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2	Making the Most of Continuous Glucose Monitoring What Information Is Available? How to Use Immediate Data? How to Use Intermediate Data? What Can Be Learned from Retrospective Analysis? Optimizing CGM System Performance
3	MiniMed Paradigm^® & Guardian^® REAL-Time CGM Systems On-Screen Reports
4	"CareLink" CareLink™ Personal: Online Reports
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6	DexCom^™7 STS^® On-Screen Reports
7	DexCom^™7 STS^®
8	DexCom^™7 STS^®
9	Freestyle Navigator^™ On-Screen Reports
10	Practical Benefits of Real-Time CGM Rumble strips (avoid serious extremes) Peace of mind Basal & bolus fine tuning Postprandial analysis Insulin action curve determination Short-term Forecasting Learning tool & immediate feedback Eliminates some blood glucose checks???
11	How to Look at the Information Immediate Intermediate Retrospective
12	Immediate Info: Alerts Alert the user of glucose levels that have crossed specified thresholds, either high or low Visual cues on-screen Vibrations, audible tones
13	Setting Alerts Individualize settings Alarm thresholds are not BG targets Balance need for alerts against “nuisance factor”
14	Alert Settings Recommendation LOW: 80 mg/dl (90+ if hypo unaware) HIGH: 240 mg/dL (lower progressively toward 180)
15	Special Alert Settings Young children (higher, wider range) Hypoglycemia unawareness (higher) Pregnancy (lower, narrower range) HbA1c of 11.0% (higher initially)
16	Immediate Info: Real-Time Adjustments
17	Immediate Info: Real-Time Adjustments
18	Immediate Info: Potential Bolus Adjustment Based on BG Direction
19	Immediate Info: Hypoglycemia Alerts
20	Intermediate Info: Use of 2/3/4 Hr Trend Graphs Effects of different food types Effectiveness of bolus amt. Reveals postprandial spikes Pramlintide/Exenatide Influence Exercise effects Impact of Stress
21	Intermediate Info: Use of 9 / 12 / 24 Hr Trend Graphs Facilitates decision-making for basal insulin doses Shows delayed effects of exercise, stress, high-fat foods Reveals overnight patterns Lets user know when bolus action is complete
22	Specific Insights to Derive
23	Case Study 1: Effectiveness of Current Program Type 1 diabetes; using insulin glargine & MDI Overnight readings are OK; HbA1c levels are elevated
24	Case Study 2a: Basal Insulin Regulation Rising 2 AM – 8 AM
25	Case Study 2b: Basal Insulin Regulation Type 1 diabetes; using insulin glargine & MDI History of morning lows Now not “covering” highs at night
26	Case Study 3: Detection of Silent Hypoglycemia Type1 diabetes; on pump Frequent fasting highs (9 AM)
27	Case Study 4: Determination of Insulin Action Curve 3-Hour Duration
28	Case Study 5: Fine-Tuning Meal Boluses
29	Case Study 6: Fine-Tuning Correction Boluses
30	Case Study 7: Postprandial Analysis Pre-meal BG levels are usually in target range HbA1c are higher than expected based on SMBG Tired and lethargic after meals
31	Case Study 8: Impact of Physical Activity Type 1 diabetes; pump user Basal rates confirmed overnight Exercises in the evening (9 PM)
32	Case Study 9: Impact of Stress Type 1 diabetes; pump user 40 years old; athletic Handsome, excellent speaker
33	Case Study 10: Impact of Various Food Types
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35	Optimal Calibration Calibrate at times when blood glucose (BG) is stable (fasting, pre-meals) Avoid calibrations during times of rapid glucose change Post meal UP or DOWN arrows are displayed In the period following a correction with food or insulin During exercise
36	Optimal Calibration Calibrate before bedtime to avoid alarms during the night Use good technique when performing BG checks for calibration Proper coding Clean hands USE FINGERSTICKS Enter the calibration immediately after the fingerstick (Dexcom, Medtronic systems)
37	Sensor Sites Site Selection “Fleshy” areas At least 3” Away from insulin infusion Avoid tight clothing areas, scars, bruises, lipoatrophy Rotate sites Bleeding/Irritation Slight bleeding OK Profuse bleeding: remove Remove introducer needle at proper angle
38	Sensor Sites Adhesive Completely cover the Transmitter & Sensor (Navigator & Medtronic systems) Check sensor daily for loose tape Apply extra tape over sensor & transmitter if tape patch begins to “curl” around edges Site Irritation Watch for redness, swelling, tenderness Remove sensor with prolonged irritation (>1 hour)
39	Signal Reception Heed transmitter ranges Medtronic: 6 ft. Dexcom: 5 ft. Navigator: 10 ft. Signals do not travel well through water Wear receiver on same side of body as sensor Keep receiver very close while charging (Dexcom) Charge transmitter fully every 6 days (Medtronic)
40	Ingredients For Success Wear the CGM at least 90% of the time Look at the monitor 10-20 times per day Do not over-react to the data Adjust your therapy based on trends/patterns Take IOB into account when using CGM values Minimize “nuisance” alarms
41	Think Like A Pancreas!