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LOOK CLOSERat the complete picture with CGM
Quick 3 Step Guide1-2-3
to interpret iPro™2 Professional CGM Report
India Medtronic Pvt. Ltd.1241 Solitaire Corporate Park, Bldg. 12, 4th Floor, Andheri-Ghatkopar Link Road, Andheri (E), Mumbai 400 093Tel: +91 22 3307 4700/01/02/03 | Fax: +91 22 3307 4704 | e-mail: [email protected]
Simple 2 Start.Easy 2 Evaluate.
Pump therapy is simple foryou and your patientsYour partner for diabetes care
Indications for Insulin Pump Therapy
Ü High insulin requirements
Ü Fear of Hypoglycemia
Ü Complications associated with diabetes
Ü Missed injections
Ü Desire for improved lifestyle / flexibility
Ü Elevated A1C
Ü Glycemic fluctuations
Ü Dawn phenomenon
Ü Insulin resistance or glucose toxicity
Ü Weight concerns
Ü Gestational or pregnancy with type 2
Evaluate Pre-Prandial – (before meals)
Evaluate Post-Prandial – (2 to 3 hours after meals)
Evaluate Overnight – (12 am to 6 am)
Close Examinationof 3 Critical Periods
Daily Overlay
Help IdentifyCause and Effect
Quick Review ofGlucose Excursionsor Trends
3 Simple Steps
Support ReportInterpretation withCritical Patient Information
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
1OVE
RNIGHT
Hyp
erglycem
ia1
OVE
RNIGHT
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
erglycem
ia
This Guide is intended to provide healthcare professionals a simple 3 Step Methodology to interpret iPro™2 professional continuous glucose monitoring (CGM) reports.
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.Note: The graphs shown in this guide are recreated artwork to illustrate glucose patterns. They are not produced by the actual software.
Note:
Patient Log Sheet
Simple 2 Start.Easy 2 Evaluate. 3 Simple Reports
Supported by Patient Log Sheet
Daily Summary
Overlay by Meal
Time BG Meal (food/drink) Medication Dosage Activity Duration
Dat
e:
Time BG Meal (food/drink) Medication Dosage Activity Duration
Dat
e:
Time BG Meal (food/drink) Medication Dosage Activity Duration
Dat
e:
Overnight Period - Hypoglycemia (12 am – 6 am)
Simple 2 Start.Easy 2 Evaluate.
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
1OVE
RNIGHT
Hyp
erglycem
ia1
OVE
RNIGHT
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
erglycem
ia
Ÿ Decrease dose of oral medication which may affect nocturnal glucose
Ÿ
be too highDose of oral medication may
Ÿ
pump at night or basal insulin dose
Decrease basal rate on insulin
Ÿ
medication which may affect nocturnal glucose
Decrease dose of oral
Ÿ
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
Decrease dose of oral
Ÿ
insulin may be too highBasal rate or long acting basal
Ÿ
be too highDose of oral medication may
Ÿ
physical activityPrior evening exercise or
Ÿ Prior evening alcohol use Ÿ
alcohol use on glucoseEducate patient on effects of
Ÿ
pump at night or basal insulin dose
Decrease basal rate on insulin
Ÿ
pump at night or basal insulin dose during periods of fasting
Decrease basal rate on insulin
Ÿ
insulin may be too highBasal rate or long acting basal
Ÿ Fasting
Potential Causes ConsiderationsUse “Overlay By Meal” [Night Time Sensor Data]
Nocturnal Hypoglycemia
400
300
200
100
40
0
Mon Tue Wed Thu Fri Sat Average
11:00p 12:00a 1:00a 2:00a 3:00a 4:00a 5:00a 6:00a
TargetRange
..........
....................................... .............................................................................. . ....70
Night Time Sensor Data (mg/dL)
Rebound Hyperglycemia
400
300
200
100
40
0
Mon Tue Wed Thu Fri Sat Average
11:00p 12:00a 1:00a 2:00a 3:00a 4:00a 5:00a 6:00a
TargetRange
70
............................................ . .................... . .........
.........
..................
............
Night Time Sensor Data (mg/dL)
Ÿ
larger dinner with high fat content
Late evening snack/dinner or
Potential Causes ConsiderationsUse “Overlay By Meal” [Night Time Sensor Data]
Ÿ
meal (i.e. fat and quantity) and dinner insulin bolus
Ÿ If on insulin pump, consider dual wave bolus
Evaluate previous evening
Ÿ
medicationInadequate dose of oral
Ÿ
acting basal insulinInadequate basal rate or long
Ÿ Variable exercise pattern
Ÿ Variable sleep pattern
Ÿ
medication which would affect fasting glucose
Increase dose of oral
Ÿ
pump at night or basal insulin dose
Increase basal rate on insulin
Ÿ
time / intensity to test glycemic response
Use standardized exercise
Ÿ
days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”)
Review excursions for specific
Ÿ
timeImprove regularity of sleep
Simple 2 Start.Easy 2 Evaluate.
Overnight Period - Hyperglycemia (12 am – 6 am)
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
1OVE
RNIGHT
Hyp
erglycem
ia2
PRE-PR
ANDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
erglycem
ia
Ÿ
be too highDose of oral medication may
Potential Causes ConsiderationsUse “Overlay By Meal”
Ÿ
medication which would affect pre-meal glucose
Decrease dose of oral
Ÿ
insulin may be too highBasal rate or long acting basal
Ÿ
may be too highInsulin bolus with last meal
Ÿ Exercise or physical activity
Ÿ
pump prior to meal or basal insulin dose
Decrease basal rate on insulin
Ÿ
prior mealDecrease insulin bolus with
Ÿ
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
Decrease dose of oral
Ÿ
“Daily Summary” and “Patient Log Sheet”)
Review previous meal (Use
Simple 2 Start.Easy 2 Evaluate.
Pre-Prandial Periods - Hypoglycemia (Breakfast - Lunch - Dinner)
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
erglycem
ia
Ÿ
acting basal insulinInadequate basal rate or long
Potential Causes ConsiderationsUse “Overlay By Meal”
Ÿ
observed hyperglycemia period or basal insulin dose
Increase basal rate prior to
Ÿ
last mealInadequate insulin bolus from
Ÿ
medicationInadequate dose of oral
Ÿ Variable exercise pattern
Ÿ
insulin regimenNon compliant to oral or
Ÿ
prior mealIncrease insulin bolus with
Ÿ
medication which would affect pre-meal glucose
Increase dose of oral
Ÿ
medication with excursion (Use “Daily Summary”and “Patient Log sheet”)
Connect behavior and
Ÿ
time/intensity prior to meal to test glycemic response
Use standardized exercise
Ÿ
complianceEducate patient on
Ÿ
days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”)
Review excursions for specific
Simple 2 Start.Easy 2 Evaluate.
Pre-Prandial Periods - Hyperglycemia (Breakfast - Lunch - Dinner)
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
2PR
E-PR
ANDIAL
Hyp
erglycem
ia
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia3
POST-PRA
NDIAL
Hyp
oglycemia
Simple 2 Start.Easy 2 Evaluate.
Post-Prandial Periods - Hypoglycemia (Breakfast - Lunch - Dinner)
Ÿ
be too highDose of oral medication may
Potential Causes ConsiderationsUse “Overlay By Meal”
Ÿ
medication which would affect post-prandial glucose
Decrease dose of oral
Ÿ
highPre-meal bolus may be too
Ÿ
activityPrior exercise or physical
Ÿ Delayed food absorption
Ÿ
bolus which would affect post-prandial glucose
Decrease pre-meal insulin
Ÿ
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
Decrease dose of oral
Ÿ
“Daily Summary” and “Patient Log Sheet”)
Review previous meal (Use
Ÿ
medicationInadequate dose of oral
Potential Causes ConsiderationsUse “Overlay By Meal”
Ÿ
medication which would affect post-prandial glucose
Increase dose of oral
Ÿ
(this could include an inadequate dose of correction insulin)
Inadequate pre-meal bolus
Ÿ
and quantityVariable meal composition
Ÿ Variable exercise pattern
Ÿ
insulin regimenNon compliant to oral or
Ÿ
bolusIncrease pre-meal insulin
Ÿ
low fat meal to test glycemic response
Ÿ Count carbohydrates , if on insulin with meals
Use standardized known carb,
Ÿ
time/intensity to test glycemic response
Use standardized exercise
Ÿ
complianceEducate patient on
Ÿ
days to better understand the relationship between activity and glucose control (Use “Daily Summary” and “Patient Log Sheet”)
Review excursions for specific
Simple 2 Start.Easy 2 Evaluate.
3PO
ST-PRA
NDIAL
Hyp
erglycem
ia
Post-Prandial Periods - Hyperglycemia (Breakfast - Lunch - Dinner)
