Using Continuous Glucose Monitoring for Patients with Hypoglycemia

  • X. J. Ma
  • J. ZhouEmail author


Hypoglycemia is one of the major challenges in diabetes management for most patients, especially among those with type 1 diabetes. Clinical studies have shown that hypoglycemia can lead to cognitive dysfunction and behavioral impairment, and severe hypoglycemia can even cause fatal outcomes such as dead-in-bed syndrome. This chapter focuses on the clinical application of continuous glucose monitoring (CGM) for diabetic patients with hypoglycemia. The classification of hypoglycemia and its adverse outcomes will be introduced. The utilization of CGM in the management of hypoglycemia in China and internationally will also be introduced in relation to both retrospective and real-time CGM. A practical example is presented here to explain how CGM can be applied to monitor hypoglycemia and to guide individualized treatment for diabetic patients.


Diabetes mellitus Hypoglycemia Continuous glucose monitoring 


  1. 1.
    Seaquist ER, Anderson J, Childs B, Cryer P, Dagogo-Jack S, Fish L, Heller SR, Rodriguez H, Rosenzweig J, Vigersky R. Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society. Diabetes Care. 2013;36:1384–95. Scholar
  2. 2.
    American Diabetes Association. 6. Glycemic targets. Diabetes Care. 2017;40(Suppl 1):48–56. Scholar
  3. 3.
    The Diabetes Control and Complications (DCCT) Research Group. Effect of intensive therapy on the development and progression of dibetic nephropathy in the Diabetes Control and Complications Trial. Kidney Int. 1995;47:1703–20.CrossRefGoogle Scholar
  4. 4.
    Warren RE, Frier BM. Hypoglycaemia and cognitive function. Diabetes Obes Metab. 2005;7:493–503. Scholar
  5. 5.
    Law JR, Yeşiltepe-Mutlu G, Helms S, Meyer E, Özsu E, Çizmecioğlu F, Lin FC, Hatun Ş, Calikoglu AS. Adolescents with Type 1 diabetes mellitus experience psychosensorial symptoms during hypoglycaemia. Diabet Med. 2014;31:1245–51. Scholar
  6. 6.
    Hendrieckx C, Halliday JA, Bowden JP, Colman PG, Cohen N, Jenkins A, Speight J. Severe hypoglycaemia and its association with psychological well-being in Australian adults with type 1 diabetes attending specialist tertiary clinics. Diabetes Res Clin Pract. 2014;103:430–6. Scholar
  7. 7.
    Nefs G, Bevelander S, Hendrieckx C, Bot M, Ruige J, Speight J, Pouwer F. Fear of hypoglycaemia in adults with Type 1 diabetes: results from Diabetes MILES - The Netherlands. Diabet Med. 2015;32:1289–96. Scholar
  8. 8.
    Kikuchi Y, Iwase M, Fujii H, Ohkuma T, Kaizu S, Ide H, Jodai T, Idewaki Y, Nakamura U, Kitazono T. Association of severe hypoglycemia with depressive symptoms in patients with type 2 diabetes: the Fukuoka Diabetes Registry. BMJ Open Diabetes Res Care. 2015;3:e000063. Scholar
  9. 9.
    Kelly D, Hamilton JK, Riddell MC. Blood glucose levels and performance in a sports cAMP for adolescents with type 1 diabetes mellitus: a field study. Int J Pediatr. 2010;2010:216167. Scholar
  10. 10.
    Sherin A, Peeyush KT, Naijil G, Chinthu R, Paulose CS. Hypoglycemia induced behavioural deficit and decreased GABA receptor, CREB expression in the cerebellum of streptozoticin induced diabetic rats. Brain Res Bull. 2010;83:360–6. Scholar
  11. 11.
    Tanenberg RJ, Newton CA, Drake AJ. Confirmation of hypoglycemia in the “dead-in-bed syndrome”, as captured by a retrospective glucose monitoring system. Endocr Pract. 2010;16:244–8. Scholar
  12. 12.
    Mo YF, Zhou J, Jia WP. Research progress of dead-in-bed syndrome in type 1 diabetes. Chin J Endocrinol Metab. 2011;27:1032–5. Scholar
  13. 13.
    Li M, Zhou J, Bao YQ, Lu W, Jia WP, Xiang KS. Evaluating the feature of hypoglycemia detected by continuous glucose monitoring system during temporary continuous subcutaneous insulin infusion in type 2 diabetes patients. Zhonghua Yi Xue Za Zhi. 2008;88:1679–82. Scholar
  14. 14.
    Maia FF, Araújo LR. Efficacy of continuous glucose monitoring system to detect unrecognized hypoglycemia in children and adolescents with type 1 diabetes. Arq Bras Endocrinol Metabol. 2005;49:569–74.CrossRefPubMedGoogle Scholar
  15. 15.
    Li M, Zhou J, Bao YQ, Lu W, Jia WP. Prediction of nocturnal hypoglycaemia with bedtime glucose level during continuous subcutaneous insulin infusion in type 2 diabetics. Zhonghua Yi Xue Za Zhi. 2010;90:2962–6. Scholar
  16. 16.
    Wentholt IM, Maran A, Masurel N, Heine RJ, Hoekstra JB, DeVries JH. Nocturnal hypoglycaemia in Type 1 diabetic patients, assessed with continuous glucose monitoring: frequency, duration and associations. Diabet Med. 2007;24:527–32. Scholar
  17. 17.
    Pettus J, Price DA, Edelman SV. How patients with type 1 diabetes translate continuous glucose monitoring data into diabetes management decisions. Endocr Pract. 2015;21:613–20. Scholar
  18. 18.
    Peyser TA, Nakamura K, Price D, Bohnett LC, Hirsch IB, Balo A. Hypoglycemic accuracy and improved low glucose alerts of the latest Dexcom G4 Platinum continuous glucose monitoring system. Diabetes Technol Ther. 2015;17:548–54. Scholar
  19. 19.
    Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011;34:795–800. Scholar
  20. 20.
    Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359:1464–76. Scholar
  21. 21.
    Mo YF, Zhou J, Bao YQ, Gao F, Lu W, Jia WP. A case of repeated severe hypoglycemia caused by type 1 diabetes complicated with secondary adrenal insufficiency. Shanghai Med J. 2013;36:474–6.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Scientific and Technical Publishers 2018

Authors and Affiliations

  1. 1.Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Diabetes InstituteShanghai Jiao Tong University, Affiliated Sixth People’s HospitalShanghaiChina

Personalised recommendations