The Curbsiders Internal Medicine Podcast

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

42 snips

Apr 1, 2024

Learn about adjusting diabetes meds to glucose patterns with CGMs, insulin adjustments, hypoglycemia scenarios, post-prandial hyperglycemia, incorporating GLP1 agonists and SGLT2 inhibitors, troubleshoot patterns, managing exercise-induced hypoglycemia, and nocturnal hypoglycemia with sulfonylureas.

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ANECDOTE

Sensor Placement Is Quick And Well Tolerated

Jeff says he places ~15 new sensors weekly and patients rarely report pain on insertion.
He describes the applicator like a small pod with an auto‑firing needle that most patients tolerate well.

INSIGHT

CGM Alone Can Improve Behavior And A1C

Simply wearing a CGM often improves A1C in people not on insulin because real‑time feedback changes diet behavior.
Visibility of post-meal spikes motivates patients to alter food choices without extra meds.

ADVICE

Order The Right Sensor Quantity And Apps

Prescribe the correct number of sensors: Dexcom G7 needs three sensors/month; Libre 3 needs two sensors/month.
Use the vendor apps (Dexcom Clarity or FreeStyle Libre) to upload data for clinic review and cloud sharing.

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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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