Key Points: AI-Assisted Summary  

  • Continuous glucose monitoring (CGM) for type 1 diabetes (T1D) can sometimes be challenging with stubborn inserters, connectivity problems, sensor failures, inaccuracies, and adhesion issues
  • CGMs provide significant benefits despite the challenges, making them indispensable for many. They offer more than glucose readings — they provide real-time trending data for T1D management
  • The interoperability of CGMs is a major strength, and the diabetes community plays a crucial role in keeping users informed and engaged in their CGM experience. While not all CGM issues can be prevented, there are strategies to enhance everyday experiences. 

 

On tech-challenging days, wearable continuous glucose monitoring (CGM) for type 1 diabetes (T1D) can feel a bit maddening. I’m sure you’re familiar. From stubborn inserters and connectivity issues to sensor failures, inaccuracies, and adhesion problems, a host of things can be taken for granted on issue-free days. 

Yet, despite these challenges, the emotional and physical benefits of CGM are undeniable. Most of us can’t imagine life without a CGM and feel strapped when we’re having hiccups with their accessibility or while waiting for replacements.  

There’s too much guessing with finger sticks. Sure, glucometers give a solid blood glucose value, but the trending provides much more “in-the-moment” clarity. Let’s be honest, it seems impossible to fathom T1D decision-making without a smart, dynamic number.  

Plus, it’s not just about real-time glucose data and trending — the interoperability is incredible, too. Lucky for us, the diabetes community is at the ready, keeping us informed and on top of our CGM game. Here, we’ve included some suggestions from ours at T1D Exchange.  

 

5 Ways to Improve Your Everyday Experience with a CGM 

Not every CGM issue is preventable, but some are. Here’s a short list to consider when dialing in real-time CGM feedback. 

 

Habit #1: “Soaking” a CGM sensor 

People generally choose to “soak” or insert a new CGM sensor during the final hours of their CGM session to improve accuracy (decrease false lows and highs) and shorten warm-up times.  

For example, with the Dexcom G7, someone may insert a new CGM sensor when their current sensor expires, and they’ve entered the 12-hour grace period.  

That said, it’s important to do your research, because with the Dexcom G7, once the sensor is detached from the applicator, its 10-day lifespan begins — even without officially starting the sensor on a phone or insulin pump. 

For now, “soaking” a CGM sensor is a user-generated suggestion that varies brand to brand. 

 

Here’s what some of our community members had to say: 

“Soaking seems to improve day 1 accuracy on the Libre 2 (and Libre 2 plus) if you soak it for a day in advance. Only once did I have it fail on the last day, presumably when the battery ran out.” 

“I insert the new sensor before recharging the transmitter, and that gives the sensor at least 30 minutes to ‘soak.’’ 

“Somewhere between 1/2 to 12 hours ahead of time, I insert a new G7 on the opposite arm. The only risk is — and it’s a big one — I occasionally forget which is the new one and which is the old one. Sigh.” 

“I insert a new G7 when I have 5-6 hours left in the grace period. There is no gap in readings, and it seems to help the wild swings I was getting on the first day of readings. I mark an ‘x’ on the old one with a Sharpie so I don’t pull the wrong one.” 

  

Habit #2: Maximize your CGM’s connectivity  

Overall, a CGM can significantly improve one’s experience with T1D, but all the beeping and lapses in data, especially in the middle of the night, can be downright annoying. 

In some cases, the exact cause of connectivity issues may be entirely clear. For example, you may wake up with your pump under your body. Other times, it may not be as obvious, or even make sense, partly because there’s more than a single cause.  

 

Here’s what some of our community members had to say: 

“Turning my phone on/off fixes things for me about 70% of the time.” 

“For pump connectivity, keep the pump and CGM on the same side of your body.” 

“For my Apple Watch, I have G7 as one of the ‘complications’ on the watch face. When it drops signal, I simply turn Bluetooth off/on, and it will reconnect. When I wear my G7 sensor on my watch arm, it loses signal less often because it’s closer to my watch.” 

“Annoyingly, I have too many signal alerts. I am not of the generation that carries my phone with me from room to room in my own home.”  

“I learned to turn Bluetooth off/on and delete past CGMs on Bluetooth to get the device to forget past CGM pairings.” 

“If the receiver were a phone and restarting the app and/or phone didn’t fix the issue, I’d recommend calling the CGM manufacturer’s tech support line. If the receiver is an insulin pump, I’d advise calling the pump manufacturer instead.”  

“On your phone, go into the Bluetooth settings and delete all the old Dexcom connections. Then go back to the Dexcom app and re-enter the code and pair. That advice came from Dexcom tech support, and it worked. I guess it gets confused as to which one to use.” 

 

Many people have success with the following: 

  • Wearing the CGM on the same side of the body as their insulin pump 
  • Keeping the receiving device within the recommended Bluetooth range (Freestyle Libre 3 has a 33 ft. range, for example) 
  • Inserting the sensor in a spot that’s not likely to be bumped or have pressure placed on it 
  • Avoiding “low power mode” on a phone, as it can turn off Bluetooth capabilities 

 

While having an Apple Watch can be a plus, it’s another thing that beeps when it loses connectivity, and it’s one of my worst offenders lately. It’s not a vital part of the system, but many of us depend on a smartwatch as a reliable source of CGM data. 

  

Habit #3: Improve a CGM’s stickiness  

Before applying wearable diabetes tech, there are several things to consider so it stays “stuck” to the skin. Namely, start with clean, dry skin and finish with an alcohol wipe. 

This will help remove any oils or lotions on the skin and prep it for the CGM adhesive.  

If you’re looking for more product information, DiabetesWise.org is a great source. There, you can find links for products from overlay patches to skin preps and everything in between.  

 

Here’s what some of our community members had to say: 

“I use Skin Tac liquid under my infusion site and my Dexcom. I have never had either come off before I pulled them off.

“I use the Dexcom G7. I simply use alcohol as an initial wipe, apply the sensor, and put the over-tape on. I have no problems with it sticking for 10 days. If I’m traveling, and I go into a pool or the ocean, I use an additional adhesive waterproof patch called Fixic.” 

“I use Skin Tac (both liquid at home and wipes when traveling) and always make sure it’s dry before attaching the sensor. In addition, I put an overlay patch on top. I’m currently using LiangMai adhesive patches.” 

“The only thing I do special is use ExpressionMed tape to help secure and decorate my Dexcom G6.” 

 

Habit #4: Protect your skin  

Wearing a CGM 24/7 can be extremely irritating for people with sensitive skin. The adhesive can cause redness, rashes, hives, and even skin breakdown. Thankfully, there are products to help provide skin protection.  

Rotating sites and giving skin time to heal are essential to skin health with T1D wearables, as is gently cleaning off any remaining adhesive after its removal.  

Some people use a skin prep product as a barrier between the skin and the CGM adhesive. For others, that’s not enough. Even removing a CGM can cause skin trauma. Many find them easier to remove after a shower or bath when the tape and skin are moist, then, keeping the skin moisturized when it’s tech-free.  

Be sure to let your diabetes care team know if you develop irritated skin that won’t seem to respond to your usual routine. They can help with product suggestions for cleaning, securing, and healing problematic skin areas related to adhesives. 

 

Here’s what some of our community members had to say: 

“I use adhesive remover, alcohol wipes, body wash for sensitive skin, and CeraVe to moisturize.” 

“I use an underpatch (from Skin Grip) under the site, but always cover it with an overpatch and Skin Tac adhesive (which doesn’t bother my skin) because the underpatch/barrier doesn’t have any adhesive.” 

“I rotate my sites and use vitamin E oil on my skin after I remove it.” 

“I occasionally use calendula lotion on skin irritated by adhesives.”   

“I used to get an itchy red rash from my Dexcom adhesive. A dermatologist prescribed Mometasone Furate cream, which works like a charm to remove the rash when I switch to another site.” 

 

Habit #5: Dial in CGM use during exercise  

For starters, CGMs measure interstitial glucose levels (glucose in the fluid under the skin) and aren’t built to keep up with rapid glucose changes.  

In other words, it takes time for a CGM to catch up with blood glucose levels, so expecting spot-on results isn’t realistic, especially during exercise. You may be unaware, but CGMs have only been tested on people during rest. So, that’s when they function their best.  

Dessi Zaharieva, PhD, an exercise scientist and athlete who lives with T1D recently sat down with T1D Exchange. Here’s a snippet of what she shared about CGM use with exercise.  

  • Movement can affect CGM accuracy, so engage with the data 
  • Expect some activities to raise glucose levels and others to lower them 
  • Be aware of CGM results and how they’re trending 
  • Verify your blood glucose with a glucometer during exercise, but don’t calibrate your CGM until 30 minutes after stopping 
  • Expect a 15-30 minute CGM lag time during exercise 
  • Results may vary day-to-day and person-to-person 

 

Visit T1D Exchange to read Dessi’s answers to frequently asked questions about exercise with T1D.