Core IM | Internal Medicine Podcast #178 Continuous Glucose Monitor (CGM): 5 Pearls Segment
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Jun 2, 2025 Discover the impactful differences between Continuous Glucose Monitoring and A1C testing in diabetes management. Learn how to interpret ambulatory glucose profiles to spot hypoglycemia and hyperglycemia patterns. The discussion highlights personalized insulin management strategies, including when to adjust doses based on glucose data. Common pitfalls in patient lifestyle and medication that affect blood sugar levels are examined. There's a focus on the role of GLP-1 agonists in optimizing treatment, ensuring patients receive tailored care.
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A1C vs CGM Differences
- The hemoglobin A1C shows average blood sugar over 3 months but is affected by red blood cell turnover and conditions like renal dysfunction.
- Continuous glucose monitors (CGMs) provide more immediate glucose trends over days and can reveal hypoglycemia or hyperglycemia not evident from A1C.
Ask Before Adjusting Insulin
- Before adjusting insulin, ask patients detailed questions about insulin timing, storage, and lifestyle changes.
- Investigate alcohol use and site rotation to uncover causes of glucose irregularities prior to medication changes.
Timing Insulin Improves Control
- A patient with post-meal high sugars improved by timing insulin 5-15 minutes before eating instead of after.
- Adjusting insulin timing based on CGM data can improve blood sugar control without increasing dosage.