Continuous Glucose Monitoring for Diabetes: Potential Pitfalls for the General Physician
Open accessAbstract
A 31-year-old man presented systemically unwell with diabetic ketoacidosis (DKA). He was using an intermittently scanned continuous glucose monitoring (CGM) device that had been recording low or normal glucose readings for the 48 hours prior to admission. The sensor site had become infected, and we believe this soft tissue infection caused his CGM device to record falsely low glucose readings leading the patient to erroneously lower his insulin doses and take extra carbohydrates, precipitating DKA. CGM devices measure glucose levels in the interstitial fluid. When interstitial glucose readings do not match symptoms or expectations, a capillary blood glucose reading should be taken to correlate and impact treatment decisions. There will be an increase in patients presenting to hospital with CGM devices as the National Institute for Health and Care Excellence guidelines have recently been updated. We use this interesting clinical case to provide context for key learning points about CGM devices for the general physician.
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CGMs measure interstitial fluid glucose that has diffused from capillaries into subcutaneous tissue and may indicate a falsely low blood glucose due to device compression, device calibration errors, and skin/soft tissue infections.
“These devices measure interstitial fluid glucose that has diffused from the capillaries and into the subcutaneous tissue and may indicate a falsely low BG due to device compression, device calibration errors, and skin/soft tissue infections [4,6,7].”
From Non-Diabetic Hypoglycemia: Evaluation and Management in Adults (2025) · cites this paper as [7]
The section “What are continuous glucose monitoring devices?” says CGMs measure interstitial-fluid glucose and reports a case in which a soft-tissue infection was believed to cause falsely low readings (page unavailable). Our copy does not state that the glucose diffused from capillaries into subcutaneous tissue or identify device compression or calibration errors as causes of falsely low readings. (LLM, conf=0.87)
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Research works printed but not linked: 3
- Lind M, Hirsch PWI, Heise T et al. Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections the GOLD randomized clinical trial. JAMA 2017;317:379-87.
- Tokarski F, Hobson C, Lartigue M, Lemaignen A, Lioger B. Streptococcus pyogenes necrotizing soft tissue infection following glucose monitoring with FreeStyle Libre device. QJM 2021;114: 58-9.
- McClatchey PM, McClain ES, Williams IM et al. Fibrotic encapsula- tion is the dominant source of continuous glucose monitor delays. Diabetes 2019;68:1892-901.
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Non-Diabetic Hypoglycemia: Evaluation and Management in Adults
Looi, E., & Lawler, H. M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14134393 · Cited by 10 · see citing works
“These devices measure interstitial fluid glucose that has diffused from the capillaries and into the subcutaneous tissue and may indicate a falsely low BG due to device compression, device calibration errors, and skin/soft tissue infections [4,6,7].”
- Authors
- Herrod, S. S., Liversedge, G., Vaidya, B., & Walker, N.
- Venue
- Clinical Medicine
- Publisher
- Elsevier BV
- Published
- 2022-09
- Volume
- 22
- Issue
- 5
- Pages
- 482-484
- ISSN
- 1470-2118 (ISSN-L)
- PMC
- PMC9595018
- OpenAlex
- W4297914158
- Cited by
- 5
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical Medicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- continuous glucose monitoring, diabetic ketoacidosis, soft tissue infection, flash glucose monitoring, interstitial glucose, capillary blood glucose, insulin dose adjustment, diabetes management
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 1, Glucose, Glycated Hemoglobin, Humans, Male, Physicians, Blood Glucose Self-Monitoring, Diabetic Ketoacidosis
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