Diabetes technology seems to be a pretty popular topic for people with diabetes—and for good reason: it is proven to improve health outcomes and quality of life, and show you the complete story of your glucose levels.
Technology is now the standard of care for those with type 1 diabetes, and its benefits for those with type 2 diabetes are becoming increasingly evident. Even with all the health and quality-of-life benefits we see in continuous glucose monitoring, connected insulin pens, and automated insulin delivery devices to assist with activities of daily living, there are still instances where issues arise. We’re here to help you figure out fixes to some of these issues so your technology continues to work for YOU.
CGM (continuous glucose monitoring devices)
When it comes to CGM, it’s important to remember that the sensor isn’t actually testing your blood, like a finger prick or blood draw. It measures the amount of glucose in interstitial fluid (the fluid around cells). As a result, the reported number seen on the CGM may lag behind glucose numbers from finger sticks; numbers can vary by more than 10%—that’s completely normal.
Accuracy
When a number on your CGM doesn’t seem right or needs verification before making a treatment decision, you can check accuracy with a fingerstick. If you’re getting wide discrepancies between the CGM and finger stick (a difference of 40 points or more), consider the following:
- Did you just place the sensor on your body? The mild trauma that occurs with sensor application can allow for blood to surround the sensor, reporting a lower glucose. Applying the sensor the day before activation (known as “soaking”) can allow time for the blood to clear and improve first-day results. Rinsing the sensor with water can help wash away the blood obscuring the sensor as well.
- Was the sensor compressed? Compression lows, where pressure from sleeping or body positioning can limit the plasma reaching the CGM filament, can cause the CGM to report a lower glucose or absent value, sort of like a mild tourniquet effect. On your CGM graph, a compression low will look like a sudden, sharp drop that is very different from the slope the CGM curve was following. If this is an issue for you, you can try rolling over in bed, shifting the body part to relieve the compression on the sensor, or double-checking your glucose with a finger stick. If you’re constantly struggling with compression lows, try placing the sensor on an area you don’t sleep on or lean on very often. Talk with your healthcare team to help identify what compression lows look like so you can recognize them and act.
Sensor Failures
I am sure I am not the only one who has had a sensor “fail” before its expiration date. It can be so frustrating—but I have a few tips as a fellow person with diabetes to help with the issue.
The electronics of a sensor rarely fail, meaning that it is our skin healing that can prevent the full wear time or sometimes cause lower glucose levels to be displayed. The healing of the skin tissue around the sensor can limit glucose from being registered. I don’t have a great deal of scientific data for this, but a little wiggle on the sensor or a rinse of additional blood away can sometimes help. Sometimes changing locations on the body will increase wear time—the posterior or back part of the body can actually be a great place for a sensor.
If you’re struggling with sensors falling off, thoroughly wash the skin, try overlays, or use body assistant products to help with infusion set, pod or CGM adherence. Remember, after you have tried all these or there is a clear issue with the sensor, call the manufacturer for a replacement if it doesn’t last the full session, fails prematurely, or reports ongoing erroneous numbers that would lead to misinformed treatment decisions.
Adhesive Issues
If you get mild to moderate irritation with adhesives from diabetes technology, prep the skin application site with an over-the-counter nasal spray, such as fluticasone or triamcinolone spray. For more severe reactions, use iv prep that can be applied to protect the skin. Remember when removing any adhesive, use warm water, adhesive remover, coconut oil, or something similar—pulling off the top layer of skin can cause irritation.
At times, a simple location change can improve sensitivity. Once removed, use a topical over-the-counter cream for comfort and healing. Always contact your healthcare provider for severe reactions or infections.
Data Connectivity
Ensure that you’re connecting with your healthcare team to share your data, and always use your email on file with their office to prevent delays in data sharing.
If your phone is not compatible with CGM technology, you can ask your healthcare team to write a prescription for a compatible phone that could be taken off your tax record or from your health savings account as a medical expense. You can also have your healthcare team issue you a controller, but the data from these controllers can only be downloaded in their office for data review.
Automatic Insulin Delivery Systems (AID)
AID systems are incredible resources for many, but can have unique technological challenges—always be quick to contact the manufacturer if you have issues with the device beyond your knowledge. Some suggestions that will help promote best use and best practices:
- Stay current with hardware and app software updates for tubed and patch pumps.
- If Phone apps ever get “stuck,” restart the phone first. If that doesn’t fix the problem, then clear the app and sign back in before calling manufacturer tech support.
- Share your usernames and passwords for technology accounts with your healthcare team, just in case.
- Stay up to date on CGM sensor pairing with AID systems or versions due to be discontinued in the future.
- If your healthcare team is having trouble seeing your AID or CGM data, encourage them to reach out to manufacturers to help them reconcile these barriers.
- Contact technology manufacturers for issues you can’t self-reconcile, any malfunction of the system, or expectations for the device.
Our goal is to live the sweet life, taking diabetes along for the ride. Technology can help make that happen. Click here to learn more about how CGM metrics are changing lives. You can find more insights from Dr. Eden Miller on the “Sugar Queens” podcast, season 2 streaming here.