When a sensor download lands in front of you with five minutes left in the consultation, the mean glucose and the estimated HbA1c are the least useful numbers on the page. They are the ones the patient has already seen, and they are the ones a dose change is least likely to move safely.
Start with the 00:00 to 06:00 band on the ambulatory glucose profile. Overnight is the window the patient cannot feel, the one where basal insulin is acting with no food and no correction, and the one where a recurring pattern is most likely to be a fixable dosing problem rather than behaviour. A nightly dip at 03:00 that recovers by breakfast is a basal question. A steady climb from midnight is a different question entirely.
Only then look at time below range, then time in range, then the average. Reading in that order tends to produce one change worth making rather than three worth arguing about.
- Look at 00:00–06:00 first, before mean glucose or estimated HbA1c
- Distinguish a nightly dip that recovers from a steady overnight rise — different fixes
- Read time below range before time in range
- Aim to leave the consultation with one dose or timing change, not several
Why it matters
The number a patient fixates on is rarely the one that should drive the next dose change.
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