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[IPk] Continuous glucose monitoring: a point to consider

I was speaking to one of the partners in the practice I now work in, who has
recently attended a conference re DM. Apparently ?Dr?Prof Kerr was there. It
seems that long acting analogues( glargine) are really going to be pushed.
This is partly due to work with the CGMS which has revealed the full extent
of nocturnal hypoglycaemia, even in those with really good control and full
daytime hypo awareness. Glargine apparently seems very effective in solving
this problem.

Apparently one man with IDDM was in a very responsible job involving night
work. CGMS revealed unsuspected nocturnal hypos and he was advised to take
time off work (?? or not given the choice to continue) until the problem
ressolved. Fortunately glargine ressolved it. I was lead to believe that the
person involved was on a pump before( had A1c of 7% and daytime hypo
awareness). This may have been a miscommunication although he could have
been one of those people who don't benefit as much from pumps ( I still find
this a little hard to comprehend as even analogues have slight variability
and surely can't be tuned as finely as pumps)

Anyway, my main point is the implication for someone in whom CGMS reveals
unsuspected and asymptomatic hypos , regarding fitness to drive and jobs.

I would be very wary of trying it for this reason, and even before I heard
of the above I would be cautious due to fitness to drive ie possible
asymptomatic daytime hypos, although I think I have good awareness

It seems that with many modern innovations there may be a price to pay and a
reason to proceed with caution ( could genetic testing and effect on life
insurance be an analogy?)

Of course, the  good thing is the guy's problems were solved so he has less
chance of loosing his daytime awareness, while retaining his good control,
fitnss to drive and ability to do his job safely. Plus reduced the ?
miniscule chance of a severe nocturnal episode resulting in him not waking
up without some assistance ( ie glucagen)
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