Continuous Glucose Monitoring (CGM) and Sensor-Augmented Pump Therapy (SAP) / UNI-MED Science (PDF)

and evaluation of CGM measurements 50 3.3.1. Overview 50 3.3.2. Displays in CareLink software 51 3.3.2.1. CareLink PERSONAL 51 3.3.2.2. CareLink PRO 52 3.3.2.3. CareLink iPro 55 3.3.3. Summary 56 3.4. References 56 4. Aspects of the combination of glucose sensor and insulin pump 62 4.1. Potential of the combination of insulin pump and sensor 62 4.2. Support of CGM when starting a patient on insulin pump therapy 62 4.3. Utilisation of CGM profiles for training pump wearers 63 4.4. Influence of CGM on the full exploitation of the extended functions of modern insulin pumps 64 4.5. CGM as proof of successful pump initiation for the medical insurance companies 65 4.6. Sensor-augmented pump therapy (SAP) 66 4.7. Interconnection of glucose sensor and insulin pump for the closed loop system 69 4.8. References 72 5. Problem analysis from glucose profiles recorded with CGM 76 5.1. Overview 76 5.2. The magic of blood glucose and what interstitial glucose tells us about it 76 5.3. Hypoglycaemic episodes 77 5.3.1. Forensics with an evolutionary biological background 77 5.3.2. Classification of hypoglycaemia based on its symptoms 78 5.3.3. Clinical pathology of compromised counter-regulation 79 5.4. Use of CGM for the analysis of the glucose profile and detection of hypoglycaemia 79 5.5. Characteristic details in the CGM profiles 81 5.6. "Criminology" of the glucose level 83 5.6.1. Fine analysis of glucose profiles by "forensic detective work" 83 5.6.2. Criminology of nocturnal hypoglycaemia and its consequences 84 5.6.2.1. Possible motive and opportunity 84 5.6.2.2. From clues to the profile of the offender 84 5.6.2.3. Catching red-handed 85 5.6.2.4. Scene of the crime and search for tracks (standard pattern) 86 5.6.2.5. Disguises and deception 87 5.6.2.6. The usual suspects 89 5.6.2.7. Key points for "criminology" 89 5.6.3. Example of a patient 90 5.7. References 93 6. Getting started on sensor-augmented pump therapy 96 6.1. Overview 96 6.2. Insulin selection 96 6.3. Insulin dosage 97 6.3.1. Daily insulin requirement and its division 97 6.3.2. Basal rate 98 6.3.2.1. Determination of the basal rate 98 6.3.2.2. Checking the basal rate 98 6.3.2.3. Use of various basal rate profiles 98 6.3.2.4. Temporary basal rate 99 6.4. Bolus delivery 99 6.4.1. Bolus management 99 6.4.2. Bolus options 100 6.4.3. Correction/bolus calculator, BolusWizard® 102 6.5. References 104 7. Clinical evidence on CSII, CGM and SAP 108 7.1. Evidence-based medicine (EBM): how far can this be demanded for CSII, CGM and SAP? 108 7.2. Clinical evidence on insulin pump therapy CSII 110 7.2.1. Overview 110 7.2.2. Experimental and clinical results of CSII in patients with type 1 diabetes 110 7.2.3. Experimental and clinical results for CSII in patients with type 2 diabetes 116 7.2.4. Meta-analyses on CSII 117 7.3. Clinical evidence for continuous glucose monitoring (CGM) 119 7.4. Experimental and clinical evidence for sensor-augmented pump therapy (SAP) 123 7.5. References 127 8. Is continuous glucose monitoring leading to a paradigm shift in diabetology? 134 8.1. Empirical diabetology 134 8.2. Diabetology based on data 135 8.2.1. HbA1c and glucose excursions 135 8.2.2. The glucose pentagon model 136 8.3. Diabetology based on data in everyday practice 138 8.4. Summary 139 8.5. References 140 Index 142