Continuous Glucose Monitoring in a Patient With Insulin-Treated Type 2 Diabetes

Abstract

J.B. is a 45-year-old white man with a medical history notable for type 2 diabetes for 12 years, dyslipidemia, coronary artery disease (status post–myocardial infarction [MI] and left anterior descending [LAD] stent placement in 2004), chronic sinus disease, and sleep apnea. His current pharmacological regimen includes atorvastatin, 40 mg daily; ezetimibe, 10 mg daily; clopidogrel, 75 mg daily; ramipril, 2.5 mg daily; metoprolol, 100 mg daily; levocitirizine, 5 mg daily; montelukast, 10 mg daily; extended-release metformin, 2 g daily; pioglitazone, 30 mg daily; exenatide, 10 μg twice daily subcutaneously; glargine, 20 units at bedtime; aspart, 0–4 units with meals; and fluticasone propionate nasal spray, as needed. He does not smoke or drink alcohol. He is 5′7.5″ tall and weighs 209 lb. His BMI is 32 kg/m2. J.B. was able to control his blood glucose levels quite well for 6 years on diet, exercise, and metformin. His A1C values during that time ranged from 5.1 to 6.6%. In 2004, he was admitted to the hospital with an acute anterior wall MI. A stent was subsequently deployed in an occluded mid-LAD artery. His post-MI course was uncomplicated. At the time of his MI, his A1C was 6%, and he weighed 178 lb. Immediately after his MI, his blood glucose levels averaged 300 mg/dl. Basal and prandial insulin was initiated during his hospital stay. One month later, his A1C was 9.5%. He remained on aspart insulin at meals and glargine at bedtime for the next several months. His blood glucose began to improve, and he was switched to glimepiride, 8 mg; pioglitazone, 30 mg; and metformin, 2 g daily. His A1C continued to improve and remained in the 6–7% range for the next year. A job change requiring travel resulted in less exercise and more eating in restaurants. He began to …