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

If you simply acquired a steady glucose monitoring system, it’s possible you’ll be questioning use it most successfully and perceive your glucose information. Read our ideas, methods, and issues to think about.

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

It’s almost definitely that you just and your healthcare crew determined that utilizing a CGM is the optimum approach so that you can handle your diabetes. Perhaps you got a prescription for a private CGM. Or perhaps you’re making an attempt CGM as a part of Dexcom’s Hello Dexcom program (a free ten-day trial), by Abbott’s MyFreestyle program (a free 14-day trial), or as a part of Medtronic’s CGM Discount Access program. You may additionally be making an attempt skilled CGM, which is owned by your healthcare clinic and worn on a short-term foundation.

If you haven’t but been capable of get CGM, ask your healthcare crew if you may get a trial system or get a prescription. CGM is beneficial for anybody with diabetes who takes mealtime insulin. While many individuals with diabetes at the moment don’t have entry to CGM, we’re hopeful that an increasing number of people will be capable to use this know-how sooner or later. Regardless of what brings you to utilizing a CGM, we’ve created a three-part information that will help you get began, together with ideas, methods, and concerns.

Click to leap right down to a part:

• Part 1: Before you start using your CGM
• Part 2: Applying your CGM sensor
• Part 3: Understanding your CGM data
• Part 4: Other tips, tricks, and considerations
• Brand-specific resources

Part 1: Before you apply your CGM

Learn the fundamentals.

Before you begin utilizing your CGM, it may be useful to grasp its primary options. Continuous glucose displays (CGM) measure the physique’s glucose (or sugar) ranges by sensing the glucose current in tissue fluid (additionally known as interstitial fluid). While a blood glucose meter (BGM) offers a measurement of the blood glucose degree at a particular second in time (if you prick your finger), CGMs present a new glucose degree each one to 5 minutes – relying on the system, that’s 288 to 1,440 occasions per day. A CGM offers a fixed stream of data on glucose ranges, traits, and patterns.

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

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 data to a smartphone app, reader, or receiver. In transcutaneous techniques, the sensor and transmitter are related as one small on-body system. Some transmitters are disposable with the sensor whereas others require an extra step to connect. In implanted techniques, the transmitter is hooked up to the pores and skin and may 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 “warm up” earlier than glucose readings can be found, how lengthy you may put on a CGM sensor earlier than needing to exchange it, and alarms that provide you with a warning to highs and lows. You can be taught extra about CGM units here. For brand-specific sources and data, click on right here to leap down.

Personal CGM vs. Professional CGM

The CGMs that we simply described are known as private CGMs – they’re owned by the particular person with diabetes and used for a lengthy time period. They can be found as real-time CGMs, the place the information may be repeatedly seen, or as intermittently-scanned CGMs, the place data is recorded the entire time, however it’s essential to scan the sensor to view the information.

Another kind of CGM is named “professional CGM.” Professional CGMs are given to somebody with diabetes for a brief session (normally one to 2 weeks) to higher perceive that particular person’s glucose ranges. After the damage interval, the particular person will evaluation the information with their healthcare skilled. This can present insights that inform the particular person’s diabetes therapy, and it could actually assist healthcare professionals advocate remedy and life-style suggestions that result in higher glucose administration.

Some skilled CGMs have a real-time mode, which means that the consumer can see their glucose ranges whereas carrying the system. Other skilled CGMs have a “blinded” mode. Blinded CGM signifies that you can not have a look at their glucose values on-demand; as a substitute, your entire glucose information is saved and shared together with your healthcare skilled. This may also help your healthcare crew establish hypoglycemia (or low blood sugar ranges). If you get a blinded skilled CGM, your healthcare crew will analyze the information and talk about it with you as soon as your put on interval is full.

While long-term, real-time CGM is only for day-to-day diabetes administration, particularly for insulin customers, skilled CGM may be an vital instrument for people who find themselves not utilizing private CGM. Periodic use of CGM may also help folks be taught the consequences of meals and bodily exercise on glucose ranges, even for these not taking any diabetes drugs.

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

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

• Reflect in your CGM targets. Perhaps you need to use CGM to stop hypoglycemia utilizing its alert system, or to stop hyperglycemia and enhance your Time in Range, or to handle glucose throughout train. Or, perhaps you and your healthcare crew are going to make use of skilled CGM for 2 weeks to discover how your life-style habits impacts your glucose ranges. Regardless, the last word aim of CGM is to enhance your diabetes administration.
• Know your private glucose targets and make a plan together with your healthcare crew for a way you’ll reply to hyperglycemia and hypoglycemia. Knowing your target glucose range is vital for responding to your real-time glucose values. For most individuals with diabetes the goal vary is 70-180mg/dl – be taught extra about Time in Range targets here. Make a plan that includes glucose pattern arrows out of your CGM that will help you forestall massive spikes out of vary. Here are some prompts so that you can talk about together with your healthcare crew:
  • What is my glucose goal once I get up and earlier than meals?
  • What ought to my glucose degree be two hours after a meal? If it’s above that worth, what actions ought to I take to deliver my glucose ranges down?
  • What is my glucose goal earlier than mattress?
  • What excessive glucose degree ought to I attempt to keep away from? What ought to I do if my glucose will get that prime?
  • What low glucose degree 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?

Part 2: Applying your CGM

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

Download the cell app related together with your CGM system if obtainable. If you’re utilizing a receiver (Dexcom system) or reader (Libre system), make sure that it’s charged day by 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. If you’ve got an implanted CGM, it is going to be utilized by a healthcare skilled and may 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 protecting your CGM on, try Adam Brown’s suggestions on the subject.

Once your system is ready up, your CGM might want to “warm up” earlier than you may see your information. Different fashions have completely different warm-up intervals, however it will usually take one to 2 hours, after which your information will probably be accessible both straight (Dexcom, Guardian, Eversense) or by scanning your sensor (FreeStyle Libre). The heat up interval for the implantable Eversense system is 24 hours.

For many individuals beginning to use a CGM, video tutorials may be fairly useful. If you’ve got the chance, it’s good to satisfy with a diabetes care and training specialist or your native pharmacist (if choosing up your CGM from a pharmacy). Here are set-up and utility ideas and tutorials in your CGM:

• Abbott: FreeStyle Libre 14-day Tutorials
• Abbott: FreeStyle Libre 2 Tutorials
• Dexcom: G6 Tutorials
• Medtronic: Guardian Sensor Tutorials
• Senseonics: Eversense Tutorials

Part 3: Understanding your CGM information

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

Interpret your real-time information.

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

• First, have a look at your CGM glucose worth. Is it in your goal vary? If your glucose degree is out of vary, which steps of your plan do you have to observe?

If you’re experiencing hypoglycemia specifically, ensure you act immediately to extend your glucose ranges.

• Second, have a look at the pattern arrow. Your CGM offers a “trend arrow,” to inform you the course and velocity with which your glucose values are altering. The pattern arrow is useful for understanding what’s occurring and how one can reply. For instance, in case your glucose worth is 90 mg/dl and your pattern arrow exhibits that your glucose ranges are taking place, it’s possible you’ll must take motion to stop hypoglycemia; in case your glucose worth is 90 mg/dl and your pattern arrow exhibits your glucose ranges are growing, you’re possible not going to develop hypoglycemia.

Trend arrows may also help with premeal insulin dosing, earlier than and after train, earlier than mattress, and to grasp the place your glucose will probably be trending within the subsequent half-hour. Trend arrows are significantly helpful when used with insulin on board (short-acting insulin that was lately taken for meals or to appropriate a excessive glucose degree and remains to be working within the physique). For instance, in case your pattern arrows are taking place and you’ve got insulin on board from an insulin dose given two hours beforehand, your danger of hypoglycemia is even larger.

For these not utilizing insulin, pattern arrows may also help perceive how completely different meals and actions have an effect on glucose ranges. For instance, if a particular person sees that the arrow is rising quickly after a sure meal or snack, they will go for a stroll to attempt to deliver it down. It may additionally sign that subsequent time you must take into account a smaller portion measurement or attempt to add protein or fats to stop glucose ranges from rising as rapidly.

Each CGM has a barely completely different interpretation of the arrows, however right here’s a normal concept of what the pattern arrows can inform you.

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

Interpret your previous information.

Once you’ve used your CGM for a few days, you may see your latest daily trends and the period of time you’re spending within the goal vary (70-180 mg/dl). This can be known as retrospective information. It is useful to evaluation your glucose information commonly to grasp how your life-style – just like the meals you eat, your train habits, your stress ranges, and drugs you employ – impacts your glucose ranges. Look at your glucose ranges over the previous two weeks, one month, and three months; speak together with your healthcare crew about traits that you’re noticing and the way they is likely to be addressed. Learn concerning the many elements that have an effect on glucose here.

During diabetes care appointments, your healthcare crew 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 needs to be a collaborative dialogue between you and your healthcare crew about how your diabetes information compares to your administration targets and what adjustments may very well be made.

Each CGM system affords a standardized one-page report, known as an ambulatory glucose profile (AGP). The AGP contains three vital parts:

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

Although there are numerous methods to view your glucose information, the AGP report usually has the entire data that you just want. We’ll clarify the three major items beneath. To be taught 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

More inexperienced, much less pink.

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

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  Image supply: diaTribe

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

• Time Below Range: glucose ranges beneath 70 mg/dl
• Time in extreme hypoglycemia: glucose ranges beneath 54 mg/dl
• Time Above Range: 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 pink bars – in different phrases, enhance Time in Range and reduce time Below Range and time in extreme hypoglycemia. See extra on Time in Range goals and standard targets.

24-hour profile, also called Ambulatory Glucose Profile (AGP).

Image supply: diaTribe

How do you determine change your diabetes administration to extend your Time in Range and reduce your Time Below and Above Range? That’s the place the 24-hour profile is useful, which exhibits your day by day glucose traits throughout the complete 24-hour day.

• Understanding what the 24-hour profile exhibits: The black line represents your median glucose degree 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 range at completely different factors within the day.
• Using the information: Compare completely different occasions of day to see what is likely to be influencing your glucose numbers. For instance, whereas the particular person proven above has glucose readings that modify significantly at 3pm (indicated by a very broad shaded space), their 8am glucose numbers are rather 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 enhance? Maybe it’s a greater 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 may also help you make habits adjustments to scale back fluctuations and enhance your Time in Range.
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  Image supply: diaTribe

  The aim: The general aim is to maintain your glucose ranges in your goal vary with out massive spikes or valleys, typically known as “flat, narrow, in range” (FNIR). In the AGP above, the inexperienced field represents the consumer’s goal sensor glucose vary (70-180 mg/dl). While the consumer stays in vary in a single day and within the afternoon, they have a tendency to see spikes within the morning and night. With the aim of FNIR in thoughts, you may have a look at your long-term information and ask, what’s making it doable for me to remain in vary? What is making my glucose spike or fall?

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

Daily glucose profiles.

With your pattern information, you can also see your day by 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 pink. Viewing the information daily may also help you consider how particular elements and behaviors impacted your glucose values on a sure day.

Image supply: diaTribe

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

A useful instrument when reviewing your information together with your healthcare crew is named DATAA. Which stands for:

• Data – have a look at your diabetes information collectively
• Assess Safety – Look for and attempt to remedy Time Below Range (hypoglycemia) first
• Time in Range – Discuss what’s working and replicate that by in search of the occasions of day or the times of the week when Time in Range was the very best
• Areas to Improve – Note if you spent extra Time Above Range (hyperglycemia) and talk about methods to scale back this
• Action Plan – Develop an motion plan collectively

Other Tips, Tricks, and Considerations

1. Exercise & your CGM

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

An vital be aware about exercising with a CGM: There may be a distinction between CGM glucose measurements and BGM glucose measurements as a consequence of what we name a “lag.” Changes in glucose ranges in interstitial fluid are usually not seen as rapidly 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 enhance as much as 24 minutes. This signifies that your CGM readings aren’t at all times going to be correct throughout train. This lag also can happen outdoors of train, any time your glucose ranges are rising or falling rapidly.

2. How 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, relatively than a nag that factors out if you’re not in vary. Alarms may be helpful instruments. By alerting you to present or predicted highs and lows, in addition to fee of change, you may enhance your Time in Range and see your 24-hour glucose profile develop into flatter, narrower, and extra in vary. You can 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 crew to find out your individualized alarm settings.

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

The potential 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 may also help you observe your glucose ranges and maintain them in vary. At the identical time, sharing your information with others makes some folks nervous and self-conscious. Decide who you need to share your information with and speak with that particular person about boundaries and the way you need to talk about your information. For extra on 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. How to speak to your healthcare crew about your CGM

Now that you just’re utilizing a CGM, speaking together with your healthcare crew about your CGM information ought to develop into a key a part of each go to.

Ahead 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. Learn about importing your information here. Note: some CGM techniques add mechanically as soon as related 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 might have questions on elements of your day by day glucose profile that you just don’t perceive, areas the place you’re having a exhausting time staying in vary, or simply normal questions that will help you navigate your information.

During the go to: To just remember to and your healthcare skilled are on the identical web page, it may be useful to take a couple of minutes in the beginning of your appointment to elucidate your interpretation of your information in your personal phrases. This could also be a good time to start out a dialog on any questions you will have ready forward of your go to. It can be vital to take time together with your care crew to develop an motion plan based mostly in your CGM information with a few simple priorities so that you can give attention to earlier than your subsequent go to.

Brand-Specific Resources

While any CGM may also help enhance your diabetes administration, there are some variations between the at the moment obtainable techniques that you could be need to take into account or speak about together with your healthcare crew – see our chart evaluating completely different CGMs here. Specifically, we advocate asking your healthcare skilled about how alarms could possibly provide you with a warning to occasions of hyperglycemia or hypoglycemia, what it means if you must calibrate your CGM, and use your CGM with good insulin pens, cell apps, and even insulin pumps in an automatic insulin supply (AID) system.

To attain out to CGM firms 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

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