Bolus Adjustment Based on Trend Information

We can also use these trend arrows to make informed decisions about our bolus strategy. For example, I can bolus based on where I am now, or I can adjust for where I will likely be in 20 minutes.

I can also adjust a bolus down to reduce the likelihood of hypoglycemia following a bolus, or adjust it up to get a correction bolus closer to my target.

 

This can be done by adjusting blood glucose numbers in correction calculations taking the trend arrow into consideration.

BG Stable:  •Usual Bolus Dose BG Rising Gradually: 1 up arrow=bolus slightly* BG Rising Sharply:  2 up arrows=bolus modestly** BG Dropping Gradually: 1 down arrow=bolus slightly* BG Dropping Sharply: 2 down arrows=bolus modestly**

Patients should think about where glucose may be in 20 minutes if it continues at the same rate.

 

Immediate Information: Hypoglycemia Alerts

•Predictive Hypoglycemia Alert or Hypoglycemia Alert & Recovering: Subtle Treatment –50% of usual carbs –Med-High G.I. food  •Hypoglycemia Alert & Dropping: Aggressive Treatment –Full or increased carbs –High G.I. food

Types of Alerts

CGMs can give us alerts when blood glucose levels exceed a programmed high or low threshold – these can be helpful to educate patients on the outcomes of management strategies and where they may warrant adjustment.

 

Another type of alert occurs when blood sugar is predicted to cross a programmed threshold – these are useful to prevent hypoglycemic episodes or warn of impending severe hyperglycemia.

 

Or when blood sugar is changing rapidly -- these can be very burdensome if overused as blood sugars routinely rise and fall throughout the day due to food intake, blousing, stress, activity and other causes. A rate of >3mg/dl is a useful alert to warn of a sudden drop during activity, or perhaps of a missed or mistimed bolus at meal time.

Hi/Low Alert:   Cross specified high or low thresholds          (must balance benefit/nuisance) Predictive Alert:   Anticipated crossing of high or low thresholds    (set for short time interval!) Rate of Change:   Rapid rise or fall                  (>3 md/dl/min fall rate useful!)