Diabetes Management

My primary care doctor at Carbon Health manages my diabetes care.Will they be sent the info and data from this program ?

If you already have a Carbon Health provider who manages your diabetes, our specialized diabetes team is here to work alongside your primary care provider. Our team will work with your provider to actively manage your condition and offer deeper expertise.

When can I ask my diabetes team questions? What is the expected response time?

You have the ability to send a message to your care team 24 hours a day, 7 days a week; however, responses to messages are typically sent Monday through Friday, 9 a.m. to 5 p.m. (Pacific Time). Questions asked after hours will usually be answered the following day.

Will I be able to get prescriptions from my medication through this program?

There are many types of glucose-lowering medications used to help control diabetes. Our doctors will work with you to choose a medication that fits your unique needs. They'll also help refill your prescriptions, to make sure there's no gap in your care.

Common medications for type 1 diabetes include:

• Humalog
• Novolog
• Lantus
• Tresiba
• Toujeo
• Lyumjev
• Fiasp
• Afrezza (inhaled insulin)
• connected insulin pens & insulin pumps

Common medications for type 2 diabetes include:

• Metformin
• Ozempic
• Trulicity
• Jardiance
• Farxiga
• Invokana
• Januvia
• Rybelsus

What does it mean to partner with a Diabetes Care and Education Specialist?

Carbon Health's Diabetes Program gives our patients the opportunity to connect with a Diabetes Care and Education Specialist (DCES). To get started, you will need to first establish care with one of our Endocrinologists. Based on your learning needs, your Endocrinologist will encourage you to partner with a DCES (diabetes educator).

What is a DCES?

A key member of the diabetes care team, a Diabetes Care and Education Specialist (DCES) is a health professional who helps people with diabetes (PWDs) learn the best ways to take care of themselves and manage the day-to-day challenges of living with diabetes. Nurses, dietitians, pharmacists, and therapists are amongst specialties that advance their skills to become a DCES. All diabetes educators are mandated to maintain their respective licensure on top of practicing as a DCES.

A person-centered approach is the cornerstone of success with diabetes self-care. A DCES shares the empathy of managing diabetes around the clock. Each person with diabetes responds very differently to factors that affect their health. One approach does not fit all. Partnering with a DCES can help identify and prioritize personal diabetes self-care goals to achieve optimal health. We work in sync with your Endocrinologist to kickstart on projects identified.

Ways to partner with your DCES

• Build a strong support network you can count on when in need
• Find ways to cope well when living with diabetes
• Address diabetes distress/burnout - feeling overwhelmed with managing diabetes
• Manage blood glucose patterns by discussing your CGM data and logged events
• Learn to use food as medicine to improve mealtime blood glucose
• Explore lifestyle changes and set small goals for eating well, sleeping well, moving more, and managing stress
• Weight and Diabetes Management - Learn how to sync goals that work for both
• Understand your diabetes medications and work with a DCES to adjust them if within their scope of practice
• Learn about managing insulin needs, adjusting background and mealtime insulin based on blood glucose patterns
• Problem-solve to move closer towards your target blood glucose range
• Learn how to treat high and low blood glucose levels
• Address psychosocial issues and feel supported in mental health needs
• Explore diabetes and technology options such as CGM and insulin delivery devices
• Address diabetes and co-morbidities by monitoring heart health, kidney health, eye health, nerve health, and sexual health

In addition

A DCES can also assist with challenges and questions that arise outside of normal care, such as:

• Resources for affordable medication and insulin
• Diabetes self-care and daily challenges related to work schedules, financial constraints, and meal planning
• Participating in ongoing research

Some DCES professionals specialize as insulin pump educators, focusing on helping with the setup and use of insulin pumps.

There might be questions that go beyond the above points. Come with your questions and partner with a DCES to feel empowered, encouraged, and knowledgeable to live well with diabetes.

Reference Association of Diabetes Care & Education Specialists (opens in a new tab)

What is a diabetes-friendly diet?

Nutrition is an important part of a healthy lifestyle when you have diabetes. Crafting and following a healthy diet (opens in a new tab) can help keep your blood sugar levels in your target range, leading to fewer diabetes-related symptoms and preventing future complications. Many people worry that a diabetes-friendly diet means that they can't enjoy any of their favorite foods, but that usually isn't the case. The goal is to have balance, which means enjoying some foods in moderation, while increasing the amount of nutrient-rich foods, including:

• Fruits
• Vegetables
• Whole grains
• Protein
• Dairy

What does a CGM device do that traditional at-home diabetes tests don't?

In addition to being time-consuming, traditional at-home diabetes tests provide only snapshot insights into your blood sugar levels, rather than a full picture. Continuous monitoring gives you a more complete record of your blood sugar levels, including trend arrows that help you know where your glucose is headed, and can alert you to high and low glucose levels. The CGM data, in combination with food and exercise logging, can provide valuable information that helps our team fine-tune your medication and care.

Is this program available only virtually?

Yes, this program is designed to be fully integrated into your daily life, so receiving care is simple and practical.

Who is eligible for diabetes care at Carbon Health?

California and Massachusetts residents living with type 1 or type 2 diabetes may be eligible for the program.

Can I do this program through my primary care provider if they are outside of Carbon Health?

Yes. You do not have to have a Carbon Health primary care provider to participate in this program. Once you are enrolled, we will provide your provider regular updates on your progress.

How to: Schedule a visit

If you're having trouble scheduling a virtual visit with your diabetes care team, please follow the steps outlined below.

In the Carbon App:

1. Click Get Care at the bottom of the screen
2. Switch the tab to Virtual at the top of the screen
3. Select Virtual Diabetes Care to schedule your appointment

On your Computer:

1. Go to patient.carbonhealth.com (opens in a new tab)
2. Click Log In at the top left of the screen
3. Log into your Carbon account.
4. If you do not remember your password, click “Forgot Password”.
5. Click Virtual Diabetes Care to schedule your appointment

How to: Join your upcoming appointment

We highly recommend joining your Virtual Diabetes Care visit from a desktop computer or laptop.

At the time of your visit, you will receive a message with a link to join your appointment in the Diabetes Care message thread.

Join from a Computer:

1. Log into your Carbon Account on the patient website: patient.carbonhealth.com (opens in a new tab)
2. Click Messages at the top right
3. Find and click into the Diabetes Care message thread
4. Scroll down to the bottom of the message thread
5. Click Press here to join your video appointment

You may have to refresh the page at the time of your visit for the visit link to pop up

The Zoom web client allows joining a Zoom meeting or webinar in a web browser without downloading any plugins or software.

Join from the Carbon App:

1. Open the Carbon App
2. Go to Messages at the bottom of the screen
3. Find the Diabetes Care message thread
4. Click Press here to join your video appointment

You DO NOT need the Zoom app to join from the Carbon App

How to: Message your diabetes care team

Please always message your Diabetes Care team in the "Diabetes program" message feed. This is where you can reach your Endocrinologist, Diabetes Educators, and Diabetes care coordinators.

In the Carbon App:

1. Open and log into the Carbon Health app
2. Click Messages on the bottom of the screen
3. Find the Diabetes Care message thread
4. Send a message!

If you address a specific person’s name, the care coordinator will make sure that provider sees your message!

On your Computer:

1. Log into your Carbon account on the patient website: patient.carbonhealth.com (opens in a new tab)
2. Click Messages at the top right
3. Find the Diabetes Care message thread
4. Send a message!

If you address a specific person’s name, the care coordinator will make sure that provider sees your message!

How to send PDF files and Photos in the message thread: You can do this by clicking the small blue plus button on the left of the messaging space to upload a PDF or Photo.

What hours can I message my diabetes care team?

We are available 9 AM - 5 PM, Monday through Friday, through the Carbon Health app messaging.

From here, you can reach your endocrinologist and our DCES (Diabetes Care and Education Specialists) for all of your clinical questions (prescription refills, labs, any symptoms, general diabetes questions) and other team members for admin questions (insurance, scheduling a visit, support).

Messaging through the Diabetes Program Message Feed in the Carbon Health app is the best way to reach your diabetes care team.

See How to message your diabetes care team (opens in a new tab) to see how you can reach them through messaging!

What is Continuous Glucose Monitoring?

CGM is short for Continuous Glucose Monitoring. In 2006, Dexcom introduced its first real-time CGM system. And in less than 20 years, CGM has revolutionized the way diabetes is managed!

“In 1999, the U.S. Food and Drug Administration approved the first ‘professional’ CGM, with which the patient was blinded to glucose data collected for 3 days, and then the information was downloaded in the health care provider’s office for review.” (opens in a new tab)

The benefits of CGM are countless. But most important is the ability to map and see your own glucose data every 5–15 minutes (depending on the system of use). Prior to CGM, you only knew your blood glucose value at the moment you checked it. With CGM one can receive up to 288 readings per day. Some compare CGM to a personal navigation system helping them keep on course throughout a day.

How does CGM Differ from Finger Sticks?

Traditional finger stick meters read capillary blood glucose levels. When you poke your finger you are literally sampling a droplet of blood to see how much sugar is in the capillary. CGM (also known as SG) differs as the sensor that is reading a glucose value does not reach the capillary. It sits just below the skin in your soft tissue and reads glucose values in the interstitial fluid. And because of these differences, a CGM value will rarely match a finger stick (BG) value as fluids are constantly shifting in our body.

What are the pieces to this puzzle?

• Transmitter
• Sensor
• Receiver / Reader

How Long Does a Sensor Last?

Depending on the system you choose, you will receive glucose values for anywhere from 10–14 days.

Can I Wear a CGM in the Water?

Yes. These are water resistant.

What Happens if it Falls Off?

Life happens, and some skin types produce more oil than others. If your sensor does not last the full amount of time, call the respective company and they will replace (usually at no cost).

Can I Travel with a CGM?

Yes you can travel and know your CGM will keep you safe! Do reference the individual company websites to read about specific guidance.

Are There Limitations when Wearing a CGM?

• Magnetic imaging
• CT scan
• Diathermy (high frequency electrical heat)
• Scuba diving - check with your respective CGM company for specific specs on water use

Sensor Adherence

In the beginning, CGM sensors were worn for about 1 week. Over time, technology improved and CGM wear time increased. Now, most CGM sensors can be worn for 10-14 days! But with extended wear time, comes the challenge of keeping the sensor in place for an extended period.

For many people, this is a near-impossible task as:

• Skin types vary. It may take differing times for sensor tape to dry and stick depending on skin type (i.e., dry vs oily skin).
• Activity types differ. Some people lead a lifestyle with more contact than others (i.e., hockey player vs office worker).
• Some people sweat more than others.

General Tips

• Place on clean, dry, lotion-free skin.
• Upon initial placement, and for a few hours after, keep the skin dry and avoid engaging in activities that may make you sweat.
• Avoid placing where the skin naturally folds or bends.
• Avoid placing over excess hair. Removal with a razor may be helpful.
• Rub around the tape immediately after insertion (consider using the back of your fingernail).
• Smooth out any wrinkles in the tape.

Additional Support

Liquid Adhesives

When using liquid adhesive:

• Create a donut hole shape on the skin with the liquid adhesive. Let adhesive dry. Insert the sensor in the center of the donut hole, avoiding liquid adhesive.
• Soak the liquid adhesive into the sensor tape after placement.

Examples of Liquid Adhesive Agents:

• Mastisol® (opens in a new tab) (Eloquest) - Comes in liquid, swabs, or single-use vials.
• Skin Tac™ (opens in a new tab) (Torbot) - Comes in wipes or liquid.

Adhesive Patches, Tapes, and Covers

• Dexcom clear over tape - order online, direct from Dexcom - FREE.

• FLS Sensor Cover (opens in a new tab).

• ExpressionMed (opens in a new tab).

• Not Just a Patch (opens in a new tab).

• RockTape® (opens in a new tab) or other Kinesiology tape.

Remember, what works for one person may not work for everyone. You may need to try several products or methods to figure out what works best for you.

How to: Link your Freestyle Libre

In the Carbon App:

1. Open and log into the Carbon Health app
2. Scroll down to the bottom and look for Devices
3. Toggle the switch on the right side to link your CGM device
4. You will be prompted to log into your LibreView account to allow access for linking your Libre

It will take time for the blood glucose data to show in your Carbon account. If it doesn’t show after 3 hours, please let your diabetes care team know via message so we can help you with troubleshooting.

How to: Scan your Freestyle Libre

The Libre sensor automatically collects blood glucose values every 15 min, but can only store 8 hours of data - make sure you scan every 8 hours to avoid any gaps in data! One of the most common gaps is overnight, so remember to scan right before going to bed, and first thing when you wake up - if you scan with each of your meals during the day, you should get everything else!

How to: Link your Dexcom

In the Carbon App:

1. Open and log into the Carbon Health app
2. Scroll down to the bottom and look for Devices
3. Toggle the switch on the right side of “Link your Dexcom”
4. You will be prompted to log into your Dexcom account to allow access for linking your Dexcom

It will take time for the blood glucose data to show in your Carbon account. If it doesn’t show after 3 hours, please let your diabetes care team know via message so we can help you with troubleshooting.

I have connected my account but it still does not work

The most common issue is that you did not connect the right account. Start by opening your Dexcom app on your phone go to Settings > Account and make sure you use the same username to connect to Dexcom in the Carbon app.

If you have verified that it is the right account but it still doesn't work you can visit this link on the Dexcom website. Login with the same account and then verify that "Carbon Health" shows up under "Authorized Third Party Applications."

Dexcom - Account Management (opens in a new tab)

If it shows up, you have connected the right account.

If it still does not work, the last step is to login to Dexcom Clarity and see if you can see your data there.

Dexcom CLARITY (opens in a new tab)

Please share if you can see your data in Clarity with your Diabetes Care Team and we will help with next steps.

How to: Find your Diabetes data

In the Carbon App:

1. Open and log into the Carbon Health app
2. Click Diabetes at the top of the screen (next to Home and COVID-19)

The Diabetes tab is only found on the My Health home screen.

You will be able to see your blood glucose graph at the top of the screen. Your CGM data will update periodically in the Carbon app.

How to: Log into the logbook

This is especially important for the tracking period after your first visit with the endocrinologist.

Please note that logging should always be done in the Carbon Health app, NOT in LibreLink or Dexcom.

Please use the Carbon App for logging because this is NOT supported on the carbon website.

In the Carbon App:

1. On the home screen, click Diabetes at the top of the screen (next to Home and COVID-19)
2. Tap the black plus button on the bottom right corner to log an item
3. Choose which item you'd like to log: Food & Drink, Insulin, Exercise, or Note
4. Check out the Logbook at the bottom of the page afterwards to see how each event affects your blood sugar!

How to: Set up both your pump and CGM in Tidepool

Here are the instructions on how to get set up in Tidepool for both your pump and CGM.

First, let's connect your pump:

1. Set up an account here: https://app.tidepool.org/signup/personal (opens in a new tab)

2. Next, download the Tidepool uploader here: https://www.tidepool.org/download (opens in a new tab)

Download the appropriate uploader for your computer type. This is a REQUIRED step. You will not be able to upload from your mobile device.

• Choose all of your device(s) -> Done

• Choose time zone -> upload device(s) -> Click See data

• For Dexcom/Libre data, it will need to be uploaded through the Dexcom App (steps shared below)
• Click Upload next to your pump device

3. Share your data with diabetescare@carbonhealth.com

• Log into your Tidepool account
• Click "Share" under your name

• Click "Invite New Member" on the top right corner

• Type in diabetescare@carbonhealth.com
• Click "Invite Member"

More detailed steps can be found here: https://support.tidepool.org/hc/en-us/articles/360029684951-Sharing-your-Data (opens in a new tab)

4. Finally, let's connect your CGM to your Tidepool Account by following the steps on the website for your CGM:

• Dexcom: https://support.tidepool.org/hc/en-us/articles/360029369552-Connecting-your-Dexcom-account-to-Tidepool (opens in a new tab)
• Libre: https://support.tidepool.org/hc/en-us/articles/4413124445972-Uploading-your-LibreView-data (opens in a new tab)

Send your diabetes care team a message if you have any questions or concerns!

How to: Share using t:connect (X2, Basal IQ, Control IQ

We prefer Tandem users to upload to Tidepool and have them connect to t:connect as a backup.

To set up an account for Tidepool, you can follow this step-by-step guide (opens in a new tab).

Tandem via T:connect Instructions:

1. Please set up an account with t:connect here (opens in a new tab).
2. Download the t:connect mobile app from your app store. More information can be found here (opens in a new tab).
3. The next step is to pair the pump to the mobile app using Bluetooth:
4. Within your t:slim X2 pump, tap OPTIONS then use the down arrow to find and select Device Settings.
5. Select Bluetooth Settings. Tap the toggle to turn on the Mobile Connection and enable Bluetooth® wireless technology.
6. Select the checkmark to turn on the Mobile Connection.
7. Return to your mobile phone, make sure that Bluetooth is turned on, then return to the t:connect mobile app and log in.
8. After logging in, select Begin to start the pairing process.
9. Make sure your pump is within close proximity to your phone. The app will automatically detect and display your pump. Select the pump’s serial number and tap Next.
10. On the pump, select Pair Device and then press the checkmark to continue.
11. Below the unique pairing code is an OK. DO NOT press the OK button, or it will unintentionally cancel the pairing process.
12. Enter the code that is displayed on the pump directly into the t:connect mobile app and press Pair with pump. It is important to note that the code is case-sensitive and must be entered exactly as it is displayed on the pump.
13. The unique code is only valid for 5 minutes. If the code expires, the pairing process must be restarted by selecting Pair Device from the Bluetooth Settings screen on your pump.
14. Once the code has been successfully entered, a confirmation screen will appear on your pump.
15. Press Sync pump data on your phone to begin using the app.
16. After you've set up t:connect, we will invite you to share data with the Carbon Health Diabetes Care Team. Just message us in the Carbon app when you've created your account.

Detailed instructions can also be found here (opens in a new tab).

I'm still having trouble!

If you are not sure what all of this means, don't panic! We're happy to help! Just make sure you have your pump information available and then message us in the Diabetes message thread in the Carbon app.

How to: Navigate your diabetes care in the patient app

Welcome to Carbon Health! Please watch the video below to learn how you can navigate your diabetes care in the Carbon Health App.

If you haven't already downloaded the Carbon Health app, you can sign up to receive the link to download the app via text here: https://carbonhealth.com/download?lng=en (opens in a new tab)

How to: Download, sign, and upload your PDF on your computer

Our virtual diabetes care team must have sent you a Medical Record Release Form to sign so they can request your records from your provider outside of Carbon Health. Look no further, please watch the video below to learn how you can download, sign and upload a PDF form into your Carbon Health account, all on your computer. If you are still having trouble with signing the form, please reach out to your diabetes care team via messages in the Carbon Health app.

How to: Review your logbook entries

To review your Logbook, tap on the “Diabetes” tab, then scroll down below the CGM graph to the Logbook section (for Metabolic Health Assessment participants, tap on the” Metabolic Health” tab and scroll down to locate your Logbook). Your last 3 entries are available for easy access, but you can also tap the “View All” button to bring up a more comprehensive list of your entries in reverse chronological order.

Tapping into any of these entries will show the associated description and a graphical representation of your CGM readings in the 30 minutes before and 4 hours after this specific event. Meal entries in particular will also include the photo you took as well as a circle in the top right hand corner that displays the change in blood glucose from the start of the meal to its peak within the next 4 hours.

The “Meal Rankings” feature can be toggled on at the top to sort meal entries by their impact on your blood glucose, in ascending order!

Learnings from Meal Rankings

Meals that raise blood glucose:

• 100 mg/dL or more are labeled in purple = PAUSE and ASSESS. Limit/avoid these foods/drinks and adjust portions. If you take mealtime insulin, consider taking it earlier relative to your meal or increasing your dose for this specific meal - consult with your care team for guidance!
• 51-99 mg/dL are labeled in yellow = RE-EVALUATE and CHANGE the meal combinations, adjust portions, and/or use sparingly. If you are taking insulin or other glucose-lowering medication, consult with your care team to discuss a possible dose adjustment.
• 50 mg/dL or less are labeled in green = MOST FAVORABLE. These are meals you may want to favor or emphasize, particularly if you enjoy them!

Point of Reference

People without diabetes generally see their post meal blood sugar below 140 mg/dL and most meals should not raise blood glucose more than 30-50 mg/dL.

Questions about how to get the most out of this feature? Send us a message, we’d love to help!

What is a DCES?

If you're wondering what Carbon Health's DCES (Diabetes Care + Education Specialist) does, please watch the video below.

Diabetes DCES Education Specialist Diabetes Care Virtual Diabetes Program

I'd like to learn more about Type II Diabetes

If you'd like to learn more about Type II Diabetes, you should contact your provider for an in-depth discussion. In the meantime, Carbon Health has a video providing a brief explainer, which is shared below.