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Continuous Glucose Monitoring
Troubleshooting Common Problems

by Neesha Ramchandani, PNP, CDE

Can I turn off some of these alarms?
CGM systems have the ability to alert you when your glucose is out of range, when your glucose is predicted to be lower than your low target range or higher than your high target range within a certain time frame, and when your glucose is changing rapidly. They will also alert you when a calibration is due, when the signal is not transmitting from the site to the receiver, and when the sensor needs to be replaced. But just because all of these alerts and alarms exist does not mean you need to use them all. While many people find them useful eventually, it is often easier to get accustomed to using a CGM system with the optional alerts and alarms turned off.

The alerts and alarms that must be on at all times are the ones that let you know when a fingerstick blood glucose calibration is needed, when the signal is not transmitting from the site to the receiver, and when the sensor needs to be replaced. Additionally, the DexCom system has a nonoptional alert that lets you know when your glucose level is lower than 55 mg/dl. All of the rest of the alerts and alarms are optional and can be turned on and off as desired.

Also keep in mind that the alerts and alarms do not need to be set to ring or beep. All systems can be set to vibrate. However, if you do not respond to a vibration, the system may eventually start ringing quite loudly to get your attention!

Another way to keep alarms and alerts to a minimum is to set your target glucose range to a reasonable level. If you set a target glucose range of 80–150 mg/dl, but your glucose often rises above 200 mg/dl after meals, you are setting yourself up to hear a symphony from your CGM. Setting the range to something that more closely resembles the levels you actually experience, such as from 80 to slightly above 200 mg/dl, will result in fewer alarms and less annoyance to you.

How can I prevent skin irritation?
If the sensor adhesive causes skin irritation, try placing a piece of hypoallergenic tape, such as IV 3000 or Tegaderm tape, on your skin first, then inserting the sensor right next to it. (Sensor manufacturers recommend against inserting the sensor through the tape because this may damage the sensor.) This generally minimizes the irritation. You should also be sure you are inserting the sensor into clean skin. A good time to insert a sensor is immediately after bathing. In rare cases, people may be allergic to the adhesive on the sensor. If you suspect this is the case, talk to your diabetes care provider; you may need to also see a dermatologist.

Is there a way to make the device more comfortable?
If wearing your sensor is causing you pain or discomfort, try inserting the sensor in a different place on your body. Fattier places, such as where you would give an injection or insert a pump infusion set, are more comfortable. Sensors should not be inserted in places where you bend or where your waistband hits your body. If you are having great difficulty finding a place to insert your sensor, ask your diabetes care provider or CGM trainer to show you other site options.

If the site is very painful and continues to bother you even when it is in an optimal location on your body, you should not leave the sensor in no matter what the glucose readings are. Continuous pain may be a sign of a sensor site infection.

How can I make the sensor stay in?
For some people, the sensor just will not stay in without help. This can occur because of sweat, natural oils on the body, body heat, friction, or other sources of irritation. The first line of assistance is to use hypoallergenic tape, such as IV 3000 or Tegaderm tape, either on top of or on the edges of the sensor and transmitter for reinforcement. This generally does the trick. However, if the reinforcement tape does not stick on the body, stronger agents can be tried.

For insulin pump sites, Mini-Med’s “Tape Tips” manual suggests applying Mitchum roll-on antiperspirant to the site for two consecutive days prior to sensor insertion. Alternatively, you can try different liquid adhesive preparations, including IV Prep, Bard protective wipes, Mastisol, and tincture of benzoin. All of these preparations make the skin surface tackier so that the sensor can adhere to the site more strongly. If you use one of these agents, make sure to clean a small area in the center with alcohol so the adhesive does not affect the sensor. You will also need an adhesive remover to help remove the sensor from your body without tearing your skin. Adhesive products that work with pump infusion sets should work just as well with sensor sites.

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