Recommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 Diabetes

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Insulin 4 endocrinologydiseasesdrugs
hyperglycemia 4 endocrinologydiseases
hypoglycemia 16 endocrinologydiseases

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Insulin 132 Science and TechnologyRecommendations for Using Real-Time Continuous Glucose Monitoring (rtCGM) Data for Insulin Adjustments in Type 1 DiabetesJeremy PettusSteven V. Edelman1University of California, San Diego, San
Insulin 8642 provide a framework to patients and clinicians on how to make these adjustments.[37]Using rtCGM Data for Insulin Dosing DecisionsImportant Conceptual Shift in Treatment Decision MakingUtilizing rtCGM data for therapy
Insulin 17704 meal first and closely monitor the glucose trend to confirm mitigation of the impending hypoglycemia. Insulin may or may not be needed depending on the size and nutrient composition of the meal, the amount of insulin
Insulin 19033 the patient would give a correctional dose of 3.7 units to achieve the glucose target of 110 mg/dl. Insulin pump users simply enter the 30-minute anticipated glucose into their pump and the correction dosage
Select Disease Character Offset Disease Term Instance
hyperglycemia 3114 does not provide adequate information to effectively manage insulin-treated diabetes to avoid extreme hyperglycemia and safeguard against hypoglycemia, which remains an ongoing threat to personal safety and well-being.[11][12][13][14][15]-[16]Whereas
hyperglycemia 7492 adjustments (increases and reductions), resulting in improved HbA1c and reduced frequency/severity of both hyperglycemia and hypoglycemia. These dosage adjustments were significantly greater than the 10-20% adjustments in
hyperglycemia 22298 for CHO containing meals. However, high fat/protein meals have delayed absorption and lead to delayed hyperglycemia , meaning that insulin doses may have to be adjusted accordingly.[44]Active insulin: The duration of
hyperglycemia 27659 “trial and error” is the norm rather than the exception.Preventing the duration and severity of hyperglycemia , while avoiding hypoglycemia is the goal in T1D. We feel that the introduction of CGM is one of the
hypoglycemia 2324 explore how 222 individuals with T1D used rtCGM successfully, defined as having a good A1c and minimal hypoglycemia , in their everyday self-management. Findings from the survey will be discussed throughout the article.
hypoglycemia 3150 to effectively manage insulin-treated diabetes to avoid extreme hyperglycemia and safeguard against hypoglycemia , which remains an ongoing threat to personal safety and well-being.[11][12][13][14][15]-[16]Whereas
hypoglycemia 4606 data (with MARD <10%) in combination with ROC arrows and alerts/alarms largely mitigates potential hypoglycemia risks associated with rtCGM-based dosing decisions and often improve glycemic outcomes.[18],[19] One
hypoglycemia 6102 of real-time rtCGM improves glycemic control as measured by HbA1c, improves time in range, reduces hypoglycemia , and improves quality of life in both children and adults with T1D.[26][27][28][29][30][31][32][33][34]-[35]
hypoglycemia 7063 survey of 222 T1D individuals who were successfully using rtCGM; success was defined as “minimal hypoglycemia , no severe hypoglycemia” and good glycemic control (mean HbA1c 6.9%), and found that they rely on
hypoglycemia 7087 individuals who were successfully using rtCGM; success was defined as “minimal hypoglycemia, no severe hypoglycemia ” and good glycemic control (mean HbA1c 6.9%), and found that they rely on their rtCGM system features,
hypoglycemia 7510 and reductions), resulting in improved HbA1c and reduced frequency/severity of both hyperglycemia and hypoglycemia . These dosage adjustments were significantly greater than the 10-20% adjustments in insulin dosing used
hypoglycemia 13600 together in time). If a user gives a correction dose within 2 hours of the last bolus, the risk of hypoglycemia is increased because subcutaneously delivered rapid-acting insulin can take up to 90-120 minutes to
hypoglycemia 17064 negate the need for a correction dose, thereby minimizing the risk of insulin “stacking” and delayed hypoglycemia .[44]Prandial Dosing With Angle DOWN ROC ArrowIn this scenario, the rtCGM shows that the current glucose
hypoglycemia 17690 to eat the meal first and closely monitor the glucose trend to confirm mitigation of the impending hypoglycemia . Insulin may or may not be needed depending on the size and nutrient composition of the meal, the amount
hypoglycemia 20710 range or does not level off, the patient should obviously take appropriate actions to prevent impending hypoglycemia . This example highlights, again, the importance of incorporating the ROC information, as in these 2
hypoglycemia 22703 reducing the correction dose. Otherwise, this can result in insulin “stacking,” which can lead to hypoglycemia .Limitations of Dosing Adjustments Based on ROC ArrowsAlthough we have seen significant improvements
hypoglycemia 23963 direction, the dosing adjustments should not be based on the ROC arrows. For example, following treatment of hypoglycemia , the trend arrows, which had been pointing down, may lag behind the trend graph. So, although the glucose
hypoglycemia 26835 and may still be working 3-5 hours after their last injection. Stacking insulin poses a high risk for hypoglycemia ; whereas, administration of conservative insulin doses, guided by rtCGM data, mitigates this risk.7.
hypoglycemia 27689 norm rather than the exception.Preventing the duration and severity of hyperglycemia, while avoiding hypoglycemia is the goal in T1D. We feel that the introduction of CGM is one of the most important advances for people
hypoglycemia 28040 validated questionnaire of 222 successful rtCGM users (mean HbA1c of 6.9% with minimal, mild, and no severe hypoglycemia ), but also from our own personal experience living with T1D for a combined 68 years, and from seeing

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