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Let’s Talk CGM Solutions

Hey guys, Robert here! Check out my bio here to refamiliarize yourself with who I am!

A topic that comes with its own array of issues is how to deal with the quirks of CGM’s (continuous glucose monitor). CGM’s such as the Dexcom, Medtronic Guardian, or FreeStyle Libre. CGM’s provide blood glucose readings every few minutes from your subcutaneous fat. They show you in graph form where your blood sugar is, where it has been the past 24 hours, where it is trending, and you only have to replace them about once every 7-14 days (depending on your model and how long it will stay on your body). With Halloween and the holidays getting closer and closer it is a handy way to track when more insulin is needed before surpassing 300 mg/dl and feel sicker than a skeleton!

I have now been on the Dexcom— G5 first, and now on the G6— and to say that I love it would be an understatement. My A1c is now hovering at a 7.2, which is a notable improvement from where I was before adopting my Dexcom. From stopping night-time lows, to catching sneaky carbs that will spike my blood sugar throughout the day, the CGM has given me a new level of awareness that I wish I had when I was first diagnosed. Having the information about my blood sugar more accessible and visible at times can be overwhelming but overall it has helped me get a better hold of my numbers! I have also found that I can also better utilize the features of my pump, like basal suspension (resting insulin given throughout the day), delayed delivery (splitting up the delivery of insulin, e.g. 5 units delivered now, and 5 more in an hour), and quick boluses (quickly calculated insulin for meals).  I have encountered a few problems of my own with the CGM, so let us talk about Location and Bruising.

Location

One of the hardest things to figure out when first using a CGM is where to put the sensor. For those already on a pump, you now require two spots for sites that aren’t easy to find. And for younger children who just don’t have the fatty tissue that some older kids or adults have, the issue can be greater. The areas that I recommend for placing your CGM are as follows: thighs (inside or outside of the upper leg), belly, buttocks, triceps, and sides.

To determine which of these regions are right for you: use your thumb and forefinger to grab the skin and tissue, with about an inch between your fingers. If you are able to get soft, squishy tissue, you are in business; if you’re pinching muscle, you probably need to look somewhere else. As you gain experience testing out each of the regions, you will learn which areas work best for your lifestyle based on visibility, accuracy, flexibility, or whatever is important to you. Personally, I like to keep my CGM on my thighs after I have used them a lot for insulin sites over the years, and it allows them time for the tissue to recover. I was initially afraid that this would compromise the accuracy of the readings, but thankfully I have not seen that as an issue. This brings me to my next, lesser-known point: you can replace CGM sites in the same area as the last because they don’t cause inflammation under the skin like insulin sites do! If you have found a spot you like you can keep it their everytime you change your sensor! I don’t aim for the exact spot but move it just an inch in any direction and repeat.

Bruising

Another issue that many diabetics fight, myself included, is bruising and general discomfort as a result of the CGM sensor sites. Especially for those that are more active or play contact sports. It is common for sites to get bumped or interfered with, and even partially removed. In order to avoid this, I have found that the hips and buttocks are the best regions for generally keeping the sites out of the way. Especially on the hips where there’s a gap between the muscle and fat, it is well suited for avoiding bruises. Another tip that I have found particularly useful is using additional adhesive products to keep the sensor intact, and unable to budge. While I employ ‘Grif Grips’ myself. RockaDex, SkinTac, and Mastisol are other options, just find what works for you! I found that when I bruised, it was often due to CGM wires that partially came out. Also worth noting are the areas known for their general propensity to bruise, namely the stomach and arms, you always run the risk of hitting a blood vessel upon insertion.

I hope that this is able to help you or your little one in getting past some of the less-than-exciting features of the CGM’s. And one last tidbit to leave you with: try not to fear to experiment with new sites! It’s worth it!

Best Wishes to all of my Dia-Brothers and -Sisters as Halloween creeps closer,

~Robert