Before opening the CGM report, ask two questions: what number do you usually sit at, and what number makes you feel bad? The answers take thirty seconds and reframe the whole consultation.
If the patient names 200 mg/dL as normal and 130 mg/dL as the level where they feel shaky and useless, you are not negotiating over a target — you are asking them to accept weeks of feeling unwell in exchange for a benefit they cannot feel. That is a reasonable thing to ask for, but only if it is named. Agreeing an interim range, saying how long the adjustment usually takes, and booking the review inside that window is a different conversation from writing "poor adherence".
It also works in reverse. A patient who names a tight personal range and still has a poor download is telling you the problem is not their perception of glucose, and the review should go to insulin timing, dosing and technology instead.
- Two questions, asked before the report is opened: usual number, and the number that feels bad
- Where the gap to guideline range is large, set an interim target and say why
- Name the adjustment period out loud so feeling worse is expected, not a failure
- Book the review inside the adjustment window rather than at the next routine slot
- A tight personal range with a poor download points the review at insulin and technology
Why it matters
It separates a patient who cannot tolerate the target yet from one who is not on the right regimen.
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