Case Study:

Daniel

Daniel is a retired baker who still likes to bake and cook.

He’s concerned about regular overnight hypoglycaemia and consequently chasing sugars in the morning. Read about how Daniel and his Healthcare Team use the FreeStyle Libre system and LibreView to minimise overnight hypoglycaemia and manage exceptional hyperglycaemic swings in the morning.

Patient Image - Daniel
Patient Image - Daniel
Patient Image - Daniel

About Daniel

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Summary

Daniel is a retired baker who still likes to bake and cook. He is concerned about his regular overnight episodes of hypoglycaemia and consequently chasing his sugars in the morning.

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Comorbidities

High cholesterol, hypertension; currently prescribed ramipril and simvastatin.

Objectives Icon

Specific Objective

The key goals are to minimise overnight hypoglycaemia and manage his exceptional hyperglycaemic swing in the mornings.

Age67BMI28.1 kg/m2
Diabetes (Type)Type 1 diabetesLast HbA1c value57.4 mmol/mol (7.4%)
ProfessionRetired bakerTarget glucose range3.9-10 mmol
Duration of diabetes37 yearsTreatmentBasal-bolus insulin therapy

Consultation One

What does the four step review tell us?

Look for patterns of glucose variability

The blue and grey bands in Daniel’s AGP are fairly narrow through the night and morning until noon, after which they widen through much of the afternoon and evening. This indicates that Daniel is not matching his insulin needs to his meals and snacks, as well as his activities on some days. His glucose is unstable during the day, including the spike after breakfast. This suggests that Daniel should be advised to consider his insulin, his diet and his daily activities.

What actions might you agree with Daniel?

  • Daniel’s prandial insulin dose should be increased to moderate the large post- breakfast glucose excursion. The timing of this bolus also needs to be considered.

  • Reducing Daniel’s correction-dose calculation in response to his glucose spike may help minimise the steep fall into the low-glucose zone.

  • Daniel is a baker and loves cooking. There is a need to discuss his lifestyle and eating behaviour to address the lifestyle-related variability as revealed by the wide grey shaded band.

Daniel - AGP Report

Consultation Two

What does the four step review tell us?

Data capture and Time in Range (TIR)

Daniel’s data capture is still excellent at 94% and his Time in Range has increased to 58%. These are positive outcomes from his last review, he can be pleased with his progress.

Daniel - AGP Report

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References & Disclaimers 
Images are for illustrative purposes only. Not actual patient or data.

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