What are the steps for a trained healthcare professional or caregiver to assist a patient with diabetes in placing or replacing Omnipod (insulin management system) and Dexcom (continuous glucose monitoring system) devices?

Step-by-Step Instructions for Assisting with Omnipod and Dexcom Placement

Healthcare professionals and caregivers must receive comprehensive initial and ongoing training—either in-person or remotely—on proper device placement technique, with regular evaluation of their ability to perform these procedures correctly. 1

Pre-Placement Preparation

Patient Assessment and Site Selection

• Examine the skin thoroughly by both visual inspection and palpation to identify any areas of lipohypertrophy (swelling/nodules), lipoatrophy (indents/cratering), or amyloidosis before device placement 1
• Avoid injecting or placing devices into sites with lipodystrophy, as this causes erratic insulin absorption and increases risk of hypoglycemia, hyperglycemia, and glucose variability 1
• Document lipohypertrophy with visuals showing site location and size to track improvements over time 1

Site Rotation Protocol

• Use injection site map handouts or rotation apps to encourage systematic rotation both between anatomical sites and within each site 1
• Maintain adequate distance from prior placement sites to prevent lipodystrophy development 1
• Avoid delivering cold insulin, as this increases lipohypertrophy risk 1

Omnipod Placement Instructions

Device Preparation

• Ensure the patient/caregiver understands that Omnipod is a tubeless insulin pump system that eliminates the physical inconveniences of conventional tubed pumps 2, 3
• Verify the pod is at room temperature before application to minimize tissue trauma 1
• Check expiration dates on all supplies before use 1, 4

Placement Technique

• Select appropriate anatomical sites: abdomen, upper arms, thighs, or lower back areas with adequate subcutaneous tissue 5
• Clean the site with appropriate antiseptic and allow to dry completely
• Apply the pod using the automated cannula insertion system, which 76% of users prefer over manual insertion methods 3
• Activate the pod according to manufacturer instructions and verify proper insulin delivery
• Teach patients to rotate sites systematically every 2-3 days when changing pods to prevent lipodystrophy 1

Post-Placement Verification

• Confirm the pod is communicating with the personal diabetes manager (PDM) or controller device 6, 2
• Verify basal insulin delivery is functioning correctly
• Ensure the patient understands alarm functions and troubleshooting procedures 5

Dexcom CGM Sensor Placement Instructions

Pre-Insertion Education

• Train patients on alarm/alert settings during CGM initiation to avoid alarm overload, which is crucial for long-term adherence 1
• Emphasize that CGM users must always have blood glucose monitoring (BGM) supplies available for calibration, when CGM accuracy is questioned, during sensor warm-up, and when glucose is changing rapidly 1, 4, 7
• Explain calibration requirements: perform no more frequently than every 8 hours and preferably no more than twice per 24 hours 8

Sensor Insertion Technique

• Select appropriate insertion sites: abdomen or upper buttocks for adults; arms may be used for some Dexcom models 1
• Rotate sensor placement sites systematically to prevent skin irritation and maintain accuracy 4
• Clean and dry the insertion site thoroughly before application
• Apply the sensor using the applicator device according to manufacturer instructions
• Secure the transmitter to the sensor and verify proper attachment
• Document the sensor insertion site, as accuracy may vary slightly by placement location 8

Sensor Activation and Calibration

• Wait for the 2-hour warm-up period before the sensor begins transmitting data (specific timing varies by Dexcom model) 7
• Perform initial calibration using an FDA-approved blood glucose meter with proven accuracy and unexpired strips from licensed pharmacies 1, 4
• Configure real-time alerts and alarms for hypoglycemia, hyperglycemia, and rapid rates of change at appropriate thresholds 8, 7
• Verify continuous data transmission to the receiver or smartphone app 8, 7

Critical Safety Considerations

Blood Glucose Monitoring Backup

• Provide BGM devices to all CGM users as they must have access to fingerstick testing at all times 1, 4
• Use only FDA-approved meters with proven accuracy and unexpired strips purchased from licensed pharmacies or distributors 1, 4
• Instruct patients to use fingerstick blood glucose for treatment decisions, such as calculating premeal insulin doses, even when using CGM 7

Ongoing Education Requirements

• Schedule regular follow-up sessions to evaluate technique, review data utilization, and assess the patient's ability to upload/share data for therapy adjustments 1
• Inadequate follow-up education leads to suboptimal outcomes; ongoing training and technique evaluation are essential 4
• Verify the patient can interpret CGM data, including time in range, hypoglycemia percentage, and hyperglycemia percentage 8

Device Integration Considerations

• For patients using Omnipod 5 with Dexcom integration, ensure proper pairing between the automated insulin delivery system and CGM 6
• Confirm follower connections for remote monitoring if applicable, particularly for pediatric patients or those with hypoglycemia unawareness 8, 7
• Document pairing status with device-specific apps in the patient record 8

Common Pitfalls to Avoid

• Never assume all meters are equally accurate—significant differences exist that can impact patient outcomes 4
• Do not allow patients to inject into lipohypertrophic areas, even if subclinical, as this negatively influences glycemic outcomes 1
• Avoid incomplete documentation of alert settings, as proper configuration is essential for detecting and preventing hypoglycemia and hyperglycemia 8
• Never fail to provide backup BGM supplies to CGM users, including unexpired strips and supplies 4
• Do not neglect to discuss factors affecting CGM accuracy, including medications (high-dose acetaminophen, salicylic acid, ascorbic acid), hypoxemia, and temperature ranges 4, 8

Sharps Disposal Education

• Instruct patients to never place sharps directly in public or household trash 4
• Provide information on sharps disposal containers and community take-back programs 4
• Prohibit needle recapping and teach patients to never recap needles 4

Telehealth Considerations

• Remote training is acceptable for device placement education when in-person training is not feasible 1
• Use visual aids and demonstration videos to supplement verbal instructions during telehealth visits 1
• Request patients demonstrate their technique via video during follow-up appointments to verify proper placement 1