Table 1 Identification of Glycemic Patterns, Causes, and Interventions in Patients with Type 1 Diabetes Using Continuous Glucose Monitoring
Glycemic pattern | Description | Possible Causes | Suggested Interventions |
|---|---|---|---|
| Hyperglycemia postprandial, glycemic drop during the night | • Inadequate basal insulin dose | • Review and adjust evening basal insulin doses |
• Inadequate ICR or CH count at dinner | • Insulin dose adjustment based on CH count | ||
| Hyperglycemia in the early morning hours, not preceded by hypoglycemia, in people with T1D | Dawn phenomenon | • Basal insulin dose adjustment • Correction bolus in early morning |
| Persistent hyperglycemia in adolescents or young adults with T1D | • Missed/insufficient dose of prandial bolus | • Education on pre-meal insulin administration • Cognitive behavioral intervention |
• Missed or underdosed basal insulin | • Education on basal insulin administration • Cognitive behavioral intervention | ||
| Postprandial hyperglycemia throughout the day. High glycemic variability starting in the morning, in T1D | • Inadequate ICR or CH count | • Education on CH count or adjust ICR |
• Inadequate bolus timing | • Administer pre-prandial bolus in advance | ||
• High intake of CH or CH with a high glycemic index | • Education on nutrition • Cognitive behavioral intervention | ||
• High protein/fat foods | • Split bolus administration | ||
• Bolus skip | • Education on bolus administration | ||
| Postprandial hypoglycemia in people with T1D | • Inaccurate CH count, not eating as expected | • Education on CH count or adjust ICR • Instruct the patient to administer insulin only for food they are sure they will eat |
• Physical activity | • Reduce insulin dose (10–50%) | ||
• Insulin overdose | • Instruct the patient to administer insulin only for the food they are certain they will eat | ||
• Inadequate prandial bolus timing | • Education on pre-meal insulin administration • Cognitive behavioral intervention | ||
• Very low insulin sensitivity factor | • Increase the insulin sensitivity factor to decrease dose | ||
• Application of a second bolus during the active life of insulin (Stacking) | • Education on insulin administration | ||
• Associated clinical conditions (gastroparesis, lipodystrophy, CKD, among others) | • Individualized diagnosis and management | ||
| Nighttime glycemic drop, morning rebound hyperglycemia in people with T1D | • Excessive basal insulin • Somogyi effect | • Basal insulin reduction |
