And so now let's talk about the different reports that you have available to you and, and uh some people have one report favor over another and this is the A GP report. And so you can see on the right, so this is the A GP report and it's showing you on the upper right hand corner that the top time in target range, the time spent low, the time spent high and then underneath it, you see a graph that kind of shows you your overall uh uh average reading, the dark line is the average and then the the middle gray is kind of um the 25% is the between 25 and 75% of the time they spend that. And then the gray is kind of the outlying maybe they had a bad day or, or something like that, but that's kind of the overall. So then you look at the average and so it's a real visual where you can see somebody's running high or somebody's running low. So, on this particular patient, the hemoglobin ACY is 7.5%. And when you see an A one C that's a mildly elevated. What that's telling you is they're probably having some highs after they're eating, uh, versus if they were double digit hemoglobin A one C and then they probably have a basil and a cranial problem. And the diabetes medication this particular patient is on is Metformin 1000 twice a day. Uh G LP one at the maximum dose, uh glipiZIDE, uh, 5 mg before breakfast and supper. And so what we're seeing in this report is that the first thing you're noticing is that they're not meeting goal for the hypoglycemia. And that's actually the most important thing that you'll wanna fix first is the hypoglycemia. So the low is 4%. It, it really should be less than 4% and the very low is, should be less than 1% and it's at 2%. So, you know, this patient is having a problem with hypoglycemia. And so if you look on the left on this particular report, it shows you what the goals are. So you don't even have to memorize that. It's right there on the report for you. And then if you look at the graph below, you can just right in front of your face, you can see that they are running low at that in the middle of the night. And then if you look at the variability on the, uh it's uh higher than 36%. So this person is having a lot of variability. If people do develop hypoglycemia and they, most of them sleep through it during the night and they don't even know they're having it. And I know I see that a lot with, uh some of my patients that are international patients and they all wear sensors when they come to the United States. For some reason, they always wear them, even if they're only on uh a Sephora and they have a different version of Sephora than we have on the market. And they'll be wearing their sensor during the night and I'll go visit them and then we'll look at the, the report the next day and they're, they're, they sleep through lows. So it's very, very common that people sleep through lows. But when people have hypoglycemia episode, the body reacts to the glycemia by putting out cortisol and growth hormone and it causes a rebound hyperglycemia. And so a lot of times if people are having hypoglycemia, if you just fix the hypoglycemia first, then they don't have as many high blood sugars later. And so, uh that's the most important thing to do first. And so there's another report that tells you the same thing. So this is the exact same patient, but it's a different uh report called glucose pattern insights. And it's, uh looks a little bit more streamlined, a little bit cleaner. Um And, and basically it has you identify and fix one problem at a time and you fix the low first and then the high second and then you assess their, their lifestyle and then you consider it alternate therapies. And so, you know, maybe, maybe they were drinking wine at night and that's what's causing the hypo, the nots they got low is from that. And then you can kind of fix that. Um, if you look on the right though, it says consideration for the clinician and it says the most important uh pattern is low on here. So you don't even have to really, you know, you can just pick up this report and know what to do because it just tells you what the pattern is. And so you can address that one pattern. There was actually a study done and it was of 35 providers and they were given 10 cases and they were given a, a GP report and a GP I report to look at on each of the 10 cases and they had two rounds of it. Um, there were, uh, uh, the pro the provider was, uh, given the history of the patient, like what the medications were on, you know, that type of thing, they were given 60 seconds to review, uh, each report and then identify the problem. And at the end of the, the study, uh, when they did the second round after the second round, then they noticed that the hypoglycemia, the therapy decisions were improved by using the GP I report and then the time to address uh improved uh with the GP I and so it saved time and they actually had better outcomes from using that particular report. Uh and then uh as far as uh provider opinion, they believe that the GP I report was preferred to, to one. And so uh they had improved decision making for cases with the GP I report. And so you can see that the A GP is in the, the dark uh black and then the gray is the GP I report. And then with the A GP report with it, it didn't give you that. Um What do you want to call it, the insights? It didn't give you the opinion of the pattern. Then actually SIA was worsened with the GP I report and it, they had prolonged hypoglycemia with the GP I. So this is the same case. But in the, oh, wait, sorry, I already did this one. I'll start, I'll start this one and go forward. How, how's that? OK. So this is the case one that we just talked about and they're on Metformin A GOP one and GLIP his eye at breakfast and supper and they're having excessive lows during the night. And so what you have to do is look at what therapy is causing the problem. And in this case, it would be the glycoside because Metformin and G LP one does not cause hypoglycemia. I would start with getting rid of glycoside at the supper dose since it's happening during the night. But if they have any further hypoglycemia, I would get rid of glycoside. And then if they are running too high because of getting rid of glicozide, I would consider using another diabetes medication that doesn't cause hypoglycemia. This is the same report in the GP I and it's basically the same thing other than it does tell you on the report that the patterns for hypoglycemia and that, of course, you would do the same thing. And this is a different case and it shows that time and target range is 69%. But the overall hypoglycemia rate is 6%. And so you can see that they're getting low, uh, during the night time and then they're spiking up high right after that. So that could be a rebound hyperglycemia case. This particular patient is on Metformin, um, at the maximum dose, a GOP one at the maximum dose and then they're also on basal insulin and prandial insulin. And so I would probably get rid of the, the medication. That's probably the culprit is the, uh, night time glaring. And I would lower that dose. Or in some people with type two diabetes, they don't really need much of basal insulin. They just need insulin for food because usually food is what's causing the blood glucose to be higher. Another trick I use all the time in patients with type one and type two diabetes is if they can take their perennial insulin 15 or 20 minutes prior to eating that will minimize the spikes in uh in post annually. And the A One C improves and their variability improves. So, in summary, we discussed how to interpret a, a glucose report and different reports that are available to you and how to change therapy to help people achieve better time and range with less glycaemic variability. And now I'm turning it over to Jennifer who's talking about patient motivation and engagement uh or using a continuous glucose monitor and she's gonna present some nice cases.
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