1. Introduction to Continuous Glucose Monitoring
Diabetes Program

2. Blood Glucose Meters
Meter measures your glucose level at that exact time.
To see a pattern clearly, you would need to check:
before every meal and snack,
two hours after every meal and snack,
at bedtime,
a few times overnight,
before and after exercise,
whenever feeling high or low.
12-30 times every day!

3. What is Continuous Glucose Monitoring (CGM)?
CGM is a small, wearable device that tracks glucose levels about every 5 minutes, day and night. Over 250 readings/day
Can notify you about highs and lows.
Tiny wire sensor is inserted under the skin and measures glucose levels in the subcutaneous fluid
Connected to a transmitter that sends the data to a monitoring and display device

4. CGM vs Blood Glucose Meters
CGM gives you a fuller picture
Gives you a CGM reading every few minutes, 24 hours a day.
Plots data on a trend graph so you can see where glucose levels have been and where they might be heading.
Trend arrows show where your glucose is headed and how fast it is changing.
Can set high and low glucose alerts so you know if glucose is headed out of range.

5. Trend arrows

6. CGM vs Blood Glucose Meter
CGM reads glucose levels from the interstitial fluid
Blood glucose meters read glucose levels from the blood
Therefore, the CGM and meter will report different glucose levels, this is normal
Readings can be different but are still considered accurate.
Usually within 20% of each other, unless the blood sugar levels are rapidly rising or falling
FDA Approved for dosing and treatment decisions

7. Dexcom G6- Dexcom’s Latest edition

8. Medtronic Guardian Connect

9. Freestyle Libre Mostly adults –FDA approved 18+
FDA has approved the 14 day Libre Flash. Not on the market yet.

10. Wearing the CGM Sensor: Small filament that sits under the skin
Measures glucose level about every 5 mins
Disposable
Length of wear:
Dexcom G6 – 10 days
Freestyle Libre: 14 days
Medtronic Guardian Connect: 7 days
Dexcom G5 and below are FDA approved for 7 day wear. FDA Approved for dosing and treatment decisions.

11. Wearing the CGM Transmitter: Display Device
Dexcom G6: Non-disposable, expires every 3 months
Medtronic: Non-disposable and rechargeable. Charge every time you change your sensor.
Libre: Disposable
Display Device
Dexcom G6:
Dexcom receiver
Smart device (iPhone and Android compatible)
Medtronic:
iPhone only
Libre:
Handheld reader or iphone used to scan sensor for data (iphone 7 or later using ios 11and later)
Transmitter and sensor waterproof, display device is not. Signal may be lost while submerged in water.

12. Wearing the CGM: Sites

13. Dexcom G6 Sensor
To insert the Dexcom sensor, first you remove the backing from the adhesive patch and then remove the safety lock. Next you will apply the sensor applicator to the prepared skin, pressing firmly to make sure it is secured. You then want to pinch the skin up around the applicator. Next you will depress the plunger with your thumb, this will introduce the needle under the skin with the sensor wire inside it. Make sure you do not have your fingers under the collar while you are pushing down on the plunger. Next you will remove the needle by putting two fingers under the yellow collar and move it from the bottom of the applicator barrel to the top of the barrel. The will remove the needle, leaving the soft, flexible sensor wire under the skin. You can then remove the applicator barrel by pressing on the 2 release tabs which feel like ridged areas. This will remove the applicator barrel. You will then want to insert the transmitter using the transmitter latch. Once the transmitter is inserted, you can snap off the transmitter latch. Then visually inspect the back of the transmitter to make sure it’s fully clicked in.

14. Dexcom G6
For Dexcom G6: enter sensor ID first and save the ID number for potential future use
Clean the Dexcom transmitter with each sensor change (prior to attaching)

15. Medtronic Guardian Sensor

16. Medtronic Guardian
system-support/inserting-and-starting-sensor
system-support/setting-up-guardian-connect

17. Freestyle Libre

18. Starting the Sensor

19. Warm up period 2 hours for Dexcom 2 hours for Guardian
12 hours for Libre (14 days – 1 hour warmup)
No data during this period
Medtronic requires calibration needed at end of warm up period

20. Calibration for Guardian Connect and Dexcom G5 and older
A finger stick blood glucose level
First calibration after the warm up will require a finger stick value
Once calibration is entered, CGM display device will start showing data
Single Calibration required at least every 12 hours
We recommend 2-4 times a day
Before breakfast
Before dinner
Before bedtime
First day of wear may require more calibrations
Wash and dry hands prior to finger stick
Sugar on skin may falsely elevate number
Enter calibration value within 5 minutes
Dexcom will require 2 BG values for the first calibration after the 2 hour warmup period.

21. Calibration
Best time to calibrate is when blood sugar values are stable:
Before a meal
First thing in the morning
When there are no up or down rate of change arrows on the receiver.

22. Calibration Do’s and Don’ts
Use the same meter
Use clean hands
Don’t
If you take Tylenol
If BG <40 or >400
If BG rapidly changing

23. Alarms for Dexcom and Guardian
High alarms
Set for 250 (more or less depending on preference)
Set snooze time for 120 minutes
Can set alarm for upward trend arrows (1 or 2 arrows up-rise rate)
Can be shut off completely, if needed
Low alarms
Set for 80 (BG may be <80 by the time the alarm sounds)
Set snooze only for 15 minutes (allows time to treat and recheck BG 15 mins later)
Can set alarm for downward trend arrows (1 or 2 arrows fall- rate)

24. Dexcom Phone Apps
Download the “Dexcom G5 or G6” and “Clarity Apps” on Smart phone used by the patient (these apps may/may not be available on all other smart phones).
Download the “Follow App” on the phone used by the person/people other than the patient

25. Data Sharing: Dexcom Dexcom G5 and G6 Mobile App with Share
Let’s you view data and trends on device
Can share data with up to 5 people
Dexcom Follow App
Can remotely view Dexcom data
Parents
School nurse
Coach

26. Dexcom data Sharing with Clinic
Receiver:
Download Clarity software on computer/laptop
Click home use, sign in
Use cable to upload data from receiver to computer/laptop
Can be downloaded in clinic for review
Phone:
Download Clarity App
Generate code: Choose for 1 year
Provide code to Doctor’s office for remote review of data

27. Medtronic Phone Apps Data can be shared with up to 5 people
Care partners do not need to have compatible devices in order to access Guardian Connect data. Care partners can access the CareLink Connect tab data from any internet-connected device (any phone, computer, or tablet with internet connectivity).

28. Medtronic data sharing with Clinic
How will CareLink® Personal help my healthcare professional?
If you have the ‘Sync to CareLink’ setting turned on, you will no longer have to manually upload your data to CareLink. This means that you’ll save time during your office visits because you will not need to download your data while in the office

29. Freestyle LibreLink App
iPhone 7 and later models

30. Freestyle data
The FreeStyle Libre software is free to download and use by you and your health care professional. For users of LibreView, you can a PDF of your reports to your healthcare team by clicking the button when viewing your reports. You can also share with your healthcare professional by linking your LibreView account to their healthcare practice.

31. Trend Graph
Prevention of severe hypoglycemia

32. Daily Life Look at trends over several days before making adjustments.
Avoid “reacting” to the number. See if a pattern develops.
Blood sugars will rise after a meal but as long as the value comes back to the target range by the next meal, no intervention is needed.
Ketone checks only necessary when blood sugar >300 for more than 2-3 hours on the trend graph.
Call the CGM company for technical concerns and if sensors are not lasting the entire 7-10 day cycle.