Why should we monitor glucose? 2 1 2/28/2020 American Diabetes - - PDF document

▶
why should we monitor glucose
SMART_READER_LITE
LIVE PREVIEW

Why should we monitor glucose? 2 1 2/28/2020 American Diabetes - - PDF document

Oct 11, 2022 494 likes •698 views

2/28/2020 Type 2 Topics: Monitoring Your Glucose with CGMs: To Poke or Not to Poke? Kevin Kam, RPh, CDCES inControl Diabetes Center WWW.TCOYD.ORG WWW.TCOYD.ORG Taking Control Of Your Diabetes, 501(c)3 is a not-for-profit educational

slide-1
SLIDE 1

2/28/2020 1

Taking Control Of Your Diabetes, 501(c)3 is a not-for-profit educational organization.

WWW.TCOYD.ORG

Taking Control Of Your Diabetes, 501(c)3 is a not-for-profit educational organization.

WWW.TCOYD.ORG

Type 2 Topics: Monitoring Your Glucose with CGMs: To Poke or Not to Poke?

Kevin Kam, RPh, CDCES

inControl Diabetes Center

Why should we monitor glucose?

1 2

slide-2
SLIDE 2

2/28/2020 2

American Diabetes Association

Recommendations for Assessment of Glucose Control

  • SMBG allows patients to evaluate their individual response to therapy

and assess whether glycemic targets are being safely achieved.

  • Integrating SMBG results into diabetes management can be a useful

tool for guiding medical nutrition therapy and physical activity, preventing hypoglycemia, and adjusting medications (particularly prandial insulin doses).

  • Among patients with type 1 diabetes, there is a correlation between

greater SMBG frequency and lower A1C. The patient's specific needs and goals should dictate SMBG frequency and timing.

American Diabetes Association Diabetes Care 2019 Jan; 42(Supplement 1): S73

Summary of Glycemic Targets

  • American Diabetes Association (ADA)*:
  • Preprandial: 80‐130 mg/dL
  • Peak postprandial⁺: <180 mg/dL
  • Hemoglobin A1c: <7.0% (needs to be individualized)
  • American Association of Clinical Endocrinologist (AACE):
  • Fasting plasma glucose: <110 mg/dL
  • 2‐Hour postprandial glucose: <140 mg/dL
  • Hemoglobin A1c: <6.5% (needs to be individualized)

*Non‐pregnant Adults ⁺1‐2 hours after the beginning of the meal

Summary of Glycemic Recommendations

Diab Care, s66 Vol 42 Supplement 1, Jan 2019 Endo Practice Vol 24 No. 1 January 2018

3 4

slide-3
SLIDE 3

2/28/2020 3

If glucose monitoring is helpful, how

  • ften should we test?

Intensive Insulin Regimens

  • Prior to meals and snacks
  • At bedtime
  • Occasionally postprandially
  • Before exercise
  • When they suspect low blood glucose and after treating low blood

glucose until they are normoglycemic

  • Prior to critical tasks such as driving

Most patients using intensive insulin regimens (multiple‐dose insulin

  • r insulin pump therapy) should perform SMBG:

(For many patients, this will require testing 6–10 times daily, although individual needs may vary)

American Diabetes Association Diabetes Care 2019 Jan; 42(Supplement 1): S73

5 6

slide-4
SLIDE 4

2/28/2020 4

T1D Exchange Registry

Miller K, et al Diab Care, Vol 36, July 2013

13‐25 years old 1‐12 years old 26‐50 years old > 50 years old

Assessing the Association between SMBG Frequency and A1c (all T1 patients) T2D on Basal Insulin/Oral Agents

  • The evidence is insufficient regarding when to

prescribe SMBG and how often testing is needed for patients with type 2 diabetes using oral agents

  • For patients using basal insulin, assessing fasting

glucose with SMBG to inform dose adjustments to achieve blood glucose targets results in lower A1Cs

  • Glucose monitoring can provide insight into the

impact of diet, physical activity, and medication management on glucose levels.

  • Assessing hypoglycemia
  • Medicare Allowance:

– Not on insulin: 100 test strips/90 days – Insulin: 100 test strips/30 days

American Diabetes Association Diabetes Care 2019 Jan; 42(Supplement 1): S73‐S74

7 8

slide-5
SLIDE 5

2/28/2020 5

1950’s 1980’s 2000’s

Home Glucose Monitoring

What is a Continuous Glucose Monitor (CGM)?

9 10

slide-6
SLIDE 6

2/28/2020 6

Typical CGM System

  • 1. Glucose sensor inserted under the skin
  • Measures glucose every 1-15 minutes
  • CGMs measure interstitial glucose
  • 2. Wireless transmitter
  • Sends glucose measurements
  • 3. Receiver (or smart phone)
  • Store, process, and display glucose

values and trends

Continuous Glucose Monitors (CGMs) Measure Interstitial Glucose

Interstitial glucose correlates well with plasma glucose.

11 12

slide-7
SLIDE 7

2/28/2020 7

https://diatribe.org/BeyondA1c

3 people, all with an A1c of 7%

https://diatribe.org/BeyondA1c

13 14

slide-8
SLIDE 8

2/28/2020 8

Trend Arrows

More information is better!

Trend Arrows… Where is your glucose going?

15 16

slide-9
SLIDE 9

2/28/2020 9

What to Do?

  • Keep an eye
  • n it
  • Go for a walk
  • Take insulin?

220 mg/dl

Alerts and Alarms

  • Dexcom ✔
  • Medtronic ✔
  • Eversense ✔
  • Not currently

available with Freestyle Libre

17 18

slide-10
SLIDE 10

2/28/2020 10

Share your data with friends and family Use your glycemic report to review your glucose data

19 20

slide-11
SLIDE 11

2/28/2020 11

21 22

slide-12
SLIDE 12

2/28/2020 12

Benefits of CGM

Consistent Use: ■ Empowers you to make healthy decisions ■ Can improve your A1c and “Time in Range” (blood glucose between 70-180 mg/dL) ■ May decrease hypoglycemia

Current CGM Options

23 24

slide-13
SLIDE 13

2/28/2020 13

Freestyle Libre 14 Day

  • Sensor worn for 14 days

– Simple insertion – 1 hour “warm up”

  • Swipe reader or smartphone over

sensor to get glucose value

– Includes glucose trend arrows

  • No fingerstick required

– Reader is also a glucose meter if needed

  • No alerts/alarms

Medtronic Guardian 3

  • Sensor worn for 7 days

– Insertion slightly more complex – 2 hour “warm up” period

  • Sends glucose data to insulin pump or

smartphone

– Includes glucose trend arrows

  • Requires 2-4x calibrations (fingersticks)

per day

  • Has alerts/alarms and sharing capability

25 26

slide-14
SLIDE 14

2/28/2020 14

Dexcom G6

  • Sensor worn for 10 days

– Simple insertion – 2 hour “warm up”

  • Sends glucose data to receiver or

smartphone

– Includes glucose trend arrows

  • No fingerstick required
  • Has alerts/alarms and sharing

capability

Sensor Smart Transmitter Mobile App Sensor lasts up to 90 days No weekly sensor insertion Removable and rechargeable On-body vibe alerts Gentle, daily adhesive patch iOS and Android platform Alarm settings & reports

Senseonics Eversense

Implantable Continuous Glucose Monitor

27 28

slide-15
SLIDE 15

2/28/2020 15 As a general rule, when the glucose results being displayed by the CGM system does NOT match symptoms, patients should confirm their glucose levels via fingerstick. Additionally, exposure to interfering substances in the blood may cause glucose sensor to inaccurately measure glucose.

  • Acetaminophen (DexG5-Not G6)
  • Ascorbic Acid/Salicylic Acid (FS Libre 14d)
  • Mannitol/Sorbitol (I.V. or PD solution-Eversense)

Don’t throw out your home glucose monitor just yet!

What's on the Horizon?

29 30

slide-16
SLIDE 16

2/28/2020 16

Freestyle Libre 2

  • Update to current Freestyle

Libre system

  • Will include optional glucose

alarms

  • Available in Europe
  • Not yet FDA approved

Dexcom G7 (under development)

  • Factory calibrated
  • Fully disposable
  • Simple application
  • Significant cost

reduction

31 32

slide-17
SLIDE 17

2/28/2020 17

Insurance Coverage

Medicare and Other Plans

  • Type 1 or Type 2 diabetes diagnosis
  • Monitoring blood glucose 4x a day or more
  • Using 3 or more insulin injections per day or

wearing an insulin pump

  • Adjust your insulin regimen based on your

glucose monitoring results

  • Visit HCP in the past 6 months and will continue

to see your HCP every 6 months

Copy of my slides: www.incontrolhawaii.net

password: TCOYD2020

33 34

slide-18
SLIDE 18

2/28/2020 18

Taking Control Of Your Diabetes, 501(c)3 is a not-for-profit educational organization.

WWW.TCOYD.ORG

Taking Control Of Your Diabetes, 501(c)3 is a not-for-profit educational organization.

WWW.TCOYD.ORG

Closing Session & Drawing 4:30PM Ballroom 313

Laugh Your Way to Lower Blood Sugars

Frank DeLima, Comedian and Entertainer We will be collecting drawing tickets at 4:30PM. Please place your duplicate ticket(s) into the box on the main-stage just prior to the closing session.

35