Diabetes technology has been shown to improve outcomes, quality of life, and show the complete picture of someone’s data. 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. The SOC state that it should be offered to everyone with diabetes! With all the scientific and quality-of-life benefits we see in continuous glucose monitoring, connected insulin pens, automated insulin delivery devices, and phone apps to assist with activities of daily living, there are still instances where issues arise. These need to be identified and mitigated to make the journey even better.
CGM (continuous glucose monitoring devices)
When it comes to CGM, it’s important to remember that they are interstitial or plasma glucose monitors—they don’t monitor blood like a finger prick or blood draw. 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%.
Accuracy
When a number doesn’t seem right or needs verification before making a treatment decision, encourage people in your care to check for accuracy with a fingerstick. Self-monitoring finger stick accuracy can vary between brands, and the values they report are not the gold standard for precision. Venous blood draw is what all CGMs are tested against for accuracy. If they’re getting wide discrepancies between the CGM and finger stick, have them consider the following:
- Did they just place the sensor on their body? The mild trauma that occurs with sensor application can allow for blood to surround the sensor, shielding the plasma glucose from the sensor filament, reporting a lower glucose. Applying the sensor the day prior to activation (also called soaking) can allow for time for the blood to clear and improve first-day results. In addition, rinsing the sensor while it’s still on with water can help wash away the blood obscuring the sensor, just be aware that it might affect adhesion.
- 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. When we see these on the tracings, they are a sudden, sharp drop that is very different from the slope the CGM curve was following. You can suggest the person with diabetes try rolling over in bed, shifting the body part to relieve the compression on the sensor, or double-checking their glucose with a finger stick. If the person is struggling with a compression low, suggest placement away from areas they lean on or lie on.
Sensor Failures
Sensors that fail before their expiration date can be extremely frustrating. The electronics of a sensor rarely fail, meaning that it is skin healing that can prevent the full wear time. In addition, near the end of sensor duration, the wearer may have noticed lower glucose levels displayed. This too can be from the healing of the tissue around the sensor, limiting the glucose from registering on the sensor. Sometimes, a little wiggle on the sensor or a rinse of additional blood away can help, but it is not a guarantee. Rotating locations on the body can also possibly increase wear time. Do remind those in your care that the posterior or back part of the body can actually be a great place for a sensor!
Sensor fall-off can be an issue as well. If this happens, suggest that the wearer thoroughly wash the skin, allow it to dry (do not apply lotion), and then try overlays, or use body assistant products to help with infusion set, pod, or CGM adherence.
When the wearer has tried all these options, or there is a clear issue with the sensor, they can call the manufacturer for 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 a person in your care gets mild to moderate irritation with adhesives from their CGM, AID, or infusion set, they can 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 under the device directly to protect the skin. Remind the wearer that when removing any adhesive, use warm water, adhesive remover, coconut oil, or something similar. Pulling off the top layer of skin can cause irritation when removing diabetes technology. Once removed, use a topical over-the-counter cream for comfort and healing.
Data Connectivity
If someone’s phone is not compatible with CGM technology, you can issue the wearer a controller through the manufacturer’s program—the data from these controllers can often only be seen through your practice, so ensure the wearer knows this. Alternatively, if it’s right for the person in your care, you can write an Rx for a compatible phone that could be taken off their tax record or bought through their health savings account as a medical expense.
Automatic Insulin Delivery Systems (AID)
AID systems have unique technological challenges—always encourage the people in your care to be quick to contact the manufacturer if they 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.
- Encourage the people in your care to share their usernames and passwords for technology accounts with you, just in case they lose them.
- Stay up to date on CGM sensor pairing with AID systems or versions due to be discontinued in the future.
- Contact technology manufacturers for issues you can’t self-reconcile, any malfunction of the system, or expectations for the device.
Diabetes technology can seriously change the lives of people with diabetes. With your help, guidance, and encouragement, people with diabetes can thrive.
Learn more about getting started with technology in your practice here.
Listen to insights from Eden Miller on the “Sugar Queens” podcast, season 2 streaming here.