Pump data interpretation using Carelink

Warning

Objectives

To provide all users of Carelink with a guide to interpreting the information provided by uploading insulin pump and/or Continuous Glucose Monitoring (CGM) data.

Scope

This document applies to all users of a medtronic pump within NHS Tayside that have registered with Carelink and receive care via the Diabetes Out There (DOT) Tayside service.

For a more comprehensive user guide, please refer to the Medtronic Carelink help pages.

Audience

Young people with diabetes within NHS Tayside and all health care professionals involved in their care.

 

Carelink navigation

Carelink adherence report
Adherence report
Carelink sensor and meter overview
Sensor & meter overview
Carelink assessment and progress
Assessment & progress
Carelink logbook
Logbook
Carelink meal bolus wizard
Meal bolus wizard
Carelink device settings snapshot
Device settings snapshot

Generate reports

Generating a report is a 4 step process:

  1. Click on "Reports" in the left side menu
  2. Select which report you would like to view - see below for recommendations
  3. Select time period required - 14 days recommended
  4. Click on "Generate Reports".

Carelink screenshot showing how to generate a report.

Select which reports you would like to view by clicking on each tile. We recommend:

  1. Assessment & progress
  2. Meal bolus wizard
  3. Sensor & meter overview
  4. Device settings snapshot
  5. Adherence
  6. Logbook

You can choose to view each one in turn, or select all of them at once to generate one long report, which is provided as a pdf file.

Glucose checks

The number of glucose checks that you do will depend on whether you are fingerpricking for blood glucose, swiping your flash glucose sensor (FGS) or have a continuous glucose monitor (CGM).

Carelink records any glucose value entered into your pump as a "BG reading", regardless of whether this is blood glucose (BG) or a value taken from FGS and entered into your pump. Readings from CGM are displayed slightly differently and gives the time that the sensor is active each day, as well as the total time the sensor has been worn over the reporting period.

The number of BG readings is located on the left side of the "Adherence" page of the report:

Carelink screenshots showing the different displays if CGM is or if CGM is not used.

Aim for 5-7 readings per day. If the average number of readings is less than 4, then there is not enough information to make any meaningful decisions; try to increase the number of glucose checks and repeat the upload in 2 weeks.

Number of boluses per day

When you are using pump therapy, you should aim to administer bolus insulin for all meals, all snacks and to correct glucose readings which are above target. Therefore we recommend aiming for at least 7 boluses per day.

This information is also available in the adherence report, under “Bolus Wizard Events”. The average number per day is displayed at the bottom of the table - see below. There is also a break down of how many boluses are with food and how many are with correction.

If you are using a pump and CGM together in automode, the "Manual Bolus" column will detail how many additional boluses the system is delivering each day to try and get you into target.

Carelink screenshot showing the number of boluses per day.

Set changes

We recommend set changes every 3 days or sooner if there is concern that insulin is not being delivered properly. If sets are kept in place for longer than this then the absorption of insulin from the site becomes less effective. This often leads to glucose readings above target. Remember to rotate your cannula sites. Repeated use of the same sites will lead to problems with insulin delivery.

You can review the number of days between set changes in the adherence report by looking at which days the cannula has been filled:

Carelink screenshot showing on which days the cannula has been filled.

Average daily insulin

This is found at the top right hand corner of the "Sensor & Meter Overview" report.

Carelink screenshot of average daily insulin

The average daily insulin is also known as total daily dose of insulin (TDD). As children grow, they need more insulin. This is especially true around the time of puberty, when the body's hormones make an individual less sensitive to insulin.

 

Average daily insulin ratio

It is useful to look at the split between basal insulin (that which is delivered continuously by your pump), and bolus insulin (administered for food or as correction doses).

Usually between 30-40% is delivered as basal and around 60-70% as bolus. If you find the opposite, that the basal component is the higher %, then this can indicate too much reliance on basal insulin and that you or your child are forgetting some boluses.

Another potential indicator of missed boluses is if the average daily carbohydrate is lower than would be expected. The table below gives a useful guide which will apply to the majority of children:

Age Female (Carbs/ day) Male (Carbs/ day)
1-3 years 115g 125g
4-6 years 170g 185g
7-9 years 205g 220g
10-12 years 255g 270g
13-14 years 285g 315g
15-16 years 300g 360g
17-18 years 310g 390g

Average glucose, blood glucose trends, and insulin:carbohydrate ratio (ICR)

Insulin correction/sensitivity factor

If a correction dose is given, the glucose should fall into the target range (4-7 mmol/l) 2 hours after the correction dose is given. If this is not the case, then consider changing your device settings.
Here is an example of logbook entries showing corrections being ineffective, as the individual’s readings are remaining above target:

Carelink ineffective corrections example

Things to note:

  • The programmed correction factor is how much we would anticipate 1 unit of insulin would lower your child’s glucose by.
  • Because small children have a low total daily dose of insulin, 1 extra unit would make a large change to their glucose. Small children therefore have a high degree of sensitivity to insulin and a high correction factor. For example, a correction factor of 8 means that 1 extra unit of insulin would be predicted to lower your child’s glucose by 8mmol/l.
  • Older children have a higher total daily dose and so are less sensitive to 1 extra unit of insulin. A correction factor of 2 may be more appropriate, meaning that 1 extra unit of insulin would be anticipated to lower their glucose by 2 mmol/l.
  • The required correction factor can be estimated using the sum: 100 divided by the total daily dose (TDD) of insulin. If the programmed correction factor is higher than the result of this sum, you may find that correction doses are not effective and therefore this should be adjusted.

Basal rate

The basal rate settings on you pump can be viewed on the "Device settings" report.

Consider:

  • Number of basal patterns used - is another pattern required (e.g. for weekends or holidays)?
  • When adjusting basal rate, adjust the rate 2 hours before the desired effect on blood glucose.
  • Highest basal demands are at dawn (especially secondary school aged children) and dusk (especially primary school aged children).
  • Make adjustments according to total daily dose of insulin - see table below.
Total daily dose Adjust basal by
Less than 10 units per day 0.025 units per hour
10-20 units per day 0.05 units per hour
21-40 units per day 0.1 units per hour
41 units or more per day 0.2 units per hour

Editorial Information

Last reviewed: 05/09/2023

Next review date: 05/09/2025

Author(s): Nicholas Conway.