Hi everyone! Please download a QR code reader onto your phone if you don’t already have one. You’ll need it to scan the QR code for your certificate at the end.
Oh, also, we’re going to use mentimeter so if you’d like to download that too then you can (although don’t have to - you can do it from your browser).
Use the code 20 27 7
CORRECTION! www.menti.com code 40 27 7
Please add any questions to the chat here and we’ll try to answer as we go along!
Can u please tell code again?
40 27 7
Sorry what's the code for again?
It’s for menti.com to allow interactive questions
Ah cool thanks
i missed qr code
Don’t worry, it is at the start and end of every presentation
So it’ll be back!
it will be back at the end of each talk and is the same on, so you just need one
Me too. How to use the QR code ?Click on it?
you need to download a QR code reader to your phone and take a photo of it
open you camera over the QR code - it should take you to the survey monkey link
Oh yea thank you
If you go to menti.com you can vote
Where can we listen to the recording in the future?
on pumpimperial.co.uk web page
what benefit does medrotic CGM this have over freestyle libre?
whats the code for menti.com
What do you think about the MiaoMiao adapter for Free Style Libre and hypos
How do you fund CGM for your patients?
Can you please tell us the difference between Dexcom and Medtronic meters again?
Menti code is 40277
@Rashid CGM has a significant impact on HbA1c, exposure to hypoglycaemia, and severe hypoglycaemia. Flash/Libre only reduces time below range in people with optimal HbA1c. In people with impaired awareness/ severe hypoglycaemia real-time CGM is the optimal treatment. See https://onlinelibrary.wiley.com/doi/10.1111/dme.13561
@Nithya The Dexcom G6 CGM is calibration free (so does not require any capillary blood glucose measurement to work) and is licensed for use to make treatment decisions (so you can dose titrate your insulin from the values). Medtronic requires twice daily calibration and is not licensed for treatment decisions so people **should** check blood glucose before insulin dosing. Dexcom CGM is more accurate in the literature than both Medtronic and LIbre, especially in the really important glucose region in target and in hypoglycaemia.
Thanks Nick, that’s very helpful
I thought the criteria to offer Dexcom is very strict
@Maria Hi! Miao Miao is fine but does not address the inherent accuracy issues with Libre, especially in the hypo range. CGM is commissioned throughout London in line with NICE Guidance. All localities have signed up to this. See http://www.londonscn.nhs.uk/wp-content/uploads/2018/10/LondonCGMcommissioning_Sep18-FINAL.pdf
how does Dexcom work?
@Pushpa The NICE guidance (NG17) gives clear criteria for CGM access, we have implemented it throughout London, see above link. I’m very happy to share the documentation that got us there
@drbeenish23 an interstitial fluid sensor detects glucose and transmits the value by Bluetooth to a smartphone or reader device. Alerts and alarms for impending hypo- and hyperglycaemia are programmable except for an urgent hypo alarm at 3.1mmol/L.
Can you please explain once more how to vote for the answers?
@Cristina go to menti.com and use code 40277
Hi you go to www.menti.com on your phone and type in the code and the questions come up
why dont we get her a 670G and the closed loop?
@Valmiki she would still need to finger prick 4 to 5 times per day so it would not solve her major issue. She may get a very small improvement in time in range (3.9 to 10mmol/L) and time below range but at significant initial and ongoing expense.
why not Dexcom as she does not have to calibrate
@drbeenish23 she doesn’t meet the criteria in the NICE/London guidance - see links above.
I am afraid not aware of different CGM and their differences from each other
same with me
Monika will go through them now!
can we be taught a lil more abt other sensors
no awareness of any technology
same, please explain the difference
Yea would be great if the different types of CGMs could be reviewed quickly
Please see current slide!
what about freestyle libre 2 ?
not explained in detail
Sorry, we have relatively little time today. There is an excellent review here https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.13942
@parez2016 Libre 2 is not yet available in the UK and uses exactly the same sensor as Libre
probably difficult to go through each during this session - some self-directed learning for us.
@Vaish Yes! Do get in touch if you have questions after you’ve had a read
Thank you Nick, and thank you for the references/papers
is minimed 670g Medtronic>?
@drbeenish23 yes it is
MARD value of different RT CGM?
accuracy. <10 ideal
Sorry what is the difference between PLBG suspend and closed loop
plz explain ISF
ISF:insulin sensitivity factor
calculated 100/total daily dose
@ankurpoddar PLGS is predictive low glucose suspend - the pump shuts off insulin delivery when hypoglycaemia is predicted and restarts when glucose returns above a pre-defined threshold. The PROLOG study is a good reference to read for PLGS effectiveness at reducing exposure to hypoglycaemia. A closed loop system also address the glucose above range by increasing insulin delivery as required.
@Rashid Siân will cover that
what type of insulin commonly used for pump ? is it novorapid , actrapid , humolog or ... ?
@parez2016 yes, any rapid analogue can be used (so aspart, lispro, or glulisine). Fiasp may reduce area under the curve of glucose after meals with pump therapy but has a small impact in the clinical studies. We use it for people who find post-prandial glucose difficult. The other potentially useful thing about fiasp is that it is fast-off as well as fast-on so may be good to avoid hypoglycaemia but that is not evidence-based.
Siân’s pizza paper is here https://www.liebertpub.com/doi/10.1089/dia.2019.0079. Education and support are really important.
is there a risk of acidosis with zero insulin?
Is it always 4 hours because of the insulin duration?
@karim not with a large bolus up front but that is why Siân says to use a temporary basal of 0% rather than stopping the pump. There is a lovely study of simulated pump failure which is very reassuring, even without a bolus and with a starting glucose in the high teens. Superboluses are complex though and are challenging to do in real life. The data suggest they’re brilliant though!
@Emily yes, you could do it for shorter than 4 if you feel that fits the food best but never longer
any risk or air entry if 0 % bolus for 4 hrs
@azhar only if you’re on an aeroplane or under the sea!
Thanks @Karim. There risk of acidosis is why we don’t do it for longer than 4 hours, because of the insulin action
@Sian what time of foods would you do the superbolus for e.g. 2 hours rather than 4 hours
*type not time
I’d often start with 2 hours and if that’s not enough insulin up front then try more next time. It helps build up patients confidence. Generally the higher the GI of the food, the more insulin you need upfront, and therefore the more hours of basal you need to add to the bolus
Does that make sense?
Yes thank you!
Sometimes it’s less about the GI and more about the patient - some people seem to have super speedy digestion systems!!!
CGM is very useful for assessing this
free style libre
cant vote yet
if delayed gastric emptying in pregnancy, why give the boluses earlier i.e. longer before meals?
We give bolus insulin earlier because of the very challenging targets 1 hour post prandial glucose targets
(Terribly written but hopefully you know what I mean)
I guess so - thank you!
@bernard hi! The early insulin action of inhibiting hepatic gluconeogenesis is still required to prevent early post-meal hyperglycaemia. The delayed component of the meal can then be managed with the levemir that is on board.
Sorry, x-posting with Siân
how can I do feedback for today to get certficate
Re-reading that I think I should have added that the delayed component of the meal can then be **partly** managed with the levemir on board
the QR code will appear shortly
what should I do with QR code?
photograph it with your phone
It will take you to a survey monkey to feedback
I am using my iPhone to view this session and has taken screenshot of QR code but it’s not working
what advise do you give for breast feeding and adjusting insulin pump rates?
Thank you very much indeed for the excellent presentations and teaching.
very comprehensive teaching session. Thanks
This has been a great course - thank you very much to the organisers
i have completed feed back form
tank you so much
Fantastic, thank you very much
thanks for the session
Can I please ask if you have any advice on how to use hypoglycaemia unawareness in patient who do a DIY AP?
Excellent talks - many thanks everyone
is Miao Miao reliable ?
Thank u for the presentation
I mean "artificial pancreas DIY
Thank you so much
Htet Htet Aung
very practical. Thanks a lot.
breast feeding and insulin
wonderful presentation, many thanks
Thank you very much
Vinit and also Akshita
Any resources for training to get familiar with interpreting CGM/FSL or pump data and implementing in decision making?
Thank you. Excellent short course.
Muhammad Hassaan Pervez
@idrisi and @Elena if you add your email address to mention that would be marvellous. thanks.
*menti (stupid autocorrect)
Thank you all :-)
Any resources to read hybrids loops Miao miao
I am unable to access the survey. Email is firstname.lastname@example.org - for feedback please. Thank you very much
where can I access the recording from today?
any further sessions coming up?
Is it possible to have a copy of the slides please?
thanks a lot!
what about free style libre 2 ? and why still not available in the UK ?
thank you so much
Thank you all ,really appreciated efforts.
Thank you everyone for getting the course out today!
any advise for breast feeding and insulin adjustment
excellent course. Many thanks.
gijitharayil@ gmail.please send the feed back form
how can we get the certificate
Thank you very much for this excellent session
Vinit and also Akshita