Record 288 blood glucose values ​​in a day. There are some "cold knowledge" about "dynamic blood glucose monitoring" that you don't know.

This article is published by Yimaitong authorized by the author, please do not reprint without permission
.

Introduction: HbA1c can reflect the average blood glucose level of the past 2 to 3 months, but blood glucose fluctuations and the risk of hypoglycemia cannot be indicated; SMBG only provides blood glucose values ​​at a certain (or a few) points in time, as if you have a grasp of blood sugar The blind touched the elephant
.

As a good supplement to the above-mentioned monitoring program, let's talk about this monitoring method that can more finely reflect the full picture of the patient's blood glucose changes throughout the day-dynamic blood glucose monitoring
.

Clinical case Teacher Zhang has a history of diabetes for more than ten years.
Currently, he is using the treatment plan of "basic insulin combined with oral hypoglycemic drugs".
This time, he came to see a doctor because of the apparently high fasting blood sugar recently, so I asked him to prescribe a point to lower fasting blood sugar.
The "good medicine"
.

I told him: "High fasting glucose may be due to either cause low blood sugar in the morning after the night rebound increase in blood sugar (also known as" reaction hematoxylin Ji "), it may be because of lack of bedtime basal insulin dose caused
.
Recommendations"
Teacher Zhang will do a "dynamic blood glucose monitoring (CGM)" to see what kind of situation he is in? Teacher Zhang followed my suggestion, and the monitoring results for several consecutive days found that Mr.
Zhang had hypoglycemia at around 4 a.
m.
many times.
It was concluded that the increase in fasting blood glucose of Mr.
Zhang was caused by the "Sumuji reaction"
.

After that, I lowered his insulin dosage before going to bed, and Mr.
Zhang's fasting blood sugar returned to normal
.

 "Blood sugar" or "interstitial fluid glucose"? Blood glucose monitoring is an important part of the comprehensive management of diabetes.
Its development has gone through a long process, from the initial urine glucose detection, to the subsequent blood glucose (BS) and glycosylated hemoglobin (HbA1c) detection, to the current dynamic blood glucose monitoring (CGM, continuous glucose monitoring)
.

 The so-called CGM refers to the monitoring technology of indirectly knowing the blood glucose level by monitoring the glucose concentration of the subcutaneous interstitial fluid through a glucose sensor.
It can provide continuous, comprehensive and reliable blood glucose information, understand the trend of blood glucose fluctuations, and find that it is not easy to be detected by traditional monitoring methods.
High blood sugar and low blood sugar
.

 It should be noted that the "dynamic blood glucose meter" is different from the traditional blood glucose meter.
It does not actually measure the glucose in the blood, but the glucose concentration in the interstitial fluid of the human body.
The latter has a significant positive correlation with the former.
Indirectly reflects blood sugar levels
.

 Note: During the monitoring period, a blood glucose meter should be used to measure finger blood glucose 4 times a day to correct the results of dynamic blood glucose monitoring
.

 Recording 288 blood glucose values ​​≠ 288 needles throughout the day Whether it is glycosylated hemoglobin (HbA1c) or self-blood glucose monitoring (SMBG) itself, there are certain limitations
.

HbA1c reflects the average blood glucose level of the past 2 to 3 months, but it cannot reflect the patient's blood glucose fluctuations and the risk of hypoglycemia; SMBG only provides blood glucose values ​​at a certain (or certain) point in time, just like a blind person touching the elephant.
Finely reflect the overall picture of the patient's blood sugar changes throughout the day
.

 The dynamic blood glucose monitoring system (CGMS) automatically records blood glucose values ​​every 5 minutes.
A total of 288 blood glucose values ​​are recorded throughout the day.
It can completely record the detailed information of the patient's blood glucose changes throughout the day, including the blood glucose value at any time, the highest blood glucose value throughout the day and The minimum value, daily blood glucose change curve and the impact of various events (such as meals, exercise, medication, emotional changes) on blood glucose, etc.
, and the analysis software automatically calculates the blood glucose within the target range (TIR, Time in range) , Time above range (TAR, Time above range), Time below range (TBR, Time below range), and many parameters that reflect blood glucose fluctuations.
It is an effective supplement to traditional blood glucose monitoring methods and helps doctors comprehensively Understanding and evaluating patients' blood glucose control status, providing scientific basis for clinical decision-making, has important clinical value for optimizing patients' blood glucose management
.

 "Dawn phenomenon" or "Sumuji reaction"? What are the clinical uses of dynamic blood glucose monitoring? 1.
Understand the postprandial hyperglycemia and nocturnal hypoglycemia that are difficult to detect with traditional blood glucose monitoring methods, and clarify the cause of fasting hyperglycemia (whether it is the "dawn phenomenon" or the "Sumuji reaction")
.

2.
Can fully understand the patient's blood glucose volatility and the quality of blood glucose control
.

 3.
You can find changes in blood glucose with the following factors, such as the types of food, exercise type, variety of drugs, psychological factors, life>
.

 4.
Help patients develop individualized sugar control programs
.

5.
It can provide a very intuitive visual education method to improve patient compliance with treatment
.

 Who are more suitable? Dynamic blood glucose monitoring is suitable for the following groups: 1.
Patients with fragile diabetes who have high and low blood sugar and large fluctuations; 2.
Patients with high blood sugar or frequent hypoglycemia patients; 3.
Patients who need to clarify the cause of fasting hyperglycemia 4.
Patients with "occult" hyperglycemia or hypoglycemia (especially asymptomatic hypoglycemia) need to be excluded; 5.
Diabetic patients receiving "intensive insulin therapy"; 6.
Patients with "gestational diabetes" or "diabetes with pregnancy"
.

 There is a big difference between retrospective CGM and real-time CGM CGMS is mainly divided into "retrospective CGM" and "real-time CGM (REAL-Time CGM)"
.

 Retrospective CGM means that the sensor is responsible for collecting data after putting it on, and exporting and analyzing the data after a certain period of time (usually 72 hours)
.

The disadvantage is that the results provided are retrospective and cannot reflect blood glucose changes in real time
.

 Real-time CGM means that after putting it on, it can automatically store blood glucose data in real time (automatically record once every 15 minutes).
You can see the instant blood glucose value through scanning, and the machine will automatically warn you when high blood sugar and low blood sugar occur, which is convenient to do in time.

。Out processing .

The current "Instant Scanning Dynamic Glucose Meter" can be worn continuously for 14 days, and does not require fingertip blood sampling for calibration
.

 Two points need to be explained: 1.
Dynamic blood glucose monitoring (CGM) cannot replace the venous plasma blood glucose level, cannot be used for diagnosis, only used for blood glucose trend monitoring, cannot replace HbA1c detection, and cannot reflect the overall blood glucose level for 2 to 3 months
.

2.
When the blood sugar is in a stable state, the tissue fluid glucose measured by the dynamic blood glucose meter and the blood capillary glucose measured by the blood glucose meter are basically the same, but when the blood sugar fluctuates greatly, there will be a certain difference between the two.
This is because The change of tissue fluid glucose lags behind that of finger blood glucose.
When the blood glucose is in the rising phase, tissue fluid glucose <finger blood glucose; when the blood sugar is in the falling phase, tissue fluid glucose> finger blood glucose, the difference between the two is about 15%
.