Diabetes Program Blood Glucose Meters Meter measures your

Diabetes Program

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!

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

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.

Trend arrows

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

Dexcom G 6 Dexcom’s Latest edition

Medtronic Guardian Connect

Freestyle Libre Mostly adults –FDA approved 18+

Wearing the CGM Sensor: Small filament that sits under the skin Measures glucose level about every 5 mins Disposable Length of wear: Dexcom G 6 – 10 days Freestyle Libre: 14 days Medtronic Guardian Connect: 7 days

Wearing the CGM Transmitter: Dexcom G 6: Non-disposable, expires every 3 months Medtronic: Non-disposable and rechargeable. Charge every time you change your sensor. Libre: Disposable Display Device Dexcom G 6: Dexcom receiver Smart device (i. Phone and Android compatible) Medtronic: i. Phone only Libre: Handheld reader or iphone used to scan sensor for data (iphone 7 or later using ios 11 and later) Transmitter and sensor waterproof, display device is not. Signal may be lost while submerged in water.

Wearing the CGM: Sites

Dexcom G 6 Sensor

Dexcom G 6 For Dexcom G 6: enter sensor ID first and save the ID number for potential future use Clean the Dexcom transmitter with each sensor change (prior to attaching) http: //www. dexcom. com/tutorials

Medtronic Guardian Sensor

Medtronic Guardian https: //www. medtronicdiabetes. com/customer-support/guardian-connectsystem-support/inserting-and-starting-sensor https: //www. medtronicdiabetes. com/customer-support/guardian-connectsystem-support/setting-up-guardian-connect

Freestyle Libre

Starting the Sensor https: //www. freestylelibre. us/support/overview. html

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

Calibration for Guardian Connect and Dexcom G 5 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

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.

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

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 fallrate)

Dexcom Phone Apps Download the “Dexcom G 5 or G 6” 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

Data Sharing: Dexcom G 5 and G 6 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

Dexcom data Sharing with Clinic Receiver: Download Clarity software on computer/laptop www. clarity. dexcom. com 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

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 Care. Link Connect tab data from any internet-connected device (any phone, computer, or tablet with internet connectivity).

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

Freestyle Libre. Link App i. Phone 7 and later models

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

Trend Graph Prevention of severe hypoglycemia

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.