Methodology Interpret CGM - infusemeddev.cominfusemeddev.com/medtronic/ADVANCE Powerpoints-pdf/Methodolog… · Objective Understand an easy to follow methodology for interpreting

Methodology to Interpret CGM Data

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Objective

Understand an easy to follow methodology for interpreting CGM tracings (the continuous blood glucose measurements)

Key Points

1-2-3 Methodology:

•Breaks down review of CGM tracings into manageable parts

•Analyze cause and effect of blood glucose changes throughout a patient’s day

•Provide therapy recommendations to improve a patient’s blood glucose control and diabetes management

1-2-3 Methodology

Three Steps to Analyze CGM Reports:

• Step 1: Look at the overnight period first

• Step 2: Look at pre-prandial levels

• Step 3: Look at post-prandial levels

Step 1: Look at the Overnight Period

Definition of Overnight Period• Night time period no longer

influenced by the last evening meal / snack

• True fasting period is usually midnight to 6 a.m.

Identify fasting values that are hypo and hyper• Anything below target range is hypo• Anything above target range is hyper• Target ranges are individually set

First: Look for Hypo•For glucose levels BELOW low limit

– Problem: basal rate is probably too high– Solution: decrease basal rate?

Second: Look for Hyper•For glucose levels ABOVE high limit

– Problem: basal rate is probably too low– Solution: increase basal rate?

Step 1: Look at the Overnight Period

Definition: Period just before asnack or meal• What is seen before a meal?

– Previous bolus (active insulin) – Previous meal residual – Post-meal activities

Identify glucose values that are hypoand hyper• Find the cause-effect relationship of

previous meal / bolus / activity• Look at breakfast, then lunch, then

dinner

Step 2: Look at Pre-prandial Periods

First: Look for HypoConsider:• Influence of bolus, previous meal,

active insulin • Exercise and activity• Food: Timing, Quantity, Composition

Second: Look for HyperConsider:• Same considerations as hypo• Plus breakfast related dawn phenomenon

Step 2: Look at Pre-prandial Periods

Definition: 3-hour period following food intake Peak values should be lower than 135-180 mg/dl (7.5 – 10.0 mmol/l)• What is seen after a meal?

– That meal’s bolus (active insulin) – Previous meal residual – Post-meal activities

Identify glucose values that are hypo and hyper• Find the cause-effect relationship

of previous meal / bolus / activity• Look at breakfast, then lunch, then dinner (and major snacks)

Step 3: Look at Post-prandial Periods

First: Look for Hypo• If hypoglycemia is observed in the

PP period (2–3 hours after meal):– Suggests issue with the bolus for that meal – Consider timing, type, accuracy of bolus – Consider influence of exercise

Second: Look for Hyper• If Hyperglycemia peaks above 180 mg/dl

(<10.0mmol/l) post meal:– Consider timing, type, accuracy of bolus– Consider food intake, food quantity and meal composition

Step 3: Look at Post-prandial Periods

Use Sensor Summary Report in Addition to the Tracings

Other Reports

• Monitor recorded over 860 readings• Average glucose sensor reading 170 mg/dL• However, range is 40 – 330 mg/dL

Day 2Day 1 TotalsDay 3Day 2Day 1 TotalsDay 3

# of Sensor Values 286 286 288# of Sensor Values 286 286 288 860

Average (mg/dL) 140 155 165 170Average (mg/dL) 140 155 165 170

Min – Max (mg/dL) 30 - 240 70 - 240 40 - 330 40 – 330Min – Max (mg/dL) 30 - 240 70 - 240 40 - 330 40 – 330

Sensor Summary Report

60%11%

29%Hyperglycemia > 140/mg/dl/min

Hypoglycemia< 70mg/dl/min

Target Range:70 to 140 mg/dl/min

Percentage of Time in High, Low and Target Range

Dawn Phenomenon

FridaySaturdaySunday

FridaySaturdaySunday

Nocturnal Hypoglycemia

Modal Day Summary Report: Case Study

Postprandial Hyperglycemia

Nocturnal Hypoglycemia

Modal Day Summary Report: Case Study

Medtronic Diabetes18000 Devonshire StreetNorthridge, CA 91325www.medtronicdiabetes.com 1-800-646-4633