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

The Curbsiders Internal Medicine Podcast

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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