SARAH: Welcome back to the QI Hub video series and today we are joined by our favorite Diabetologist, Dr. Amber Healey. 

AMBER: Hi, Thanks for having me back. Oh, of course. Always, always. 

SARAH: We are talking about CGMs today. We have done lots of videos on CGMs. You can find links to those on the SEOQI HUB website if you'd like to revisit some of those. And today we realized that we were missing an important piece on CGMs and that is troubleshooting. So technology is good when it works, 

AMBER: Right. But what do we do when it stops working or doesn't work the way we expect it to?

SARAH: Well, it's a good thing we're here 'cause that's what we're gonna talk about today. So we have a few things we wanted to share with you. So Dr. Healy has picked a few things that we feel would be important for you to learn about. So the first thing we're gonna talk about was the lag. The lag in the CGM versus a finger stick. So tell me more about that, Dr. Healey. 

AMBER: So it's known that there's about a 15 to 20 minute lag on sensors compared to what your finger stick would be. So if your glucose is changing at a more rapid rate, it's not gonna keep pace, the CGMs not gonna keep pace with what's going on down at your finger. Uh, so you know, they're allowed to have some margin of error when they bring these to market. Usually About 20% margin of error. So, uh, it's really important to reemphasize that if your symptoms don't match what you're seeing on your sensor, that you do a finger stick. 

SARAH: Okay. I really like that. We just had a conversation about this the other day at the pharmacy. Someone had called and asked, they're like, the difference was so big. So we had a nice discussion on that flag. 

AMBER: Well, and well, and also if that know keeping that 20% in mind. If the difference is more than 20%, maybe your sensor is not accurate and there is an issue with it and you should consider, uh, looking to get a replacement for it. 

SARAH: Let's talk about that since we brought that up already. And we're talking about maybe replacing that sensor. So what if it falls off or what if you do need to replace it? What if you're getting error codes or messages that you need to replace that, what would you do? 

AMBER: I'd remove the sensor. And I would call the company.  So Dexcom and Abbott both have, um, online resources for patients and phone numbers for patients where you can talk to them about getting a replacement sensor because uh, if you do call the pharmacy, 

SARAH: they're not going to help you. 

AMBER: They're not gonna replace it. Your insurance isn't gonna pay for an extra one. I know it'd be great. I have people ask me all the say all the time, it'd be really great if you could write me for three a month of the Freestyle Libre three plus because in case one falls up or off or I have an issue, I just have an extra one. I'm like, your insurance is only gonna cover two. So if you have those issues, I direct them to contact the, the company from where they get their sensor. 

SARAH: Fantastic. That's a good, that's a good option. We also wanted to talk about error codes. So there are specific codes that you wanted to talk about. 

AMBER: There aren't specific codes. You'll just say sensor error. Sensor error.

SARAH: What does, what do you do then? 

AMBER: Well, sometimes it'll tell you to keep it on for the next couple of hours and wait for it to clear out. I know one time I placed one while I was at a conference, got up the next morning and had an error code and, um, I just kept it on and waited a few hours and it corrected itself. Um, and the, the rep told me that it had to do something to do with, um, white blood cells in the area clearing out.  I have not corroborated that information. But sometimes it'll just say, leave it on. Other times it'll tell you error replace. And so replace, 

SARAH: Okay. So it'll actually let you know what you need to do with that? 

AMBER: It should, yes. Okay. 

SARAH: There also is a comment. Someone had mentioned blood or there the, the bleeding or there's blood in the tube or something along those lines. What, what, can you tell us more about that? 

AMBER: So I've had people come in and they'll tell me that, you know, they'll keep bleeding after a placement and they can't get it to stop. That's gonna affect accuracy, so you should remove it, get the bleeding to stop, don't put the sensor back in that same area. And I've had other people, they've gotten one of these error codes we mentioned earlier, and, uh, they will remove the sensor find it was actually bent and they're bleeding. 

SARAH: Oh. 

AMBER: And so that, that was part of the issue with just how it ended up getting placed. So, um, you know, that can definitely affect accuracy if you've accidentally hit a subcutaneous capillary.

SARAH: Okay. All right. Well that's, that's actually really good information. We did talk about them falling off already, but is there any place specifically that someone can go to check out more information about that? So I know the, the manufacturer websites are a place. Is there anything else they could utilize as a resource? 

AMBER: I found a really great article that popped up, uh, mid-January of this year, uh, from Breakthrough T 1D. And for those of you that are not aware, breakthrough, T 1D was previously JDRF and they had a great, uh, source about, and it had each of the different sensor companies on it with their phone numbers and their links to their websites to help people get replacement sensors. They also had some really nice tips about how to improve the accuracy of the sensors on that. Uh, that website and you know, the sensors we give for to people with type one diabetes are not different than we give people with type two diabetes. So this is just a great resource for anybody that is using A CGM.

SARAH: Fantastic. So that's breakthrough. T 1D previously JDRF. Mm-hmm. Which would be a nice resource for understanding more about CGMs and having some information there. Mm-hmm. Awesome. And how about anything that might improve accuracy with the CGMs? 

AMBER: Yeah, I know I just, uh, we alluded to that site that had it, but some things are staying hydrated. Okay. Another thing is, um, with the Dexcom specifically, yeah. Try not to, you can calibrate in that first 24 hours, uh, you know, with against, uh, a finger stick to help its accuracy. 'cause sometimes the first 24 hours of a placement of either type of sensor is not the most accurate as the sensor gets saturated with the interstitial fluid. Um, unfortunately you can't calibrate a libre, but you know, it, it doesn't hurt to still look at your finger if something doesn't make sense. Um, and then again, if symptoms don't match what you're seeing on your sensor, use your glucometer for backup. And if the variability is more than the 20% we talked about earlier, you may want to consider replacing the sensor because there have been bad batches that have been out and, and there's different recalls that have occurred in the past. So maybe your sensor was part of that batch. 

SARAH: Yep. Awesome. Alright, I have found this information really helpful. So thank you Dr. Healy for your time today. So thank you for joining us for troubleshooting CGMs and um, I promise we'll be back with another informational video for you. And don't forget, SEOQI hub, uh, website for your CGM information.