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Calibration Tips for New CGM Users

By Karrie Hawbaker

Public Relations Manager

Posted:  9/27/2012 4:11 PM

Tags:

Today, I’m excited to introduce Lori Schlosser, mother of 14-year-old Noah, who lives with Type 1 Diabetes. In today’s guest post, Lori shares with us some of the challenges that parents face when raising a child with Type 1 Diabetes as well as some tips she has learned since Noah’s recent incorporation of CGM technology into his daily diabetes management. If you have tips of your own, we’d love for you to share them with us in the comments below!

I’m just not a “numbers person.”  From my personal observation, most people either gravitate toward computation with numbers or composition with words.  I would be the latter.  That’s one reason my life as the mom of a child with T1D has been such a challenge.  Since my son, Noah, was diagnosed six years ago, at age eight, my life has become replete with so many numbers to understand and monitor… blood sugar readings, insulin to carb ratios, correction factors, A1C’s, and on and on.  Then there’s all the counting, measuring and estimating that goes into every morsel passing Noah’s lips.  Forget counting sheep to sleep.  By the time my head hits the pillow, I’m exhausted from counting ALL DAY LONG!  My nighttime routine is even trickier, because I’ve been, well, sleeping, and I have to wake up enough to poke a sleeping Noah and troubleshoot yet more numbers. 

Granted, Noah is 14 and very capable with much of his routine.  Still, we’ve found his pump trainer’s mantra to be so true, “A pump is only as good as its programmer.”  With a teenager, we’re constantly tweaking something, because there’s nothing routine about teenage life!  Not the activities or the stressors or the food or the growth hormones!  Just because Noah’s a bigger boy doesn’t mean I’ve stopped worrying about dangerous nighttime numbers…especially after late-night basketball or, on the other end of the spectrum, six pieces of pepperoni pizza at dinner! 

It’s little wonder I could hardly wait for Noah to get his hands on a Continuous Glucose Monitor (CGM).  I anticipated real perks for both of us.  Noah would save his fingers (and the constant interruptions) from so many blood sugar checks, and we would have some girthy numerical data to share with someone who loves the numbers and really knows what to do with them…. his endocrinologist. 

I have not been disappointed, particularly since we chose to compliment Noah’s CGM with mySentry, which looks like an alarm clock and provides a remote CGM readout.  mySentry captures the same info displayed on Noah’s pump.  Most of the time mySentry is on my bedroom nightstand, so I can check it periodically as Noah sleeps.  Occasionally, I move it to the kitchen, if I want to keep an eye on his blood sugar in the daytime.  We quickly learned mySentry even picks up his CGM when he’s outside cutting the grass.  That was an unexpected perk! (Editor’s note: the mySentry Outpost and Monitor can communicate up to 50 feet or greater, but can vary depending on the setup of your home.)

These tools are not a panaceas, but they have been a godsend for Noah and his numerically-challenged, sleep-deprived mother.  We delayed purchase because of mixed reviews from other parents of kids with T1D.  Most of the criticism surrounded CGM accuracy.  From my perspective, accurate data has a lot to do with good calibration.  Always the cautious parent, when Noah first began wearing his CGM, I had him do his regular blood tests (6-8 times daily) and made a two-day chart of meter vs. sensor readings.  Then we sat down with his pump trainer and asked her to explain the differences in the chart.  In retrospect, this was a fabulous way to learn about the CGM and how best to calibrate for Noah’s body.

These are the down and dirty tips I offer those who may be new to sensor therapy….or those who may be considering it.

• Appreciate the learning curve.  It takes at least a couple wears before you feel comfortable inserting the sensor needle and calibrating.  Yes, it’s a formidable needle.  If you’re working with a smaller child, do your homework.  Talk with your diabetes care team about when and how this technology might best be used in your particular situation.

• Use Medtronic’s on-line tutorials found in myLearning.  They’re worth your time, particularly the ones offering “story problems” about calibration. 

• It takes a little more “sticky” to make the CGM feel secure and comfortable.  Given Noah’s activity level, we’ve had very good luck using liquid adhesive under two transparent dressings.  We use liquid adhesive remover, as well.  If you want to sample adhesives, call the Medtronic 24-Hour HelpLine and ask for a Tape Kit.  

• A calibration every 12 hours is the minimum.  We have found numbers to be more accurate if Noah calibrates every 5-7 hours…. usually before breakfast, lunch, dinner and bedtime.  If he’ll be sleeping more than 8 hours, I also calibrate once during the night.  I know, that’s still a lot of finger sticks, but it’s half what he typically requires…and the predictive alarms allow an effective response to potential highs and lows…such a perk, especially through the night!

• Plan ahead.  Noah inserts the sensor at least 6 hours before we need good tracking.  In our experience, numbers are much more reliable after two or three calibrations.  

• Never calibrate when blood sugar is low or high.  Look for a steady trend graph for 30 minutes or so, with no arrows up or down at the time of calibration.

Finally, remember that the trend is more important than the number.  The real value in a CGM has to do with capturing blood sugar direction and speed.  Once you get used to seeing those trend graphs, you’ll come to rely on them for helping to make all sorts of management decisions.  My favorite decision follows the reassurance I get from a 2 a.m. glance at mySentry….confident Noah is sleeping peacefully, and there will be no more numbers for this reluctant calculator until I’ve finished resting, too!

IMPORTANT SAFETY INFORMATION
- Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems.
- Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms.

Medtronic Diabetes Insulin Infusion Pumps
- Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day.
- Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.

Medtronic Diabetes Continuous Glucose Monitoring (CGM) Systems
- The information provided by CGM systems is intended to supplement, not replace, blood glucose information obtained using a home glucose meter. A confirmatory fingerstick is required prior to treatment.
- Insertion of a glucose sensor may cause bleeding or irritation at the insertion site. Consult a physician immediately if you experience significant pain or if you suspect that the site is infected.

Medtronic Diabetes mySentry Monitor
The real-time glucose values provided by the mySentry monitor, as received from the Paradigm REAL-Time Revel insulin pump, are not intended to be used directly for making therapy adjustments. Rather, they provide an indication that may require a confirmation fingerstick measurement. All therapy adjustments should be based on measurements obtained using a blood glucose meter and not based on the value displayed by the monitor or Paradigm REAL-Time Revel insulin pump.

Once you turn off an alarm on the mySentry monitor, you need to attend to the alarm on the pump itself. You cannot respond to pump alarms directly through the mySentry monitor.

Failure to monitor your blood glucose independently of the real-time glucose values provided by the mySentry monitor, as received from the Paradigm REAL-Time Revel insulin pump, may result in hyperglycemia or hypoglycemia and significant physical injury, including death.

Transmission of all data or alarms cannot be guaranteed with the mySentry system.
Please visit www.medtronicdiabetes.com/about/safety.html for complete details.

Please visit www.medtronicdiabetes.com/importantsafetyinformation for complete safety information.
 

Comments

Carrie

Posted on Thu Sep 27 19:18:37 GMT 2012

Very well written - when people ask me about CGM I always tell them I love it - but
there are some tricks and quirks to it. From now on I can just refer them to your blog.
You hit the nail on the head- love your tips.

Lori Schlosser

Posted on Fri Sep 28 05:10:25 GMT 2012

Thanks, Carrie! It takes some persistence....but so does everything about blood sugar management! We have found the benefits of CGM therapy far outweigh the quirks. :) Appreciate your comment!

Maggie

Posted on Fri Sep 28 13:40:57 GMT 2012

Thanks for the great tips and how dedicated your are to your son's health!! I love my CGM but struggle with the alarms at night time. As we all know your body has it's own idea what happens a night and you will trend up/down some. Some nights though I feel like I am listening to alarms all night and not sleeping soundly. I have turned the alarm off at night when I am really tired but the days that I am really tired I have been more active or more stressed so I should be more aware of what is going on.

My healthcare team has has me go a bit looser on the parameters for the alarm trend but I am really "attached" to my organs and like a tight control on my blood sugars!! I guess I can't have the best of both worlds all the time!!!

Judith Schmader

Posted on Fri Sep 28 14:55:02 GMT 2012

I just received my CGM and Link. Since Ive only been on it for about 5 days it seems to me that it is not what I expected it to be.....I need to be more patient with it I guess and give it a chance.

Charlotte Satiroglu

Posted on Wed Oct 03 16:39:54 GMT 2012

I have been using a CGM for 13 years and this is my last week because I can not get the supply's I need. There is a hold on my account because I could not pay a $50 payment towards the balance of $900. I had a mini stroke last year and lost my income. I have applied for SS but was denied 3 times so now I have a lawyer and we are waiting for a hearing date. I have insurance and it pays 100% for my supply's but metronomic will not ship until I pay the $900 plus late fees now. needless to say I have paid for 13 years of supply's with no problem and have owned 4 pumps all paid in full except for this last one. I am not asking for something for free. I just want to order my supply's and my insurance will pay for it. I hope there is no one out there having this problem too. Please be wear this could happen to you.

Pat

Posted on Thu Oct 04 13:38:20 GMT 2012

we just had our first night with MySentry. I read somewhere to unplug it while she was at school, which I did. then 1/2 hr later a very loud sound emitted. So I plugged it back in & hit silence while it says it is searching for pump. is that all we can do? thanks for your tips, it's helpful reading it.

Karrie

Posted on Fri Oct 05 16:15:28 GMT 2012

Judith and Charlotte, I'm sorry to hear this. I’ll have someone from our team reach out to each of you shortly to see how we can help.

Karrie

Posted on Fri Oct 05 16:18:29 GMT 2012

Maggie, I’m sorry to hear you’re having trouble with alarms at night. I have passed along your information to our HelpLine team and someone will be in touch shortly to see how we can help.

Karrie

Posted on Fri Oct 05 22:00:30 GMT 2012

Pat, the sound you heard was the fail safe alarm. After mySentry gets unplugged, in about 10 minutes, an alarm will go off for a few seconds to alert that the mySentry does not have power. After this one time alarm, as long as the mySentry is unplugged, you should no longer hear those alarms. When your daughter is out of range of the mySentry for a long period of time, you have two options:

1. Unplug, and when she returns plug the mySentry back in and it should take a few minutes to link
2. Or, hit the alarm button on top once, and it will stay silent. When your daughter returns, hit the alarm button once and it will sound alarms again.

Hope this helps. If you have any more questions just let me know.

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