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Using Professional Continuous Glucose Monitoring to Modify Eating Behavior in Patient on ‘Heart Healthy’ Diet

Published Online: September 14th 2012 US Endocrinology, 2012;8(2):74-76 DOI: http://doi.org/10.17925/USE.2012.08.02.74
Authors: Howard Wolpert
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Abstract
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Abstract:
Overview

Diabetes management is often complex and requires the involvement of various team members and technology for behavior change and successful outcomes. This paper shows how one provider utilized a team approach and the use of professional continuous glucose monitoring to help this patient identify needed behavior change to improve outcomes.

Keywords

Type 2 diabetes, professional continuous glucose monitoring, diabetes therapy management software

Article:

1c) measurements and is often missed by fingersticks. The result is that patients are unaware of their individual glucose variability and how their daily activities (exercise, eating habits, and general lifestyle) affect their blood glucose and may put them at risk for short-term problems as well as long-term complications. Professional CGM continues to improve over time and provides data in formats that are easy to access, interpret, and share with patients. Providing this data to patients can assist them to modify behaviors and see successes in their management of this complex disease.

Case Study
Henry is a 67-year-old vice president of sales and marketing at a large telecommunications company. Diagnosed with type 2 diabetes 23 years ago, he has sought to keep his blood glucose, weight, and other cardiovascular risk factors in check through the following measures:

  • using a basal-bolus insulin regimen:
    • bed time insulin glargine (20 units); and
    • pre-meal insulin lispro, dosed according to an Insulin:Carbohydrate ratio of 1:15 and correction factor of 50 (1 unit of insulin for every 50 mg/dl above his target blood glucose of 120 mg/dl).
  • taking atorvastatin (10 mg) with low-dose aspirin (81 mg) daily;
  • maintaining a ‘heart-healthy’ diet, containing large quantities of fruits and vegetables;
  • checking his blood glucose every morning and evening; and
  • walking 90 minutes per day.

Despite these healthy habits, Henry’s HBA1c is 8.2 %, higher than the widely accepted target of 7.0 %. At the same time, his self-monitoring of blood glucose (SMBG) logbook indicates pre-breakfast and pre-dinner average of 90–110 mg/dl, consistent with published guidelines.1,2 The handwritten entries also reveal regular breakfasts of cold cereal with a banana each morning, followed by frequent ‘pick-me-ups’ of fruit throughout the day. Scanning the pages, the physician notes the lack of mid-day readings compared with other time periods. Henry explains that he often takes clients out for extended lunch meetings and feels uncomfortable checking his blood glucose in these situations. He adds that because carbohydrate counting is ‘hit-or-miss’ in restaurants, he deliberately restricts his orders to lean meats and vegetables. Furthermore, with lunch as his major meal of the day, his dinner often consists of a salad, with fat-free dressing, prepared after a 5-mile ‘speed walk’ every evening. >To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

The author has no conflicts of interest to declare.

Correspondence

Howard Wolpert, MD, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215-5306, US. E: Howard.Wolpert@joslin.harvard.edu

Support

The publication of this article was funded by Medtronic Diabetes. The views and opinions expressed are those of the author and not necessarily those of Medtronic Diabetes.

Received

2012-09-19T00:00:00

References

  1. Handelsman Y, Mechanick JI, Blonde L, et al., American Association of Clinical Endocrinologists medical guidelines for clinical practice for developing a diabetes mellitus comprehensive care plan, Endocr Pract, 2011;17(Suppl. 2):1–53.
  2. American Diabetes Association, Standards of medical care in diabetes—2011, Diabetes Care, 2011;34(Suppl. 1):S11–61.
  3. Atkinson FS, Foster-Powell K, Brand-Miller JC, International tables of glycemic index and glycemic load values, Diabetes Care, 2008;31:2281–3.
  4. Blevins TC, Bode BW, Garg SK, et al., Statement by the American Association of Clinical Endocrinologists consensus panel on continuous glucose monitoring, Endocr Pract, 2010;16:730–45.
  5. Rubin RR, Borgman SK, Sulik BT, Crossing the technology divide: practical strategies for transitioning patients from multiple daily insulin injections to sensor-augmented pump therapy, Diabetes Educ, 2011;37(Suppl. 1):5S–18S.
  6. American Diabetes Association, Bantle JP, Wylie-Rosett J, et al., Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association, Diabetes Care, 2008;31(Suppl. 1):S61–78.
  7. Hirsch IB, Insulin analogues, New Engl J Med, 2005;352:174–83.

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