Diabetic coma and continuous glucose monitoring -
This way you will be able to access your testing equipment wherever you are, making it easier to manage your blood glucose. Glucose monitoring is useful for people with type 2 diabetes who take insulin or certain medications that can cause hypoglycemia.
It is generally unnecessary in people who manage their diabetes with diet alone or who take medications that do not cause hypoglycemia, especially if they have reached their glucose goals.
Your health care provider can help you determine how frequently to check your glucose based on your situation. Most people with type 2 diabetes who perform glucose monitoring use BGM.
For people taking insulin, CGM may be used if available and affordable. See 'Who should use CGM? How to check your blood glucose — The following steps include general guidelines for testing blood glucose levels.
However, because the instructions can vary between devices, it's best to check the package insert for your glucose meter or talk with your health care provider.
It's important to never share monitoring equipment or fingerstick devices, as this could lead to infection. Lancets that are used more than once are not as sharp as a new lancet and can cause more pain and injury to the skin.
Alternate sites are often less painful than the fingertip. However, results from alternate sites are not as accurate as fingertip samples. This should not be a problem if you always use the same site. However, when your blood glucose is rising rapidly eg, immediately after eating or falling rapidly in response to insulin or exercise , it's more accurate to use the fingertip, as testing at alternate sites may give significantly different results in these situations.
If you have difficulty getting a good drop of blood from your fingertip, try rinsing your fingers with warm water and shaking your hand below your waist. This can help get the blood flowing. The results will be displayed on the meter after several seconds.
Blood glucose meters — There is no single blood glucose meter that is better than others. Your health care provider or pharmacist can help you choose a meter based on your preferences as well as other factors like cost, ease of use, and accuracy; it should be one that is approved by either the International Organization for Standardization or the US Food and Drug Administration FDA.
Medicare also covers costs of BGM. Accuracy of home BGM — Blood glucose meters are reasonably accurate. However, there can be some variability between meters, so it is always wise to use caution and common sense. If you get a result that does not fit with how you feel for example, if it says your blood glucose is very low but you don't have any symptoms , take a second reading or use an alternate method for testing your blood glucose such as a different meter.
Blood glucose meters are least accurate during episodes of low blood glucose. See "Patient education: Hypoglycemia low blood glucose in people with diabetes Beyond the Basics ".
The accuracy of BGM can be affected by several factors, including the type of blood glucose strip and meter. Inaccurate readings can be caused by the use of expired strips, improper storage of strips exposure to high temperature and humidity , inadequate cleansing of your skin, and ingestion of vitamin C and acetaminophen.
It's a good idea to check the accuracy of your blood glucose meter occasionally by bringing it with you when you have an appointment to get blood testing. This way, you use your home monitor to check your blood glucose at the same time that blood is drawn and compare the results.
If the results differ by more than 15 percent, there may be a problem with your meter or other equipment; your provider can help you figure out what's going on and how to correct the problem. Help for people with vision impairment — People with vision impairment a common complication of diabetes sometimes have difficulty using glucose meters.
Meters with large screens and "talking" meters are available. If you have impaired vision, you can get help from the American Association of Diabetes Care and Education Specialists ADCES at Continuous glucose monitoring CGM is a way to monitor your glucose levels every 5 to 15 minutes, 24 hours a day.
Because of reliability issues, warm-up periods, and the need to calibrate some of the devices, CGM does not eliminate the need for at least occasional fingersticks.
CGM systems are described in detail above see 'Continuous glucose monitoring' above. Who should use CGM? CGM systems are most often used by people with type 1 diabetes. Periodic use of CGM can also help you and your health care provider determine when your glucose is low or high and how to adjust your medication doses or food intake to prevent these fluctuations.
Devices that combine an insulin pump with a CGM system are also available. See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ".
Advantages — There is evidence that people with type 1 diabetes who use a CGM system consistently and reliably rather than blood glucose monitoring [BGM] have modestly better managed blood glucose levels. The "real-time" CGM devices automatically display your glucose level every five minutes, using numbers, graphics, and arrows so you can easily tell if your level is increasing, decreasing, or stable figure 3.
The receiver recording device can also be set to trigger an alarm if your glucose level gets above or below a preset level, which can be especially helpful for people who cannot feel when they have low blood glucose also known as "impaired awareness of hypoglycemia".
Most CGM systems permit real-time "sharing" of your CGM readings with others eg, family members or caregivers. Some, but not all, of these intermittently scanning CGM devices are able to alert you of low or high glucose readings. You can download glucose results from the CGM system to your computer, tablet, or smartphone, allowing you to see glucose trends over time.
If you take insulin, your health care provider can help you figure out how to use this information to adjust your insulin dose if needed. Drawbacks — CGM systems may show lower glucose values than blood glucose meters, especially when blood glucose levels are rapidly rising. In addition, the costs associated with CGM are greater than those of traditional glucose meters.
Not all continuous glucose meters and supplies are covered by commercial health insurance companies. Glucose testing — The results of glucose testing with blood glucose monitoring BGM or continuous glucose monitoring CGM tell you how well your diabetes treatments are working.
Glucose results can be affected by different things, including your level of physical activity, what you eat, stress, and medications including insulin, non-insulin injectable medications, and oral diabetes medications. To fully understand what your glucose levels mean, it is important to consider all of these factors.
When keeping track of your results, you should include the time and date, glucose result, and the medication and dose you are taking. Additional notes about what you ate, whether you exercised, and any difficulties with illness or stress can also be helpful but are not generally required every day.
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Next Previous. Key Messages Recommendations Figures Full Text References. Chapter Headings Introduction Methods Change in Terminology Strength of Wording Real-Time Continuous Glucose Monitoring rtCGM Intermittently-Scanned Continuous Glucose Monitoring isCGM Comparison of rtCGM and isCGM in People With Type 1 Diabetes Masked Continuous Glucose Monitoring Glucose Monitoring in Women With Diabetes During Pregnancy Glucose Monitoring in Children and Adolescents With Diabetes Glucose Metrics Importance of Diabetes Self-Management Education Author Disclosures.
Introduction The Diabetes Canada Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada CPG were last published in 1. Methods A consolidated search strategy for adults, children and pregnant women was developed by modifying and updating PICO population, intervention, comparison and outcome questions used for the CPG chapters 9, 34, 35, Change in Terminology Glucose monitoring remains a cornerstone of diabetes management.
Real-Time Continuous Glucose Monitoring rtCGM For people living with type 1 diabetes who use basal-bolus injection therapy or continuous subcutaneous insulin infusion CSII , rtCGM has been shown to reduce A1C 4—9 and increase glucose time in range TIR 5 , 7 , 8 , 10 , while simultaneously reducing duration and incidence of hypoglycemia 5 , 7—11 in adults and children.
Intermittently-Scanned Continuous Glucose Monitoring isCGM The use of isCGM has been shown to be beneficial for people living with type 1 or type 2 diabetes using insulin therapy to decrease time spent in hypoglycemia 15— Comparison of rtCGM and isCGM in People With Type 1 Diabetes Two studies have directly compared rtCGM with isCGM in adults with type 1 diabetes.
Masked Continuous Glucose Monitoring A pragmatic, open-label month study of the use of masked CGM every 3 months, for 5 to 14 days before their clinical visit, compared to usual clinical care among those with type 2 diabetes in general practice, showed no difference in the primary endpoint of A1C at 12 months 24 , but there was an increase in TIR at 12 months and lower A1C at 6 months.
Glucose Monitoring in Women With Diabetes During Pregnancy Accuracy of rtCGM and isCGM in pregnancy In a study of the performance of rtCGM Dexcom G6 in 32 pregnant women with diabetes type 1, type 2 and gestational diabetes across sensor wear sites, accuracy of rtCGM was acceptable overall mean absolute relative difference [MARD] was Glucose monitoring in pregnant women with type 1 and type 2 diabetes The Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy CONCEPTT trial randomized women pregnant and planning pregnancy with type 1 diabetes, to rtCGM, in addition to CBG testing or CBG testing alone Glucose monitoring in pregnant women with gestational diabetes Frequent CBG testing is essential to guide management of gestational diabetes Glucose Monitoring in Children and Adolescents With Diabetes CBG testing Among children and adolescents with type 1 diabetes, frequent CBG testing 4 or more tests per day was associated with lower A1C 34 , rtCGM Two of 3 randomized controlled trials which included children as young as 6 years, comparing rtCGM to CBG testing, showed lower A1C and less TBR in both adults and children 7 , 9 , but this was not seen in pediatric participants in the other study, which had very low use of rtCGM and was under-powered to detect differences in hypoglycemia isCGM An open label study of isCGM in 76 children aged 4 to 17 years with type 1 diabetes using CSII or MDI showed lower A1C and more TIR, with no change in TBR which was low at baseline Hypoglycemia in children with type 1 diabetes Avoidance of severe hypoglycemia in children is of particular concern for families and providers.
Glucose Metrics When continuous glucose data are captured, it is possible to generate glucose metrics, including TIR, time above range TAR , TBR and glycemic variability standard deviation or coefficient of variation , which may be summarized along with the ambulatory glucose profile see Table 2 Importance of Diabetes Self-Management Education The importance of diabetes self-management education when introducing or using newer glucose monitoring technologies has been clearly illustrated in recent trials.
In some circumstances, such as when significant changes are made to therapy, or during pregnancy, it is appropriate to check A1C more frequently.
Testing at least every 6 months should be performed in adults during periods of treatment and healthy behaviour stability when glycemic targets have been consistently achieved [Grade D, Consensus].
For individuals with type 2 diabetes including children and adolescents on once-daily insulin, in addition to noninsulin antihyperglycemic agents, testing at least once a day at variable times is recommended [Grade D, Consensus].
If achieving A1C targets or receiving antihyperglycemic medications not associated with hypoglycemia, daily CBG testing is not recommended except during illness or at risk of hyperglycemia e.
surgery, steroid treatment when more frequent testing may be required [Grade D, Consensus]. Women with gestational diabetes or type 2 diabetes during pregnancy: should be requested to perform CBG testing 4 times daily fasting and postprandially for 1 week to assess blood glucose levels and need for pharmacotherapy.
in women who do not require antihyperglycemic medications, CBG testing can be reduced to 4 times per day on alternate days [Grade B, Level 2 33 ] in women who require insulin therapy, CBG testing should be performed 4 times daily, both fasting and postprandially, to improve pregnancy outcomes [Grade B, Level 2 32 ] If CBG meter readings are suspected to be inaccurate or are discordant from A1C, CBG results should be compared with a simultaneous laboratory measurement of venous blood glucose [Grade D, Consensus].
Blood ketone testing methods may be preferred over urine ketone testing, as they have been associated with earlier detection of both ketosis and response to treatment [Grade B, Level 2 62 ].
Author Disclosures A. References Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada clinical practice guidelines for the prevention and management of diabetes in Canada.
Can J Diabetes ;42 suppl 1 :S1e Berard LD, Siemens R, Woo V. Diabetes Canada clinical practice guidelines for the prevention and management of diabetes in Canada: Monitoring gly- cemic control.
Can J Diabetes ;42 suppl 1 :S47e Banasiak K, Cleary D, Bajurny V, et al. Language Matters - A Diabetes Canada Consensus Statement. Can J Diabetes ;44 5 e3. Deiss D, Bolinder J, Riveline J-P, et al. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring.
Diabetes Care ;e2. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose moni- toring on glycemic control in adults with type 1 diabetes using insulin injec- tions: The DIAMOND randomized clinical trial.
JAMA ;e8. Lind M, Polonsky W, Hirsch IB, et al. Continuous glucose monitoring vs con- ventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: The GOLD randomized clinical trial.
JAMA ;e Battelino T, Phillip M, Bratina N, et al. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care ;e Garg SK, Voelmle MK, Beatson CR, et al. Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: A prospective 6-month study.
Diabetes Care ;e9. Battelino T, Conget I, Olsen B, Schütz-Fuhrmann I, Hommel E, Hoogma R, et al. The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial.
Diabetologia ;55 12 e Haskova A, Radovnicka L, Petruzelkova L, et al. Real-time CGM is superior to flash glucose monitoring for glucose control in type 1 diabetes: The CORRIDA randomized control trial. Diabetes Care Nov;43 11 e Heinemann L, Freckmann G, Ehrmann D, et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections HypoDE : A multicentre, randomised controlled trial.
Lancet ; e Polonsky WH, Hessler D, Ruedy KJ, Beck RW, Diamond Study Group. The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: Further findings from the DIAMOND randomized clinical trial.
Diabetes Care ;40 6 e Lawrence JM, Laffel L, Wysocki T, Xing D, Beck RW, Huang ES, et al. Quality of Life Measures in Children and Adults with Type 1 Diabetes: The Juvenile Dia- betes Research Foundation Continuous Glucose Monitoring Randomized Trial.
Diabetes Care ;33 10 e7. Beck RW, Riddlesworth TD, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: A randomized trial.
Ann Intern Med ;e Bolinder J, Antuna R, Geelhoed-Duijvestijn P, et al. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: A multicentre, non- masked, randomised controlled trial. Lancet ;e Haak T, Hanaire H, Ajjan R, et al.
Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin- treated type 2 diabetes: A multicenter, open-label randomized controlled trial. Diabetes Ther ;e Oskarsson P, Antuna R, Geelhoed-Duijvestijn P, et al.
Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: A pre-specified subgroup analysis of the IMPACT randomised controlled trial. Diabetologia ;61 3 e Castellana M, Parisi C, Di Molfetta S, et al.
Efficacy and safety of flash glucose monitoring in patients with type 1 and type 2 diabetes: A systematic review and meta-analysis. Flashglucosemonitoringsystemforpeoplewithtype1ortype 2 diabetes: A health technology assessment. Ontario health technology assessment series ;19 8 :1e Evans M, Welsh Z, Ells S, Seibold A.
The Impact of Flash Glucose Monitoring on Glycaemic Control as Measured by HbA1c: A Meta-analysis of Clinical Trials and Real-World Observational Studies. Diabetes Therapy : Research, Treatment and Education of Diabetes and Related Disorders ;11 1 e Hásková A, Radovnická L, Petruzelková L, Parkin CG, Grunberger G, Horová E, et al.
Real-time CGM Is Superior to Flash Glucose Monitoring for Glucose Control in Type 1 Diabetes: The CORRIDA Randomized Control Trial. Diabetes Care ;43 11 e Reddy M, Jugnee N, Laboudi El A, Spanudakis E, Anantharaja S, Oliver N.
A randomized controlled pilot study of continuous glucose monitoring and flash glucose monitoring in people with Type 1 diabetes and impaired awareness of hypoglycaemia. Diabetic Medicine: A Journal of the British Dia- betic Association ;35 4 e Reddy M, Jugnee N, Anantharaja S, Oliver N.
Switching from Flash Glucose Monitoring to Continuous Glucose Monitoring on Hypoglycemia in Adults with Type 1 Diabetes at High Hypoglycemia Risk: The Extension Phase of the I HART CGM Study. Use of professional-mode flash glucose monitoring, at 3-month intervals, in adults with type 2 diabetes in general practice GP-OSMOTIC : A pragmatic, open-label, month, randomised controlled trial.
Adjustments of statistical models included age, sex, diabetes duration, migration background, insulin therapy pump or injections , and treatment period. Interpretation: These findings provide evidence that continuous glucose monitoring can reduce severe hypoglycaemia and ketoacidosis risk in young people with type 1 diabetes on insulin therapy.
Continuous glucose monitoring metrics might help to identify those at risk for acute diabetes complications. Funding: German Center for Diabetes Research, German Federal Ministry of Education and Research, German Diabetes Association, and Robert Koch Institute.
Monitorinng took place from Breakfast skipping and weight gain to Mayand study follow-up for Diabetic coma and continuous glucose monitoring randomized trial continued through December Metformin during pregnancy BGM indicates contjnuous glucose monitoring; CGM, continuous glucose monitoring. c Two participants in the standard BGM group initiated real-time CGM before completing the week visit. d One participant in the CGM group and 6 participants in the standard BGM group were missing CGM data at follow-up. Missing data were handled using direct likelihood. Baseline data for these participants were included in the model. Contributor Disclosures. Athlete meal planning fontinuous the Disclaimer at the end of this cima. GLUCOSE TESTING OVERVIEW. If you have diabetes, you have an important Natural immune system support in your own medical care and monitoring your glucose sugar level is a key part of this. Although diabetes is a chronic condition, it can usually be managed with lifestyle changes, medication, and self-care measures. The main goal of diabetes treatment is to keep your glucose levels in the target range. 
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