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So You Got a CGM – Now What?


This content material initially appeared on diaTribe. Republished with permission.

By Katie Mahoney, Hanna Gutow, and Diana Isaacs

Should you simply bought a steady glucose monitoring system, you could be questioning the way to use it most successfully and the way to perceive your glucose information. Learn our ideas, methods, and issues to contemplate.

Congratulations – you bought a steady glucose monitor (CGM), a wonderful device to help diabetes administration. Hopefully you’re feeling optimistic and excited that you’ve got the chance to make use of this expertise.

It’s most probably that you simply and your healthcare staff determined that utilizing a CGM is the optimum approach so that you can handle your diabetes. Maybe you got a prescription for a private CGM. Or possibly you’re attempting CGM as a part of Dexcom’s Hello Dexcom program (a free ten-day trial), by means of Abbott’s MyFreestyle program (a free 14-day trial), or as a part of Medtronic’s CGM Discount Access program. You may additionally be attempting skilled CGM, which is owned by your healthcare clinic and worn on a short-term foundation.

Should you haven’t but been capable of get CGM, ask your healthcare staff if you will get a trial gadget or get a prescription. CGM is really helpful for anybody with diabetes who takes mealtime insulin. Whereas many individuals with diabetes presently don’t have entry to CGM, we’re hopeful that increasingly people will be capable of use this expertise sooner or later. No matter what brings you to utilizing a CGM, we’ve created a three-part information that can assist you get began, together with ideas, methods, and concerns.

Click on to leap all the way down to a bit:

Half 1: Earlier than you apply your CGM

Study the fundamentals.

Earlier than you begin utilizing your CGM, it may be useful to grasp its primary options. Steady glucose displays (CGM) measure the physique’s glucose (or sugar) ranges by sensing the glucose current in tissue fluid (additionally known as interstitial fluid). Whereas a blood glucose meter (BGM) gives a measurement of the blood glucose stage at a selected second in time (while you prick your finger), CGMs present a brand new glucose stage each one to 5 minutes – relying on the gadget, that’s 288 to 1,440 occasions per day. A CGM gives a continuing stream of knowledge on glucose ranges, traits, and patterns.

A CGM can both be transcutaneous (it goes by means of your pores and skin) or implanted (it lies beneath your pores and skin). CGMs require three primary components:

  1. A sensor that displays real-time glucose ranges beneath your pores and skin.
  2. A transmitter that sits on prime of the sensor and sends glucose info to a smartphone app, reader, or receiver. In transcutaneous techniques, the sensor and transmitter are linked as one small on-body gadget. Some transmitters are disposable with the sensor whereas others require a further step to connect. In implanted techniques, the transmitter is hooked up to the pores and skin and will be eliminated with out harming the sensor beneath the pores and skin.
  3. A smartphone app, reader, or receiver to gather and show your information.

CGMs have a variety of features that differ by model and mannequin, together with the period of time the CGM must “heat up” earlier than glucose readings can be found, how lengthy you possibly can put on a CGM sensor earlier than needing to interchange it, and alarms that warn you to highs and lows. You’ll be able to study extra about CGM units here. For brand-specific assets and knowledge, click on right here to leap down.

Private CGM vs. Skilled CGM

The CGMs that we simply described are known as private CGMs – they’re owned by the particular person with diabetes and used for an extended time period. They’re out there as real-time CGMs, the place the information will be constantly considered, or as intermittently-scanned CGMs, the place info is recorded all the time, however it is advisable scan the sensor to view the information.

One other sort of CGM known as “skilled CGM.” Skilled CGMs are given to somebody with diabetes for a brief session (often one to 2 weeks) to raised perceive that particular person’s glucose ranges. After the damage interval, the particular person will evaluation the information with their healthcare skilled. This may present insights that inform the particular person’s diabetes remedy, and it could possibly assist healthcare professionals suggest remedy and way of life suggestions that result in higher glucose administration.

Some skilled CGMs have a real-time mode, which means that the person can see their glucose ranges whereas carrying the gadget. Different skilled CGMs have a “blinded” mode. Blinded CGM signifies that you can’t take a look at their glucose values on-demand; as an alternative, your entire glucose information is saved and shared together with your healthcare skilled. This can assist your healthcare staff establish hypoglycemia (or low blood sugar ranges). Should you get a blinded skilled CGM, your healthcare staff will analyze the information and focus on it with you as soon as your put on interval is full.

Whereas long-term, real-time CGM is handiest for day-to-day diabetes administration, particularly for insulin customers, skilled CGM will be an necessary device for people who find themselves not utilizing private CGM. Periodic use of CGM can assist individuals study the consequences of meals and bodily exercise on glucose ranges, even for these not taking any diabetes medicines.

Mirror in your objectives, know your targets, and make a plan to reply to highs and lows.

It may be useful to replicate in your CGM objectives, set your glucose targets, make plans for responding to your glucose readings, and resolve with whom you wish to share your information:

  • Mirror in your CGM objectives. Maybe you wish to use CGM to stop hypoglycemia utilizing its alert system, or to stop hyperglycemia and improve your Time in Vary, or to handle glucose throughout train. Or, possibly you and your healthcare staff are going to make use of skilled CGM for 2 weeks to discover how your way of life habits impacts your glucose ranges. Regardless, the final word aim of CGM is to enhance your diabetes administration.
  • Know your private glucose targets and make a plan together with your healthcare staff for the way you’ll reply to hyperglycemia and hypoglycemia. Figuring out your target glucose range is necessary for responding to your real-time glucose values. For most individuals with diabetes the goal vary is 70-180mg/dl – study extra about Time in Vary objectives here. Make a plan that comes with glucose development arrows out of your CGM that can assist you stop large spikes out of vary. Listed here are some prompts so that you can focus on together with your healthcare staff:
    • What’s my glucose goal once I get up and earlier than meals?
    • What ought to my glucose stage be two hours after a meal? Whether it is above that worth, what actions ought to I take to carry my glucose ranges down?
    • What’s my glucose goal earlier than mattress?
    • What excessive glucose stage ought to I attempt to keep away from? What ought to I do if my glucose will get that prime?
    • What low glucose stage ought to I attempt to keep away from? What ought to I do if my glucose will get that low? What ought to I do if my glucose ranges are trending down?

Half 2: Making use of your CGM

Join the CGM to the app and set the system up.

Obtain the cellular app related together with your CGM system if out there. Should you’re utilizing a receiver (Dexcom gadget) or reader (Libre gadget), ensure that it’s charged each day. The CGM ought to include directions for making use of the sensor (each seven, ten, or 14 days) and pairing the app, reader, or receiver together with your sensor and transmitter. When you’ve got an implanted CGM, it will likely be utilized by a healthcare skilled and might last as long as 90 days. To leap to brand-specific directions and tutorials, click on right here. To find out about CGM adhesives and ideas for conserving your CGM on, try Adam Brown’s suggestions on the subject.

As soon as your system is about up, your CGM might want to “heat up” earlier than you possibly can see your information. Totally different fashions have totally different warm-up durations, however this can usually take one to 2 hours, after which your information might be accessible both instantly (Dexcom, Guardian, Eversense) or by scanning your sensor (FreeStyle Libre). The nice and cozy up interval for the implantable Eversense system is 24 hours.

For many individuals beginning to use a CGM, video tutorials will be fairly useful. When you’ve got the chance, it’s good to satisfy with a diabetes care and schooling specialist or your native pharmacist (if choosing up your CGM from a pharmacy). Listed here are set-up and software ideas and tutorials on your CGM:

Half 3: Understanding your CGM information

When you’re arrange together with your CGM and the nice and cozy up interval is full, you possibly can entry your information. There are two kinds of information you’ll wish to take note of: real-time information and previous information.

Interpret your real-time information.

Relying on the CGM model you’re utilizing, you possibly can both entry your glucose information at any time by taking a look at an app in your cellphone, your good watch, or your receiver. For these utilizing an intermittently-scanned CGM, you possibly can view your glucose ranges by scanning your sensor together with your good cellphone or reader. Taking a look at your information can really feel overwhelming at first, so we suggest specializing in two elements of your real-time information:

  • First, take a look at your CGM glucose worth. Is it in your goal vary? In case your glucose stage is out of vary, which steps of your plan must you comply with?

Should you’re experiencing hypoglycemia particularly, be sure to act straight away to extend your glucose ranges.

  • Second, take a look at the development arrow. Your CGM gives a “development arrow,” to let you know the course and pace with which your glucose values are altering. The development arrow is useful for understanding what’s happening and how one can reply. For instance, in case your glucose worth is 90 mg/dl and your development arrow reveals that your glucose ranges are happening, you could must take motion to stop hypoglycemia; in case your glucose worth is 90 mg/dl and your development arrow reveals your glucose ranges are growing, you might be seemingly not going to develop hypoglycemia.

Development arrows can assist with premeal insulin dosing, earlier than and after train, earlier than mattress, and to grasp the place your glucose might be trending within the subsequent half-hour. Development arrows are notably useful when used with insulin on board (short-acting insulin that was not too long ago taken for meals or to appropriate a excessive glucose stage and remains to be working within the physique). For instance, in case your development arrows are happening and you’ve got insulin on board from an insulin dose given two hours beforehand, your threat of hypoglycemia is even larger.

For these not utilizing insulin, development arrows can assist perceive how totally different meals and actions have an effect on glucose ranges. For instance, if an individual sees that the arrow is rising quickly after a sure meal or snack, they’ll go for a stroll to attempt to carry it down. It might additionally sign that subsequent time you need to think about a smaller portion dimension or attempt to add protein or fats to stop glucose ranges from rising as shortly.

Every CGM has a barely totally different interpretation of the arrows, however right here’s a common concept of what the development arrows can let you know.

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Picture supply: diaTribe

We suggest working together with your healthcare staff to resolve how usually to verify your glucose ranges. Many individuals profit from checking glucose when waking up, earlier than meals, earlier than bodily exercise, and at bedtime. Some individuals profit from checking one to 2 hours after meals. An individual also needs to verify their CGM any time they really feel signs of excessive or low glucose. CGM alarms are particularly useful for monitoring glucose ranges as they alter – extra on this beneath.

Interpret your previous information.

When you’ve used your CGM for a couple of days, you possibly can see your current daily trends and the period of time you’re spending within the goal vary (70-180 mg/dl). That is additionally known as retrospective information. It’s useful to evaluation your glucose information commonly to grasp how your way of life – just like the meals you eat, your train habits, your stress ranges, and medicines you employ – impacts your glucose ranges. Take a look at your glucose ranges over the previous two weeks, one month, and three months; speak together with your healthcare staff about traits that you’re noticing and the way they is perhaps addressed. Study in regards to the many components that have an effect on glucose here.

Throughout diabetes care appointments, your healthcare staff can view this information in an Ambulatory Glucose Profile (AGP) report and use it to speak with you about how your diabetes administration goes and any potential changes to your care plan. This ought to be a collaborative dialogue between you and your healthcare staff about how your diabetes information compares to your administration objectives and what adjustments might be made.

Every CGM system presents a standardized one-page report, known as an ambulatory glucose profile (AGP). The AGP consists of three necessary elements:

  1. CGM key metrics
  2. 24-hour profile
  3. Every day glucose patterns

Though there are lots of methods to view your glucose information, the AGP report usually has all the info that you simply want. We’ll clarify the three essential items beneath. To study extra, learn our in-depth piece on understanding your AGP report: “Making the Most of CGM: Uncover the Magic of Your Ambulatory Glucose Profile.”

CGM key metrics

Extra inexperienced, much less purple.

The time in vary bar reveals the share of time you spend in 5 glycemic ranges:

  • data




    Picture supply: diaTribe

    Time in Vary: glucose ranges between 70-180 mg/dl

  • Time Beneath Vary: glucose ranges beneath 70 mg/dl
  • Time in extreme hypoglycemia: glucose ranges beneath 54 mg/dl
  • Time Above Vary: glucose ranges above 180 mg/dl
  • Time in extreme hyperglycemia: glucose ranges above 250 mg/dl

Your aim is to develop the inexperienced bar and shrink the purple bars – in different phrases, improve Time in Vary and reduce time Beneath Vary and time in extreme hypoglycemia. See extra on Time in Vary goals and standard targets.

24-hour profile, also referred to as Ambulatory Glucose Profile (AGP).

chart

Picture supply: diaTribe

How do you determine the way to change your diabetes administration to extend your Time in Vary and reduce your Time Beneath and Above Vary? That’s the place the 24-hour profile is useful, which reveals your each day glucose traits throughout the total 24-hour day.

  • Understanding what the 24-hour profile reveals: The black line represents your median glucose stage all through the day based mostly on information from a set interval of your CGM use (e.g., the final two weeks). The blue shaded areas assist present how a lot your glucose ranges fluctuate at totally different factors within the day.
  • Utilizing the information: Examine totally different occasions of day to see what is perhaps influencing your glucose numbers. For instance, whereas the particular person proven above has glucose readings that adjust tremendously at 3pm (indicated by a really large shaded space), their 8am glucose numbers are far more constant (the shaded space at 8am is narrower), regardless of being greater. This particular person additionally commonly sees a spike in sensor glucose readings at round 9am. What’s inflicting that improve? Perhaps it’s the next carbohydrate breakfast alternative, forgetting to bolus, not bolusing early sufficient, or not accounting for all of the carbs in breakfast. Reflecting on what’s inflicting a spike or valley can assist you make habits adjustments to cut back fluctuations and improve your Time in Vary.
  • chart

    Picture supply: diaTribe

    The aim: The general aim is to maintain your glucose ranges in your goal vary with out large spikes or valleys, typically known as “flat, slim, in vary” (FNIR). Within the AGP above, the inexperienced field represents the person’s goal sensor glucose vary (70-180 mg/dl). Whereas the person stays in vary in a single day and within the afternoon, they have an inclination to see spikes within the morning and night. With the aim of FNIR in thoughts, you possibly can take a look at your long-term information and ask, what’s making it potential for me to remain in vary? What’s making my glucose spike or fall?

  • The excellent news is the aim for most individuals is to spend 70% or extra Time in Vary. Nevertheless, growing your Time in Vary by even 5% (an additional hour per day in vary!) will be useful. You don’t have to achieve perfection to enhance medical outcomes.

Every day glucose profiles.

Together with your development information, you can also see your each day 24-hour glucose profiles from the final two weeks. The figures present the goal vary (70-180 mg/dl) in grey, spikes above 180 mg/dl (hyperglycemia) in yellow, and valleys beneath 70 mg/dl (hypoglycemia) in purple. Viewing the information day-to-day can assist you consider how particular components and behaviors impacted your glucose values on a sure day.

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Picture supply: diaTribe

To take advantage of out of your each day glucose profiles, it may be useful to log your each day meals and train to match together with your glucose profile and see which behaviors assist you to keep in vary and which of them are likely to make you exit of vary.

A useful device when reviewing your information together with your healthcare staff known as DATAA. Which stands for:

  • Data – take a look at your diabetes information collectively
  • Assess Security – Search for and attempt to resolve Time Beneath Vary (hypoglycemia) first
  • Time in Vary – Focus on what’s working and the way to replicate that by searching for the occasions of day or the times of the week when Time in Vary was the best
  • Areas to Enhance – Be aware while you spent extra Time Above Vary (hyperglycemia) and focus on methods to cut back this
  • Action Plan – Develop an motion plan collectively

Different Ideas, Tips, and Issues

1. Train & your CGM

To find out about the way to use your CGM earlier than, throughout, and after train, try our article “Exercise Well with Your CGM – Recommendations, Glucose Trends, and Strategies.”

An necessary be aware about exercising with a CGM: There is usually a distinction between CGM glucose measurements and BGM glucose measurements on account of what we name a “lag.” Modifications in glucose ranges in interstitial fluid will not be seen as shortly as they’re within the blood. At relaxation, the interstitial glucose lags about 5 minutes behind the blood glucose; in conditions when glucose adjustments quickly, comparable to throughout train, lag time can improve as much as 24 minutes. Which means that your CGM readings aren’t all the time going to be correct throughout train. This lag also can happen exterior of train, any time your glucose ranges are rising or falling shortly.

2. Easy methods to make CGM alarms your pal

Adam Brown has written about how it may be useful to consider your CGM as a accomplice in your diabetes administration, moderately than a nag that factors out while you’re not in vary. Alarms will be helpful instruments. By alerting you to present or predicted highs and lows, in addition to fee of change, you possibly can improve your Time in Vary and see your 24-hour glucose profile turn out to be flatter, narrower, and extra in vary. You’ll be able to personalize your CGM alarm settings to your most well-liked thresholds or flip them off fully (although some units gained’t allow you to flip off an pressing low alarm at 55 mg/dl). It’s useful to work together with your diabetes care staff to find out your individualized alarm settings.

3. Sharing information with buddies, household, and care-partners

The power to share your real-time glucose information together with your care-partners and family members is a big plus of utilizing CGM – your help community can assist you monitor your glucose ranges and preserve them in vary. On the similar time, sharing your information with others makes some individuals nervous and self-conscious. Resolve who you wish to share your information with and speak with that particular person about boundaries and the way you wish to talk about your information. For extra on the way to method these conversations, try Kerri Sparling’s “To Share or Not to Share: My Approach to Diabetes Data,” and “How to Coach Your Care-Partner on CGM Data.”

4. Easy methods to speak to your healthcare staff about your CGM

Now that you simply’re utilizing a CGM, speaking together with your healthcare staff about your CGM information ought to turn out to be a key a part of each go to.

Forward of the go to: To assist visits go easily, many healthcare professionals will ask you to add your CGM information earlier than you come into the workplace (or earlier than your telehealth appointment) to allow them to evaluation the information and be ready to speak with you. Study importing your information here. Be aware: some CGM techniques add routinely as soon as linked to the clinic’s information portal. It’s additionally useful to look over your information – like your AGP report – and give you inquiries to ask your healthcare skilled forward of the go to. You will have questions on components of your each day glucose profile that you simply don’t perceive, areas the place you’re having a tough time staying in vary, or simply common questions that can assist you navigate your information.

In the course of the go to: To just be sure you and your healthcare skilled are on the identical web page, it may be useful to take a couple of minutes at first of your appointment to elucidate your interpretation of your information in your personal phrases. This can be time to begin a dialog on any questions you’ll have ready forward of your go to. It is usually necessary to take time together with your care staff to develop an motion plan based mostly in your CGM information with a couple of easy priorities so that you can give attention to earlier than your subsequent go to.

Model-Particular Sources

Whereas any CGM can assist enhance your diabetes administration, there are some variations between the presently out there techniques that you could be wish to think about or speak about together with your healthcare staff – see our chart evaluating totally different CGMs here. Particularly, we suggest asking your healthcare skilled about how alarms could possibly warn you to occasions of hyperglycemia or hypoglycemia, what it means if it’s a must to calibrate your CGM, and the way to use your CGM with good insulin pens, cellular apps, and even insulin pumps in an automatic insulin supply (AID) system.

To achieve out to CGM corporations for product help, contact their customer support departments:

  • Abbott: +1-855-632-8658
  • Dexcom: +1-888-738-3646
  • Medtronic: +1-800-646-4633
  • Senseonics: +1-844-736-7348

This text is a part of a collection on Time in Vary.

The diaTribe Basis, in live performance with the Time in Vary Coalition, is dedicated to serving to individuals with diabetes and their caregivers perceive Time in Vary to maximise sufferers’ well being. Study extra in regards to the Time in Vary Coalition here.



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