CGM Brand Information

This page lists highlights of Continuous Glucose Monitoring (CGM) Brands and links to more brand resources. Please visit our Continuous Glucose Monitoring page for a full list of our CGM webpages. 

Insurance coverage for CGM varies. Patients are asked to have their insurance companies check under "Glucose Meters" and "Medical Devices". Patients with no insurance coverage are encouraged to contact their employer's human resources department, as the employer determines the coverage available for their employees. 

Abbott's Freestyle Libre

PRODUCT SUMMARY: LIBRE

  • Libre is a Flash glucose monitoring system (may also be referred to as iCGM or intermittent CGM in articles). It requires the user to physically scan the sensor with a reader or a smart phone to obtain readings, hence has no automated alarms for high or low readings. However, there are third party products available to attach to the Libre so that it continuously sends glucose results to an app and provide alarms. 
  • Each sensor is indicated to last 14 days. 
  • No calibration is required (eg. no finger stick)..
  • No transmitter is attached; Upon scanning, the reader or smart phone app indicates if the value is above or below target.
  • Each scan provides the current glucose reading, a trend arrow (if glucose is trending up or down) and up to 8 hours of previous data in graph form all visible on the handheld device.
  • The handheld scanner is also a blood glucose meter and blood ketone meter. (Although a bolus calculator exists in the meter,it can only be accessed after doing a capillary glucose test. This feature will not be of use for those using CGM results to determine their insulin doses).
  • Capillary glucose testing is required in some cases as outlined in the product manual. Unless indicated for exceptions, no confirmatory capillary glucose test is required prior to bolusing.
  • Encourage patients review  Abbott's Sensor Adhesion Guide

WEBSITE / COMPANY INFO: LIBRE

  • Libre Website
  • Libre User Manual 
  • Libre Insertion Training Videos for Patients 
  • Abbott's full YouTube Video Library, including those for healthcare providers
  • Calgary Contacts:  
    • This email address is being protected from spambots. You need JavaScript enabled to view it. (Northwest Calgary and Central AB/Red Deer)
    • This email address is being protected from spambots. You need JavaScript enabled to view it.  (South Calgary and Southern AB/Lethbridge)
    • This email address is being protected from spambots. You need JavaScript enabled to view it. (Northeast/Southeast Calgary, Medicine Hat)
  • Libre Compassionate Supplies Request for MD, NP, prescribing pharmacist. 
  • Freestyle Libre Health Care Professional (HCP) Quick Reference Guide. Note:
    • page 14: How to perform a sensor accuracy check (against a blood glucose meter - should be withing 20% of meter when sensor has stable arrow).
    • pages 23-24:If you receive a Low Glucose message* (3.9 mmol/L), you should note the following:
      • 53.5% of the time this Glucose Message is wrong
      • 46.5% of the the time this Glucose Message is correct.
    • page 26: If you receive a Low Glucose or Glucose Going Low message*, you should note the following:
      • 63.3% of the time this Glucose Message is wrong
      • 36.7% of the time this Glucose Message is correct
  • Company materials re: Vitamin C
  • Company materials re: ASA, Acetaminophen, Advil

APPS and ONLINE SERVICES: LIBRELINK

1. LibreLink: A smartphone app approved by Health Canada for iPhone 7 and up and for Android version 5 and higher. If a person wishes to use both scanner and phone, the iPhone must be paired within the first 60 minutes of setting up the reader/scanner; the Android can be paired at any time. The app allows the phone to be used as a scanner, showing the glucose data inside the app. The app uses near field communications (the same technology that a tap debit/credit card uses, located on back of Android phone or near top of iPhone). The app can replace the Libre handheld reader/scanner for viewing data, however cannot do blood or ketone testing. The LibreLink app also sends data up to a cloud service (LibreView).Visit Abbott's Freestyle LibreLink App webpage for more information about the app (user manual links at bottom of the webpage).

Quick notes to be aware of: to use iphone to scan you need to do sensor start up with the phone (not reader), and if using both reader and phone you will need to scan both devices for them to show all the data. 

2. LibreLinkUp:  A smartphone app that friends/family/healthcare professionals* can download to view the glucose data of another person. A person with diabetes can actively share data with up to 20 people who have the LibreLinkUp app. (*AHS has not approved the use of the LibreLinkUp app on healthcare provider smartphones to view patient data.) Visit the LibreLinkUp Website 

3. LibreView: A cloud service that stores patients' glucose data and provides reports. (Requires the download of a device driver to recognize when a blood glucose device is plugged in. ) Comes in two versions.

LibreView Personal:
Patients create a cloud account, upload data, email PDF reports, share data with friends/family/healthcare professionals* via LibreLinkUp or by linking to a  *LibreView professional account  (requires the download of a device driver to recognise when a blood glucose device is plugged in) *AHS legal has not approved the use of LibreLInkUp or LibreView Professional for AHS clinics or educators. To sign up or login to LibreView access the website. 

LibreView Professional*:
This cloud service is similar to a Diasend Professional Account. A clinic registers for a professional account and provides their educators access to this clinic account.  Patients are provided a clinic ID number and may link their personal LibreView account data to the professional account to be viewed by any educator within the clinic. The Professional account holds data from numerous patients.  *AHS legal has not approved the use of LibreView Professional for AHS clinics or educators. 

4. Freestyle Desktop Software

After consultation with AHS Legal & Privacy regarding the terms of use of this desktop software, they recommend we not upload patient data into the software. We may start a Privacy Impact Assessment if we wish to pursue its use. As of July 2019, this has not been pursued as clinics routinely have patients access their own personal LibreView Cloud account or have educators use Diasend which has AHS legal approval.

HIGH AND LOW GLUCOSE MESSAGES: LIBRE

The Libre (flash or iCGM) will provide on-screen messages only after the sensor is scanned. It does not provide automated alerts or alarms. The low and high messages below are separate from the Target Glucose Range (the latter is programmed individually for patients and is displayed on reader or software graphs). 
In each case below, the messages would appear after scanning the Libre sensor. Touching the Libre message on the reader or app provides more information and potentially an option to set a reminder.
  • LO:  Appears when < 2.2. mmol/L
  • Low Glucose Message: Appears when < 3.9 mmol/L
  • Glucose Going Low: Appears if glucose is projected to be low (<3.9 mmol/L) within 15 minutes
  • HIGH: Appears when > 27.8 mmol/L
  • High Glucose Message: Appears when > 13.3 mmol/L
  • Glucose Going High: Appears if glucose is projected to be high (> 13.3 mmol/L) within 15 minutes

HEALTHCARE PROFESSIONAL TRAINING

REPORTS: LIBRE

  • Libre Desktop Software Reports (examples)
  • LibreLink App Reports
  • 15 minute interval report: this additional report lists the automatically stored readings every 15 minutes, with the scanned readings to the right. To access, plug a Libre Reader into their software, go to top corner to File,  choose export all data. The report will be numerous pages in length (e.g. over 50)
  • Visit Ambulatory Glucose Profile (AGP) for interpretting software reports
  •  On-screen Reports from the reader (scanner): See the video "Understanding More" at 1 minute 35 seconds.
  • Diasend - Libre results may be uploaded at home to a personal online Diasend account using the cord included in the box. Patients on an Omnipod pump may also upload their pump information to the same personal Diasend account to merge the pump and Libre data. (In clinic, educators may upload Libre results using the white Diasend box; results upload to a clinic account, not to the patient's personal account). 
COST: LIBRE
  • Please contact the company for the most accurate pricing and information. Insurance coverage may be under the category of glucose meters (SMBG) or medical devices.
  • Pseudo DINs for FreeStyle Libre:
    Reader = 97799170
    Sensor = 97799171
  • For older cost reference, in 2018 the approximate pricing was $89 per sensor (2 weeks; no off-label re-use is possible). The reader is optional ($49). Note, dispensing fees differ between pharmacies. Patients paying out of pocket may wish to call pharmacies to investigate their fees (dispensing, shipping). This includes online Canadian pharmacies and diabetes supply stores e.g. Bayshore, Diabetes Express, Diabetes Depot.

Dexcom 

PRODUCT SUMMARY: DEXCOM G6 and G5

  • Dexcom is an rtCGM and can provide automated alarms and alerts for low or high gluocse readings or rate changes. 
  • A transmitter (112 day use) is attached to the sensor (10 or 7 day use depending on version) and wirelessly sends results to an app on a smart phone or a separately purchased receiver.
  • The screen of the app or receiver  shows current glucose level, a trend arrow (if glucose is trending up or down) and graphs for numerous hours previous data.
  • Capillary glucose testing is required in some cases as outlined in the product manual. Unless indicated for exceptions, no confirmatory capillary glucose test is required prior to bolusing.
  • Key G6 features vs G5:
    • 10 day sensor wear indicated (G5 is 7 days)
    • No calibration with finger stick (G5 requires calibration every 12 hours).
    • Slimmer transmitter
    • New one touch auto-applicator (although it is bigger than the G5 applicator)
    • New Urgent Low Soon Alert.
    • G6 readings can be used to make diabetes treatment decisions when taking up to a max acetaminophen dose of 1,000mg every 6 hrs. Taking a higher dose may affect the G6 readings. (G5 users are advised to not rely on sensor data if having recently taken acetaminophen.)
    • G6 app allows users to record events eg. insulin, carbs, exercise.
    • Both versions of sensors can be "reset" for extended use with off-label strategies developed by the diabetes community. For safety, educators are encouraged to suggest periodic finger stick tests if a patient is using off-label resets. 

WEBSITE: DEXCOM

  • Dexcom website
  • G6 Instructional Videos and recorded webcast: Dexcom G6 What Clinicians Need to Know 
  • Dexcom G6- What Clinicians Need to Know (webinar recording- 30 mins)  
  • REP CONTACT: Calgary Kirstie Smith Senior Territory Manager Alberta Cell 403-618-0989 Technical Support 1-844-832-1809 Dexcom Care 1-844-832-1811 This email address is being protected from spambots. You need JavaScript enabled to view it.
  • Dexcom Support: Includes numbers Dexcom Care (RNs that connect with patients/skype if available to help them setup Dexcom), Customer Service, Technical Support and Insurance Support. However, support documents are here. 

APP: DEXCOM  MOBILE

  • Dexcom G5 Mobile and Dexcom G6 app are available for Android and Apple. Delete the G5 app before installing the G6. 

SETTING ALERTS: DEXCOM

Setting Low Alerts: Dexcom

  • Low Alert: Optional. Choose a glucose reading high enough to allow time to eat to prevent hypoglycemia. Ask patient at what BG level they would consider taking action with glucose/carbohydrate to prevent a low, and set the “Low Alert” slightly above that. Individualize with patient. Avoid setting “Low Alerts” under 4 mmol/L since the goal is to act to prevent lows.
  • Low Alarm: Hard coded. Remind patients an alarm will sound at 3.1 mmol/L. This is NOT an optional alarm. This may make patients feel more comfortable setting a low alert that is in mid 4 mmol/L range.
  • Repeat Low Alert: Optional. Consider the typical time it will take to recover from a low. (Patients may need to use capillary glucose test as interstitial glucose can take longer to align with blood glucose when changing rapidly.)
  • Fall Rate Alert: Optional. User chooses one option.
    • 0.11 mmol/L alerts user when one arrow down (3.3 mmol/L in 30 minutes)
    • 0.17 mmol/L alerts user when two arrows down (5.1 mmol/L in 30 minutes)

Setting High Alerts: Dexcom

  • Consider starting with the “High Alert” turned off for new users.
  • High Alert: Optional. Ask patient at what BG level would they consider taking action to treat a high. Consider setting the high target slightly below that level, so they may take action to prevent that high. Keep safety in mind; a negotiation may be needed. Factory preset is 11.1 for high alert.
  • Repeat High Alert: Optional. Consider the typical time it will take to recover from a treated high, so not creating unnecessary alarms.Review insulin action time so patients don’t stack corrections
  • Rise Rate Alert: Optional. User chooses one option.
    • 0.11 mmol/L alerts user when one arrow up (3.3 mmol/L in 30 minutes)
    • 0.17 mmol/L alerts user when two arrows up (5.1 mmol/L in 30 minutes)

REPORTS: DEXCOM 

  • Online cloud reports are available automatically through Clarity or via set-up through Diasend (see below).
  • Video Review of Clarity Online (YouTube)
  • Sample Dexcom Clarity reports (pdf)
  • Dexcom Clarity User Guide (pdf)
  • Dexcom Clarity for Clinics (e.g Healthcare Professional Login ) is not approved for use by AHS legal. See the option for Patient Login below. 
  • Dexcom Clarity for Home Users: Visit the Patient login site for Clarity.  With the patient's permission, input the patient's username and password into the HOME USER option (this is the username/password used when setting up the Dexcom app on their phone). The data will already exist in the Clarity cloud even if the patient has not yet accessed it. (Do not use the Clinic Option as not approved by AHS legal at this time.)
    • Tips for Using Dexcom Clarity (more to come in the future): 
      • Overview Report page provides excellent information on overall glycemic control including: estimated A1c, average glucose, and glucose variability [standard deviation (SD) and coefficient of variation (CV)]. 
        • The following information on 'Glucose Variability' is from the article- International Consensus on Use of Continuous Glucose Monitoring: Stable glucose levels are defined as a CV < 36%, and unstable glucose levels are defined as CV ≥ 36%. The authors recommend that variablity should be considered among other factors of the overall clinical representation of glycemic control. 
  • Diasend 
    • Patient viewing of Dexcom results in Diasend: Dexcom results may be electronically directed to a personal online Diasend account (cloud to cloud) if the user is using a Dexcom smart phone app. Once in their personal Diasend accounts,  patients click "Connect App", then click "connect" for Dexcom G5 Mobile app. They need to input their username and password for their Dexcom app.  Patients on an Omnipod pump may also upload their pump information to their personal Diasend account to merge the pump and Dexcom data. 
    • Educator viewing of Dexcom results from Dexcom receiver in Diasend: In clinic, educators may upload Dexcom results from a Dexcom handheld receiver -  if the patient has one - by connecting it to the white Diasend box. Results upload to a clinic account, not to the patient's personal account. (The use of Clinic Accounts in Diasend has been approved by AHS legal).
    • Linking personal Diasend account to a clinic Diasend account: Patients  follow the instructions provided by their clinic which include a clinic code. (The use of Clinic Accounts in Diasend has been approved by AHS legal).
TIPS: DEXCOM
  • Remind patients to call tech support if their glucose reading frequently has problems showing up on their phone app. They may also try a thinner phone case.
  • Patients can purchase an optional separate receiver. Both the phone app and receiver can receive data at the same time with no impact on transmitter battery.

COST: DEXCOM

  • Please contact the company for the most accurate pricing and information. Insurance coverage may be under the category of glucose meters (SMBG) or more likely, medical devices.
  • For cost references, in 2018 the approximate cost was $87 CA per G5 sensor (7 days; off-label re-use is possible) and in 2019 $100 CA per G6 sensor (10 days; off-label re-use is possible) plus the purchase of 3-4 transmitters/year (G5  $389 CA; G6 $289 CA). The cost of an optional receiver is approximately $500.

Medtronic Guardian (previously Enlite)

PRODUCT SUMMARY: MEDTRONIC

Medtronic Guardian rtCGM is available for use only with a Medtronic Insulin Pump. Once activated with the pump, it can provide automated alarms and alerts for low or high gluocse readings or rate changes. Each sensor is indicated to last 6 days.  A transmitter is attached to the sensor and sends glucose results to the pump, where the user can view current glucose level, a trend arrow (if glucose is trending up or down) and graphs for numerous hours previous data. Calibration with a fingerstick capillary glucose meter is required every 12 hours. Confirmatory capillary glucose test is required prior to bolusing. Capillary glucose testing is required in additional situations cases as outlined in the product manual. Confirmatory capillary glucose test is still required prior to bolusing. The use of trend arrows to adjust insulin doses is not indicated by Health Canada. However, patients may have devised personal methods for addressing this. If programmed to do so, the sensor in conjunction with the pump can temporarily suspend insulin delivery if a low sugar is not addressed.

WEBSITE: MEDTRONIC

  • Visit the website for the stand-alone Guardian CGM
  • Visit the website for the Guardian integrated into Medtronic Insulin Pump 
  • Contacts: Calgary and area: This email address is being protected from spambots. You need JavaScript enabled to view it. 403-829-1932

SETTING ALERTS: MEDTRONIC 630G CGM and 670G Manual Mode

The CGM with the Medtronic 630G pump allows for different alarm thresholds to be set over the day, if desired. The 630G pump can also automatically suspend insulin delivery a low limit is reached and not responded to by the user.The graph below shows the different alerts available. Please visit the Medtronic CGM page for descriptions of the alerts and alarms available in the Guardian System, the 630G insulin pump and in "manual mode" of the 670G pump.

 cgm brands medtronic cgm glucose alerts 2016

REPORTS: MEDTRONIC CARELINK 

COST: MEDTRONIC

  • 2018 approximate pricing: $65 CAD per sensor (6 days; off-label re-use is possible). Medtronic insulin pump with transmitter is required. Please contact the company for the most accurate pricing and information. Insurance coverage may be under the category of glucose meters (SMBG) or medical devices.
MEDTRONIC TRAINING MATERIALS

To view a list of all our CGM pages (as this is one of many), please visit our main page, Glucose Sensors and Continuous Glucose Monitors (CGM),