Tech It Easy: 8 Diabetes Device Hacks to Help You Stay in Range

Hack # 1: Where to Wear Your Continuous Glucose Monitor

We get asked all the time if it’s okay to wear your CGM in places other than the manufacturer’s recommendation. The short answer is yes! Generally speaking, you can wear your sensor anywhere you have subcutaneous tissue.

Some common locations are:  

• The abdomen
• The back of your upper arm
• The upper thigh
• The lower back
• The upper buttocks

CGM companies list guidelines in specific locations on the body because that’s where their sensor placement was studied when they received FDA approval, but other locations can work just as well (and sometimes better).

Hack # 2: How to Keep Your CGM in Place

Have you ever gotten so sweaty that your sensor falls off? We don’t need to know the details, but adhesives can help. Before applying any type of adhesive, make sure you’re putting it on clean skin. Dirt, oil, moisture, and lotions can all interfere with adhesives.

There are lots of different types of adhesive products, including:

• Skin-Tac
• GrifGrips
• Skin Grip
• Not Just a Patch
• Kinesiology tape

Some adhesives can be difficult to remove, so adhesive removers like Skin-Tac or Mirabalm can help protect your skin when you’re taking off your continuous glucose monitor.

Hack # 3 How to Avoid Compression Lows

Compression lows happen when a CGM sensor gets pressed against a hard surface (like a mattress) leading to artificially low CGM readings. 

You can usually tell a compression low by a series of steady readings followed by a sharp drop:

How to manage compression lows:

• Sensor Placement: Be strategic about sensor placement. Avoid putting the sensor on areas that you often sleep on, such as your abdomen or upper arms. Consider placements like the back of the upper arm (if you don’t sleep on it) or the thigh.

• Sleeping Position: If you don’t want to change where you wear your CGM, experiment with different sleeping positions or try using pillows to relieve direct pressure.

• Implantable Continuous Glucose Monitor: You can also try the Eversense 365 CGM, which has an implantable sensor that lasts for a full year. Compression lows don’t happen with this device.

Keep a glucose meter close by your bed so you can double check a low before eating everything in sight (unless you have obvious low symptoms).

Hack # 4: How to Make the Most of Your Exercise Settings

If you use a hybrid closed-loop (HCL) insulin pump system, it has an exercise setting that can really help keep you in range when you’re working out. The setting uses an increased target glucose level and adjusts insulin delivery accordingly to help prevent lows.

A typical goal to shoot for in exercise mode is a higher goal like 150 or 160 mg/dL.

Some systems allow for a percent reduction in insulin administration depending on the intensity and duration of the exercise.

The key is to put your system in exercise mode one to two hours before you start your activity.

Try to remember to turn exercise mode off 20-30 minutes before you stop exercising to prevent a post-exercise rise. 

Hack # 5: Using Exercise Settings to Stay in Range During A Night Out & Before Surgery

While it’s primarily used for exercise, there are other times exercise mode can be helpful:

• Alcohol can cause delayed hypoglycemia, especially several hours after drinking. If you’re going out, using the exercise setting may help prevent lows later when you’re sleeping.

• Before surgical procedures: Exercise settings are also often used before surgical procedures, and are usually set at bedtime the night before. 

Always check with your doctor before making any changes to your diabetes regimen.

Hack # 6: How to Prevent Correction Dose Lows

There are a few important ways you can avoid going low from a correction dose:

1. If you’re about to give yourself a correction dose and your HCL system says “no correction dose recommended”, please take that advice! Some systems are more aggressive than others, and if you ignore its advice you will go low. If you look at the insulin given over the previous two hours (as well as the trend arrow of your CGM) you will see that you already are being automatically corrected by the algorithm.
2. Entering fake carbs is another strategy often used to correct for a high. However, if you enter fake carbs, your HCL will still give you your normal basal rate plus the insulin for the fake carbs you entered but did not eat. This can easily lead to hypoglycemia. If you know you’ve under-bolused for a meal, enter carbs a little later to make up for it when you see your glucose rising.
3. Inhaled insulin Afrezza can also be used in certain situations to correct for a high. Afrezza gets into your system fast and gets out of your system fast, so there’s less chance for low blood sugars.

Hack # 7: How to Deal with False Highs and Lows from Heat

Taking a hot bath, jacuzzi, or sauna can give you false high glucose values.

If you are someone who has false high blood sugar readings from heat, you might want to temporarily suspend insulin delivery on your hybrid closed-loop insulin pump system before you take a shower, bath, hot tub, etc. If you see high readings when you get out and you’re in doubt, check with a finger stick.

Hack # 8: How to Adjust Your Insulin Pump for Altitude Changes in Flight

A recent study investigated how atmospheric pressure changes during commercial airline flights can affect insulin pump delivery in the following ways:

• During takeoff, a drop in cabin pressure can cause air bubbles to form in the cartridge, which can cause a small amount of extra insulin to be delivered.
• At cruising altitude, rapid decompression (a rare occurrence of sudden loss of cabin pressure) could cause pumps to release too much insulin.
• During descent, the air bubbles dissolve which can pull small amounts of insulin back into the pump. This may lead to blood sugar being higher than usual.

Before takeoff you could try disconnecting your pump, then removing any air bubbles before reconnecting it at cruising altitude about 20 minutes later. For pumps that can’t be disconnected, you may need a small snack to avoid or to treat hypoglycemia after takeoff.

Everyone can be affected differently though, so pay attention to your blood sugars and try to always bring fast-acting carbs in your carry-on.

CGM and Hybrid Closed-Loop Insulin Pump Hacks: The Takeaways

Mastering CGM and hybrid closed-loop technology takes time, but knowing some of the tips and tricks and understanding how to use the devices to your advantage can make a big difference in improving your time in range and quality of life. At the end of the day, it’s all about using this technology to work for you, not against you.

Staying educated and experimenting with what works for you and your lifestyle is key. Joining an online community group is a great way to meet other people and get new ideas on how to live a long and healthy life with diabetes.