Introduction: A 45 year old lady (RC) with type 1 diabetes of 41 years duration was referred to the hospital Diabetes Education Service. She presented with a non-healing R) heel ulcer with osteomyelitis, requiring long term intravenous antibiotic treatment. Hospital length of stay was extended with highly erratic blood glucose levels (BGLs). The glucose control was characterised by significant insulin sensitivity and severe hypoglycaemia unawareness. HbA1c was 68mmol/mol/8.4%. RC was 45kg with an insulin total daily dose of 3 – 5 units. There were 43 hypoglycaemic events recorded in 33 days (1.3 events per day), with 10 severe events requiring medical emergency intervention. BGL’s ranged from 1.1mmol/L – ‘HI’ (>27.8mmol/L) using a hospital glucose meter (FreeStyle OptiumH).
Treatment: Diabetes Education strategies focused on hypoglycaemia prevention, liaising with the patient, medical physicians and education support for nursing staff. Continuous Glucose Monitoring (CGM) was recommended as tool to predict hypoglycaemia episodes and provide information to assist glucose control. The CGM sensor measures glucose values in the interstitial fluid every five minutes in real-time for up to seven days. Inpatient CGM was commenced to complement BGLs recorded from the hospital glucose meter.
Discussion: In this case, CGM was found to be a valuable supplemental tool to capillary glucose monitoring in the hospital setting, providing an alert system to warn of impending hypoglycaemia, predict glucose trends and patterns and minimise erratic glycaemic fluctuations. The frequency of hypoglycaemic events reduced (0.7 events per day) with no BGL’s detected < 3.1mmol/L. Patient confidence in diabetes self-management was improved through access to real-time glucose monitoring alerts and the ability to intervene and prevent unnecessary hypoglycaemia events.
Conclusion: CGM can be used to predict glycaemic trends and hypoglycaemia events in high risk hospital inpatients. It provided useful information for the patient and nursing staff to interpret and act on glucose levels early to avoid hypoglycaemia and associated rebound hyperglycaemia events.