Daniel’s Time Below Range is poor at 10% which is well above the recommended target of less-than 4%. Also, his AGP shows a consistent drop in glucose overnight from midnight through to 6:00am, and his Snapshot report shows with significant low glucose events in this period. There is another steep fall towards the low-glucose zone around 12:00pm–2:00pm, again associated with low glucose events. His glucose variability later in the day also puts him at risk of hypoglycaemia at these times. These trends are a priority for management.

The most striking aspect of Daniel’s AGP is the major spike in glucose in the morning between 6:00am and noon. His Daily Patterns report shows that his average glucose level at this time is 18.1 mmol/L. Adjusting his prandial insulin dose and timing before breakfast should be a priority of this consultation. The blue and grey bands show variability well above the target range throughout the afternoon and into the evening, with a poor time above target performance of 42%.

Daniel’s overnight lows are still a priority as his glucose is still consistently falling overnight. If anything, it is more of a concern as his median line and blue shaded band are dropping below target between midnight and 6:00am, with low glucose events overnight with some readings below 3.0 mmol/L. His trough between late-morning to early afternoon is still a cause for concern, between 10:00am – 2:00pm. These low-glucose problems are confirmed by the fact that his time below target has increased to 13% and requires immediate intervention.

The changes in Daniel’s treatment have reduced the morning glucose spike significantly, with average glucose levels within his target range, which is really encouraging. However, the blue median line and blue shaded band of variability are swinging upwards above Daniel’s target range from 1:00pm–9:00pm and should be addressed. His time above range has reduced significantly from to 42% to 26%, good progress, but it still needs to improve further.