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Continuous Glucose Monitoring
Getting Started

by Linda Mackowiak, M.S., R.N., C.D.E.

If you’re not sure how to use the information you’re collecting, speak to your health-care provider.

Intermediate term. If you develop a problem requiring immediate care, such as an episode of hypoglycemia, your monitoring data may be able to help you determine when the problem started and what may have caused it. Your data can also help you evaluate how well your response to the problem worked. Did your treatment raise your blood glucose level fast enough? Did it raise it too much? Best of all, your data may give you some ideas on preventing the same problem from happening again.

Longer term. Looking at the glucose information collected overnight, over some portion of the day, or over the course of several days can help you to see the big picture. Depending on which device you’re using, you may need to upload your data to a computer to make a graph showing glucose ups and downs, or you may be able to display graphs covering certain time periods on the monitor itself.

You may notice that some days look much different from others. Why is that? You may discover that exercise, school, work, or dining out can have a big effect on your glucose pattern for the day.

What usually happens after eating? Does it vary depending on the time of day, foods eaten, or timing of your premeal insulin dose?

When does hypoglycemia happen? Do you ever get delayed hypoglycemia after exercising?

If you use an insulin pump, does the length of time between infusion set changes appear to have any effect on your glucose pattern?

It may help to keep detailed written records of your daily routine, food intake, exercise, and stress level for a few days to look at alongside a graph of your glucose levels. Bring your records along with your continuous glucose monitoring information to your next appointment with your diabetes care provider. Together you can evaluate how well your diabetes regimen is keeping your blood glucose levels in target range and what changes you might make for improvement.

A word on alarms
Finding the right alarm settings may take some time. You want the alarms to alert you to situations that require action, but you don’t want the alarms to overwhelm you or interrupt your day or your sleep too often. The best setting for an alarm may not always be the actual glucose value at which you wish to take action. You may have to move the settings up or down and reassess until you find the best setting. Also, different times of day (or night) and different situations, such as work or recreational activities, may require different settings. Expect to have to change your settings occasionally; you may even choose to silence the alarms in some circumstances.

Setting the low alarm. The higher you set your low glucose alarm, the more low alarms you are likely to get. In fact, if you set your low alarm fairly high, you may get alarms when your blood glucose level is simply at the low end of normal. One reason this may happen is that the rise in interstitial fluid glucose level lags behind the rise in blood glucose level after meals. While some people may find “low normal” alerts helpful, others may consider them a nuisance. You can avoid such alerts by setting your low glucose alarm lower, but if you do, you may not always get enough warning for real lows.

If you have hypoglycemia unawareness, meaning you do not sense the early signs of hypoglycemia, you may decide to set your low alarm on the high side to help you to prevent episodes of hypoglycemia and keep your blood glucose level in a safe range.

Setting the high alarm. The high glucose alarm on your continuous monitor can be useful in a number of situations. For one thing, it can alert you to a missed insulin dose or a problem with insulin delivery from a pump. (In both cases, the likely result is glucose that is higher than normal.) It can also be useful to evaluate the effect of food choices on your glucose level or, for those who use rapid-acting insulin, the amount and timing of premeal insulin doses.

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