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Quick Guide to Interpret iProTM2 CGM Reports
- 1. 1-2-3 Quick 3 Step Guide to interpret iPro™2 Professional CGM Report Pump therapy is simple for you and your patients Your partner for diabetes care Indications for Insulin Pump Therapy Ü Elevated A1C Ü High insulin requirements Ü Glycemic fluctuations Ü Fear of Hypoglycemia Ü Dawn phenomenon Ü Complications associated Ü Insulin resistance or glucose toxicity Ü Weight concerns Ü Gestational or pregnancy with diabetes Ü Missed injections Ü Desire for improved lifestyle LOOK CLOSER / flexibility at the complete picture with CGM with type 2 India Medtronic Pvt. Ltd. 1241 Solitaire Corporate Park, Bldg. 12, 4th Floor, Andheri-Ghatkopar Link Road, Andheri (E), Mumbai 400 093 Tel: +91 22 3307 4700/01/02/03 | Fax: +91 22 3307 4704 | e-mail: rs.indiadiabeteshelpdesk@medtronic.com Simple 2 Start. Easy 2 Evaluate.
- 2. OVERNIGHT Hypoglycemia Simple 2 Start. Easy 2 Evaluate. 1 3 Simple Reports Supported by Patient Log Sheet Note: OVERNIGHT Hyperglycemia This Guide is intended to provide healthcare professionals a simple 3 Step Methodology to interpret iPro™2 professional continuous glucose monitoring (CGM) reports. 1 You may use the information in the report to adjust therapies and/or suggest lifestyle changes for your patients. It is recommended that you make only one or two adjustments for your patient at a time to better understand the effect of each change on his/her glucose control. PRE-PRANDIAL Hypoglycemia Note: The graphs shown in this guide are recreated artwork to illustrate glucose patterns. They are not produced by the actual software. 2 3 Simple Steps Overlay by Meal Close Examination of 3 Critical Periods Quick Review of Glucose Excursions or Trends Daily Summary Meal (food/drink) Medication Dosage Activity Duration Time BG Meal (food/drink) Medication Dosage Activity Duration Time BG Meal (food/drink) Medication Dosage Activity Duration Date: Date: Evaluate Post-Prandial – (2 to 3 hours after meals) Patient Log Sheet Support Report Interpretation with Critical Patient Information 3 BG Date: Time POST-PRANDIAL Hyperglycemia Evaluate Pre-Prandial – (before meals) 3 Help Identify Cause and Effect POST-PRANDIAL Hypoglycemia 2 Evaluate Overnight – (12 am to 6 am) PRE-PRANDIAL Hyperglycemia Daily Overlay
- 3. Wed Thu Fri Sat Ÿ Basal rate or long acting basal 400 insulin may be too high 300 Ÿ Prior evening exercise or 200 physical activity .. ..... ..... .... ...... ....... ........ .... .... . 100 Target Range . . . . .. 70 .......................................................................... . .... 40 0 11:00p 12:00a 1:00a 2:00a 3:00a 4:00a 5:00a 1 Average 6:00a Ÿ Prior evening alcohol use Ÿ Decrease basal rate on insulin Ÿ Decrease dose of oral medication or insulin which may affect nocturnal glucose Ÿ Decrease basal rate with use of temp basal feature on insulin pump at night Ÿ Educate patient on effects of exercise on glucose Ÿ Educate patient on effects of alcohol use on glucose Rebound Hyperglycemia Ÿ Dose of oral medication may be too high Night Time Sensor Data (mg/dL) Mon Tue Wed Thu Fri Sat Average Ÿ Decrease dose of oral medication which may affect nocturnal glucose 400 Ÿ Basal rate or long acting basal 300 insulin may be too high 200 . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 100 .... .... 70 .... ... . . . . .......... .... . . . . . .. .... . ... .... ... ....... ....... ........ ........ 0 12:00a 1:00a 2:00a 3:00a Ÿ Fasting Ÿ Decrease basal rate on insulin pump at night or basal insulin dose Ÿ Decrease basal rate on insulin pump at night or basal insulin dose during periods of fasting 40 11:00p Target Range 4:00a 5:00a 6:00a 1 pump at night or basal insulin dose 2 Tue medication which may affect nocturnal glucose 2 Night Time Sensor Data (mg/dL) Ÿ Decrease dose of oral 3 be too high 3 Ÿ Dose of oral medication may OVERNIGHT Hyperglycemia Nocturnal Hypoglycemia Considerations PRE-PRANDIAL Hypoglycemia Potential Causes PRE-PRANDIAL Hyperglycemia Use “Overlay By Meal” [Night Time Sensor Data] POST-PRANDIAL Hypoglycemia (12 am – 6 am) Mon OVERNIGHT Hypoglycemia Simple 2 Start. Easy 2 Evaluate. POST-PRANDIAL Hyperglycemia Overnight Period - Hypoglycemia
- 4. Overnight Period - Hyperglycemia Simple 2 Start. Easy 2 Evaluate. Ÿ Increase dose of oral medication which would affect fasting glucose Ÿ Inadequate basal rate or long acting basal insulin Ÿ Increase basal rate on insulin pump at night or basal insulin dose Ÿ Variable exercise pattern Ÿ Use standardized exercise time / intensity to test glycemic response Ÿ Variable sleep pattern Ÿ Improve regularity of sleep time Ÿ Review excursions for specific days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”) 1 2 Inadequate dose of oral medication 2 Ÿ 3 If on insulin pump, consider dual wave bolus 3 Evaluate previous evening meal (i.e. fat and quantity) and dinner insulin bolus PRE-PRANDIAL Hypoglycemia Late evening snack/dinner or larger dinner with high fat content Ÿ Ÿ Ÿ OVERNIGHT Hyperglycemia Considerations PRE-PRANDIAL Hyperglycemia Potential Causes POST-PRANDIAL Hypoglycemia Use “Overlay By Meal” [Night Time Sensor Data] POST-PRANDIAL Hyperglycemia (12 am – 6 am)
- 5. Pre-Prandial Periods - Hypoglycemia Simple 2 Start. Easy 2 Evaluate. Potential Causes Ÿ Decrease basal rate on insulin Insulin bolus with last meal may be too high Ÿ Decrease insulin bolus with Exercise or physical activity Ÿ Decrease dose of oral prior meal medication or insulin Ÿ Decrease basal rate with use of temp basal feature on insulin pump Ÿ Educate patient on effects of 2 2 pump prior to meal or basal insulin dose exercise on glucose Ÿ Review previous meal (Use “Daily Summary” and “Patient Log Sheet”) 3 Ÿ Basal rate or long acting basal insulin may be too high medication which would affect pre-meal glucose 3 Ÿ Ÿ Decrease dose of oral PRE-PRANDIAL Hypoglycemia Ÿ Dose of oral medication may be too high PRE-PRANDIAL Hyperglycemia Ÿ Considerations POST-PRANDIAL Hypoglycemia Use “Overlay By Meal” POST-PRANDIAL Hyperglycemia (Breakfast - Lunch - Dinner)
- 6. Pre-Prandial Periods - Hyperglycemia Simple 2 Start. Easy 2 Evaluate. (Breakfast - Lunch - Dinner) Potential Causes Ÿ Inadequate basal rate or long Considerations Increase insulin bolus with prior meal Increase dose of oral medication which would affect pre-meal glucose Connect behavior and medication with excursion (Use “Daily Summary”and “Patient Log sheet”) Ÿ Variable exercise pattern Ÿ Use standardized exercise time/intensity prior to meal to test glycemic response Ÿ Non compliant to oral or Ÿ Educate patient on compliance Ÿ Review excursions for specific days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”) Ÿ Inadequate dose of oral medication insulin regimen 2 Ÿ last meal 3 Ÿ Ÿ Inadequate insulin bolus from 3 Ÿ acting basal insulin PRE-PRANDIAL Hyperglycemia Increase basal rate prior to observed hyperglycemia period or basal insulin dose POST-PRANDIAL Hypoglycemia Ÿ POST-PRANDIAL Hyperglycemia Use “Overlay By Meal”
- 7. Post-Prandial Periods - Hypoglycemia Simple 2 Start. Easy 2 Evaluate. (Breakfast - Lunch - Dinner) Use “Overlay By Meal” Potential Causes Considerations Decrease dose of oral medication which would affect post-prandial glucose Pre-meal bolus may be too high Ÿ Decrease pre-meal insulin bolus which would affect post-prandial glucose Ÿ Prior exercise or physical activity Ÿ Decrease dose of oral medication or insulin Ÿ Decrease basal rate with use of temp basal feature on insulin pump Ÿ Educate patient on effects of exercise on glucose Ÿ Review previous meal (Use “Daily Summary” and “Patient Log Sheet”) Ÿ Delayed food absorption 3 Ÿ 3 Ÿ POST-PRANDIAL Hypoglycemia Dose of oral medication may be too high POST-PRANDIAL Hyperglycemia Ÿ
- 8. Post-Prandial Periods - Hyperglycemia Simple 2 Start. Easy 2 Evaluate. (Breakfast - Lunch - Dinner) Potential Causes Ÿ Inadequate dose of oral medication Ÿ Inadequate pre-meal bolus (this could include an inadequate dose of correction insulin) Ÿ Variable meal composition and quantity Considerations Ÿ Increase dose of oral medication which would affect post-prandial glucose Ÿ Increase pre-meal insulin bolus Ÿ Use standardized known carb, low fat meal to test glycemic response Ÿ Count carbohydrates , if on insulin with meals Ÿ Variable exercise pattern Ÿ Use standardized exercise time/intensity to test glycemic response insulin regimen Ÿ Educate patient on compliance Ÿ Review excursions for specific days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”) 3 Ÿ Non compliant to oral or POST-PRANDIAL Hyperglycemia Use “Overlay By Meal”