From the Guidelines
The next step for this 30-year-old woman with a hypoglycemic seizure should be continuous glucose monitoring (CGM) rather than adding a 3:00 AM glucose check. CGM would provide a comprehensive 24-hour glucose profile, capturing nocturnal hypoglycemic episodes that might be missed with intermittent testing, as suggested by the patient's history of diaphoresis upon awakening despite normal daytime glucose levels, which strongly suggests nocturnal hypoglycemia, a condition that can be dangerous as evidenced by her seizure 1. The use of CGM is supported by recent guidelines, including those from 2020, which highlight the importance of glucose assessment using continuous glucose monitoring for patients with diabetes, especially for those at risk of hypoglycemia 1. Key benefits of CGM include:
- Providing real-time data and alerts for hypoglycemic trends before they become severe
- Being less disruptive to the patient's sleep than waking for finger sticks
- Allowing for the establishment of the pattern of hypoglycemia, which can inform adjustments to medication dosing, timing, or dietary recommendations to prevent future hypoglycemic episodes and reduce the risk of seizures 1. Given the patient's history and the advantages of CGM over intermittent glucose monitoring, CGM is the preferred next step for managing this patient's condition and preventing future hypoglycemic episodes.
From the Research
Hypoglycemic Seizure and Glucose Monitoring
- A 30-year-old woman is hospitalized after a hypoglycemic seizure, and she frequently awakens with diaphoresis but normal glucose levels at home with four times daily checks.
- The next step in managing her condition could be to implement continuous glucose monitoring (CGM) or add another check at 3:00 AM to better understand her glucose levels and prevent future hypoglycemic episodes.
Benefits of Continuous Glucose Monitoring
- CGM has been demonstrated to be clinically valuable, reducing risks of hypoglycemia and hyperglycemia, glycemic variability (GV), and improving patient quality of life 2.
- CGM provides a comprehensive assessment of blood glucose levels, allowing the identification of high and low glucose levels, in addition to evaluating glycemic variability 3.
- CGM can help reduce HbA1c and mean glucose, and it is beneficial for people using either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) 2.
Comparison with Additional Glucose Checks
- Adding another check at 3:00 AM may not provide the same level of comprehensive glucose data as CGM, which can detect hypoglycemia and hyperglycemia more accurately 4.
- CGM can identify hypoglycemic events that may not be detected by standard glucose monitoring, and it can provide real-time data to help prevent future hypoglycemic episodes 5.
Duration of Continuous Glucose Monitoring
- The optimal duration of CGM data to report times in ranges and other glycemic metrics is at least 14 days, but some metrics may require longer window lengths 6.
- A 4-week period of CGM data may be sufficient to robustly assess some outcomes, such as mean glucose and percentage time in target range, but longer durations may be needed for other metrics 6.