13 months in and CGM is still the thing I get wrong
13 months in and CGM is still the thing I get wrong, and the part I actually want to talk about is at the bottom.
Pulling the figures out of the title: 13 months. All of it is written down as it happened rather than reconstructed.
On hypoglycaemia, because the risk gets attributed to the wrong thing constantly.
Incretin-based agents stimulate insulin secretion in a glucose-dependent way: the effect scales with glycaemia rather than acting unconditionally. That is why monotherapy risk is low. Where risk rises substantially is in combination with agents that lower glucose independently of the current level.
Which means the question "does this cause hypos" is not answerable without knowing the rest of the regimen — and that the person who can answer it is the one who wrote the regimen. Nothing on this board is a substitute for that conversation, and the good threads here end by saying so.
The order things move in, since nobody explains it and it worries people.
Postprandial excursions generally respond earliest. Variability tends to narrow before the average does, which is visible on a sensor and invisible on a lab result. Fasting glucose is often the laggard, and A1c — being a three-month average — is the last thing to reflect anything.
So a month in which the sensor looks better and the fasting number has not moved is the ordinary sequence, not a contradiction. Knowing that in advance would have saved me a quarter of unnecessary worry, which is why it is worth writing down.
Ask me anything specific. Anything general I will probably get wrong.
best — the order this archive was captured in
Continuous monitoring shows the shape: postprandial excursions, overnight behaviour and time in range. Two people with identical A1c can have very different distributions.
Continuous monitoring shows the shape: postprandial excursions, overnight behaviour and time in range.
Adding the obvious one — bring the export, not the single number, to whoever manages this.
How long between the two A1c measurements?
How long between the two A1c measurements?
Disagreeing with this line: that endpoint is from the obesity programme and does not answer the question.
Agreed on variability. Two people with the same average can have completely different days.
Certain conditions affect A1c independently of glycaemia. If a result looks inconsistent with the sensor data, that is a question for whoever manages your care rather than for this board.
Yes — the person managing your diabetes is the one to talk to, and this board is explicit about that.
Certain conditions affect A1c independently of glycaemia.
Agreed, and the glucose-dependence point is the reason the risk profile reads the way it does.
Small fix — insulin secretion in this class is glucose-dependent, which is precisely why the risk you describe comes from the other agent.