#433 CGMs, Insulin, and How to Adjust Diabetes Meds to Glucose Patterns

Step up your diabetes game! Learn the ins and outs of continuous glucose monitors (CGM) including key features, what and how to order, interpreting CGM data (time in range, time above range, etc.), and how to make adjustments to a patient’s insulin regimen, aka “insulin pattern matching”. We discuss common scenarios including overnight hypoglycemia, exercise-induced hypoglycemia, post-prandial hyperglycemia, what to do when the patient runs high all the time, and how to incorporate GLP1 agonists and SGLT2 inhibitors into a patient's regimen. Returning guest and Paul’s favorite frenemy, Dr. Jeff Colburn (VCU Health) returns!

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Show Segments

00:00 Introduction and Diabetes Puns

01:00 Introduction of Guest and Topic

09:12 Qualifications and Eligibility for CGMs

11:32 Types of CGMs and Sensor Placement

24:47 Interpreting CGM Data and Alarms

34:30 Troubleshooting Patterns and Adjustments

35:23 Understanding Hypoglycemia and Counter Regulatory Hormone Responses

36:15 The Rule of 15 and Addressing Hypoglycemia

37:10 Reducing Basal Insulin to Address Nocturnal Hypoglycemia

38:29 Addressing Postprandial Highs with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin

39:51 Managing Exercise-Induced Hypoglycemia

41:43 Preventing Exercise-Induced Hypoglycemia with Snacks

43:42 Managing Nocturnal Hypoglycemia with Sulfonylureas

45:31 Addressing Postprandial Hyperglycemia with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin

46:54 Adjusting Basal Insulin to Address Morning Hyperglycemia

51:18 Troubleshooting High Blood Sugars with Basal Insulin and Mealtime Insulin

56:49 Managing High Blood Sugars with Basal Insulin and Mealtime Insulin

57:44 Addressing Adherence and Medication Barriers

59:39 Using Continuous Glucose Monitors (CGMs) for Diabetes Management

01:02:30 Using Sulfonylureas and Basal Insulin Combination as a Stopgap

01:05:49 Considering Patient Adherence and Barriers to Treatment

Credits

Writer and Producer: Matthew Watto MD, FACP

Show Notes: Matthew Watto MD, FACP

Cover Art and Infographic: Matthew Watto MD, FACP

Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   

Reviewer: Emi Okamoto MD

Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP

Technical Production: PodPaste

Guest: Jeff Colburn MD

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