#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! Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME 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 Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Panacea Financial Download the 2024 Residents & Fellows Survey Report for free at panaceafinancial.com/report.