprehensive knowledge of device operation, data interpretation, and troubleshooting. This video, specifically for school nurses from the American Diabetes Association (ADA), is a great starting point.
• Policies & Protocols: CGM usage guidelines should be clearly outlined in students' Diabetes Medical Management Plan (DMMP) or healthcare provider's orders. This includes guidelines for routine review of readings, handling alerts, emergency procedures, and any accommodations needed to support the students' general CGM use - including access to a device and wireless network, if necessary.
• Supply Concerns: According to the ADA, if a CGM detaches, "no portion of the CGM should be discarded while at school," and it is recommended that the student (if permitted by the DMMP) or student's family be responsible for inserting a new sensor. Schools should also ensure appropriate stock of general diabetes care supplies.
• Glucometer Availability: While a CGM replaces most fingerstick checks, a blood glucose meter should be available in case of malfunction or detachment. Additionally, a fingerstick may be necessary if the student exhibits symptoms inconsistent with CGM readings or if the DMMP or provider's orders require it for insulin dosing.

Continuous glucose monitors are more than just a technological marvel; they are a lifeline for students managing diabetes and a paradigm shift in diabetes management for school nurses. They offer unprecedented opportunities for real-time monitoring and proactive interventions that enhance the health, safety, and academic success of students with diabetes.