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Continuous Glucose Monitoring (CGM)
- CGM works by sensing glucose levels in the body’s interstitial fluid, which is the fluid between tissue cells
- It provides glucose levels every few minutes (varies depending on device), allowing the user to see a graph and trend of glucose levels rather than a single measurement at a given point in time
- Has 3 main components- sensor, transmitter and receiver
- Types – Real time, intermittently scanned, professional and implantable
Insulin pumps are small, computerized devices that deliver ultra-short acting insulin in two ways:
- In a steady measured and continuous dose (the "basal" insulin)
- Bolus dose with meals to control the rise in blood glucose due to carbohydrates and correction dosing for elevated glucose.
This delivery mimics the body's normal release of insulin
- Doses are delivered through a flexible plastic tube called a catheter. With the aid of a small needle, the catheter is inserted through the skin into the subcutaneous fat tissue and taped in place - the tube/needle combination is called an infusion set.
- Types of insulin pump – (a) tubing and (b) tubing-free
- Closed loop system- Three technological building blocks are required to facilitate automated glucose-responsive insulin delivery
- An insulin pump able to continuously deliver insulin
- A continuous glucose monitoring system measuring glucose
- Computer algorithm that directs insulin pump’s delivery based on real-time glucose measurements
- Current closed-loop systems adopt the hybrid closed-loop approach requiring input from the user at mealtime
- People who like the idea of a pump
- Active people, who benefit from changes in basal rates or suspending the pump when exercising
- People who have frequent low blood glucose
- Anyone who has delays in absorption of food from the stomach (gastroparesis)
- Women planning pregnancy
- People who want to use the pump’s bolus calculator functions to determine insulin doses
Other factors to consider
- The insulin pump doesn’t remove the need to check blood glucose.
- There are technical aspects to using a pump—setting it up, putting it in, interacting with it—that are more complicated in some ways than using injections. It is vitally important to receive training from a diabetes educator prior to starting pump therapy. Without education, the pump may not be utilized to its greatest value, or even worse, safety may be an issue.
- If it breaks or falls off, the person wearing it needs to be ready to give insulin by injection.
- It can be expensive, so find out which pumps are covered by your insurance and if the pump meet your needs.
- All pumps are an extra piece of hardware attached to the body, either with tubing or attached to the skin. There are many clever ways to wear pumps and hide them from view.
Commitment to Pump Safety
- Patients and/or caregivers should be ready and willing to do what it takes to use the pump safely
- Checking blood glucose is important as it will warn the patient of a pump dysfunction, or if the infusion set stops working
- Malfunction can cause high blood glucose levels and possibly even diabetic ketoacidosis, which is very serious and dangerous.
Introduction to insulin pumps
Checking your blood glucose is a simple process using a lancing device, lancet, test strip and meter. Your diabetes team can teach you how to use the blood glucose meter you have chosen. The following are general instructions for using a blood glucose meter.
- Wash your hands or clean your finger (or other site) with alcohol. If you are using alcohol, let it dry before you prick your finger
- Prick the site with a lancing device.
- Place a small drop of blood on a test strip.
- Follow the instructions for inserting the test strip and using the blood glucose meter.
- In seconds, the blood glucose meter reads your blood glucose level.
Supplies You Will Use
- Blood glucose meter — reads blood glucose.
- Test strip — collects blood sample.
- Lancet or small needle — fits into lancing device, pricks finger, and provides small drop of blood for glucose strip.
- Lancing device — pricks finger when button is pressed. Most devices have dials to select depth of needle entering the skin. Start with a middle depth. If you get more blood than needed, dial the number down so the lancet does not go as deep. If you get too little blood, dial the number up so lancet goes deeper.
- Alcohol wipes or soap and water — to clean fingers or other testing site.
- User manual — provides information about your meter. After reading it, place the manual in a safe place so that you can find it when you have a question about your meter.
- Warranty card or papers — complete, make file copy and send in immediately.
Can’t get blood out of your finger?
- Place hands under warm water and rub together
- Hang hand down below waist • Grasp finger near area to be pricked and squeeze gently for three seconds
- Place finger on table or firm surface to avoid moving while pricking
- If lancing device has dial-a-depth, increase setting by 1 level
- Use new lancet every time you check blood glucose
Hurts too much?
- If lancing device has dial-a-depth, decrease setting by 1 level
- Use new lancet every time you check blood glucose
- Try a thinner lancet or a different lancing device • Use sides of fingertips instead of fingertip pad
- Try alternate site testing meters
- Review user manual – error codes and problems are identified in manual
- Make sure right amount of blood is on strip
- Make sure blood is on correct part of strip
- Call toll-free manufacturer’s number (listed on back of meter and in user manual)
- Ask diabetes educator for suggestions