Jackie’s blue-shaded band is consistently narrow, meaning she has low day-to-day variability; her outer grey band is wider, especially at night. There is a lot of air under the clouds for most of the afternoon and evening, indicating there is scope to bring her glucose down and back towards her target range without increasing the risk of hypoglycaemia.

This could also increase her current Time in Range from 55% towards the target of more-than 70%. A concern is that Jackie is also not scanning her sensor every day, she should be encouraged to do this, in order to ensure her AGP report can be reviewed with confidence.

What actions might you agree with Jackie?

• A reduction in Jackie’s basal glargine 300 is recommended to reduce the overnight incidence and risk of hypoglycaemia.
  

• This may also influence Jackie’s eating and drinking habits, to prevent her ‘chasing her sugars’ with food to prevent a hypo.
  

• Jackie must be counselled to scan her sensor each day to collect more data on her glucose control.
  

The width of the blue and grey shaded bands on Jackie’s profile have been significantly reduced, except for during the evening hours and the median line is flatter than before. Her glucose variability is 34.6%, below the target threshold of 36%, so a good outcome!

What actions might you agree with Jackie?

• The elimination of the threat of hypoglycaemia provides an opportunity to address Jackie’s median glucose levels and improve her Time in Range; this can be done by slowly titrating up her insulin glargine dose to achieve success.
  

• Jackie may benefit from the introduction of bolus insulin to prevent her lunchtime excursion, but the complexities of the regimen and her busy lifestyle may lead to compliance issues.
  

• Because of her hectic and unpredictable lifestyle, careful consideration should be made before making any changes to Jackie’s treatment.