![]() Suppose a person who is about to consume 60 g carbohydrates has an I:C ratio of 1:15 that person would need 4 units of insulin to cover the carbohydrate content of the meal. ![]() Many people with diabetes dose their mealtime insulin based on two factors: the carbohydrates in the food they are about to eat (using their I:C ratio) and their need for correctional insulin to bring their current premeal glucose level into the target range (based on an individualized insulin sensitivity factor, which is the blood glucose lowering in mg/dL to be expected per unit of rapid-acting insulin delivered when glucose is above target). Trend arrows may be used to make insulin dose adjustments for CGM users who are prescribed bolus insulin ( 8, 30). Note that vitamin C and salicylic acid (aspirin) may affect the accuracy of readings with the FreeStyle Libre and Medtronic systems.Ĭan prevent hypoglycemia during and after exercise. For FreeStyle Libre users, a gap in data may be present if sleeping >8 hours.Ĭurrent readings and trend arrows inform mealtime insulin dose calculations and timing of insulin injections around meals.Įnables evaluation of mealtime treatment and determination of the need for corrective action.Įnables evaluation of current glucose reading and trend arrow to determine whether corrective action is needed to prevent nocturnal hypoglycemia or hyperglycemia.Īllows for monitor of the effects of illness on glucose levels. Table 2 describes various scanning and viewing strategies for CGM users ( 8).įacilitates completed stream of readings and retrospective review of previous night’s glucose trends. Patients can also benefit economically because there is no additional cost for frequent scanning or viewing sensor glucose information compared with fingerstick BGM, which requires a new test strip for each reading. ![]() Effects on hypoglycemia occur as early as within the first 48 hours of sensor use, with further hypoglycemia reduction in the ensuing week ( 23). Moreover, reductions in A1C occur early with use of the FreeStyle Libre system and are sustained over time ( 26). In an international study of patients who averaged 16 scans per day, higher frequency scanning yielded significantly better glycemic outcomes compared with low-frequency scanning, a result that was consistent across the various countries in the study ( 23). Frequent scanning provides favorable benefits such as improved overall TIR and decreased hypoglycemia and A1C ( 23– 25). The Freestyle Libre requires users to scan it a minimum of once every 8 hours to capture all of the data because the on-body sensor only stores 8 hours of glucose data at a time. Outside of the United States, the FreeStyle Libre, Dexcom G6, and Medtronic Guardian systems are approved for use in pregnant women however, at this time no personal CGM devices are approved for such use in the United States. In addition, individuals with poorly managed diabetes would benefit from real-time monitoring combined with education about the effects of diet, activity, and medications on glycemic management. Other candidates for CGM would be patients with advanced age or complex patients with comorbid and additional chronic diseases who may be at increased risk for hypoglycemia and hospitalization for complications related to glucose control. For those at risk for hypoglycemia such as patients using sulfonylureas, basal insulin, mealtime insulin, or insulin pumps, CGM systems that have alarms such as the Dexcom G6, Medtronic Guardian Connect, Eversense, or FreeStyle Libre 2 would be preferred because they all offer real-time glucose alerts. ![]() Ideal candidates for personal CGM use would be individuals who need or want more engagement with their diabetes management. For patients using the system’s app on a mobile device, data are automatically uploaded to the Cloud, allowing HCPs to view data at any time by logging into an HCP portal. For patients using a dedicated reader that comes with their device, data can be downloaded in the clinic or at home by patients using a cable that connects the reader to a computer. This type of system is sometimes referred to as “flash CGM.” All the systems shown in Table 1 provide software that allows results to be accessed by HCPs and patients, which can be useful for both educational and treatment purposes. In addition, the FreeStyle Libre system requires the user to “swipe,” or scan, the receiver or a smartphone over the sensor to obtain a reading. Differences among the available systems include varying need for calibration with fingerstick BGM, differing software and phone applications (apps) for data showing and interpretation, and differing sensor warm-up periods and wear times. Several options exist for both professional and personal CGM ( Table 1). ![]()
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