Having good blood sugar levels with diabetes despite gastroparesis

Press release
Frankfurt am Main, August 12, 2020

This is possible with diabetes software and Flash Glucose Measurement System (FGM)

Gastroparesis, i.e. a gastric emptying disorder, can occur as an autonomic neuropathy, i.e. a nerve disorder, if diabetes mellitus has existed for a long time.

Mr. Jörg Möller, who has type 1 diabetes, was diagnosed with gastroparesis a few years ago when, during a gastroscopy, he still had food residue in his stomach in the morning, even though it had been over 14 hours since his last meal. This led to increased blood sugar levels, i.e. HbA1c values. The HbA1c value - also known as long-term blood glucose - reveals how high the blood glucose level has been in the past eight to twelve weeks.

At the time, he measured his blood glucose in the traditional way using a finger prick and used the SiDiary diabetes software to monitor and document his diabetes.

It was only when he was prescribed a flash glucose monitoring system (FGM) by his doctor, the Freestyle Libre, that he noticed that his glucose levels were always too high at night. It occurred to him that if he adjusted his nighttime basal rates on his insulin pump, he could lower the high glucose levels. He was able to monitor the basal rates in detail in the new version of his diabetes software SiDiary in the animated glucose progression timeline.

Comparison of classic blood glucose measurement vs. measurement with FGM

People with diabetes take the classic blood glucose test several times a day using a finger prick. The drop of blood is dabbed with a test strip and inserted into a blood glucose meter, which indicates the blood glucose level.

In comparison, an FGM measures the sugar in the tissue around the clock, giving patients a complete picture of changing glucose levels. With an FGM, a sensor is attached to the upper arm. A small sensor is placed under the skin during application. The sensor continuously measures the glucose values and stores them. The patient can scan and read the glucose values using a reader or an app on their cell phone.

Initial situation: Excessive glucose fluctuations in gastroparesis

Figure 1 clearly shows that there are strong glucose fluctuations, particularly at night, with moderately elevated median values. The cause is gastroparesis. Mr. Möller only sees this when he uses the FGM.

Figure 1: Representation of the glucose progression in the colored traffic light system (red=bad, green=good) at the top and the basal rates at the bottom from 0 a.m. to midnight. The target range of glucose values to be achieved is shown shaded in SiDiary.

The increase in basal rates visible above from 04:00 onwards starts too late for the problem of high blood glucose levels at night. Mr. Möller has therefore adjusted the nocturnal basal supply on his insulin pump.

Of course, basal insulin is not primarily intended to cover meals. However, there is no bolus insulin that is injected and only takes effect 6 hours later. The intended maximum effect at night cannot be precisely determined by a delayed bolus.

Result: The glucose values have normalized

As you can see in Figure 2 below, the change in nightly basal rates is successful, especially when combined with a general change in meal insulin regimen. Glucose levels have normalized.

The overall fluctuation range of the glucose values and the standard deviation could be further improved.

In the very colorful glucose curve timeline at the top of the figure, you can clearly see that the glucose curve was previously often in the red-colored bad area and has changed towards green for good glucose values.

Figure 2 - Illustration of the glucose curve at the top and the basal rates at the bottom after adjusting the basal rates

"Looking back, I can say that it was precisely the interaction between FGM & SiDiary that helped me to improve my glucose balance. Without the FGM I would not have seen that my main problem was at night and without SiDiary I would not have been able to make a difference by adjusting my basal rates", says Mr. Möller happily.

In the animation of the glucose profile, which you can activate in SiDiary, you can see this very impressively in this video: https://www.youtube.com/watch?v=Ci_izLqSWl4

In the video you can see the simpler representation of the glucose profile, in which the standard deviation is colored. SiDiary can also display the AGP graph (AGP = Ambulatory Glucose Profile), with uncolored standard deviation.

Conclusion: The result of your efforts is immediately visible in the SiDiary diabetes software

An FGM, in combination with the SiDiary diabetes software, is not only a valuable aid in analyzing the glucose profile, but also has a motivating component. In contrast to the snapshots taken with conventional SMBG (self-monitoring of blood glucose), you can immediately see the result of your own efforts.

“For a quick overview, I like to use the glucose profile with the colored standard deviation in the SiDiary diabetes software,” says Möller. “For a more in-depth analysis, I use the AGP, as I can see whether the fluctuations are more in the interquartile range and therefore affect the insulin dosage or rather the interdecile range and therefore the behavior.”

For Mr. Möller, this not only resulted in a normalization of his HbA1c from 8.0 to 5.8, but also an improvement in the standard deviation.

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SINOVO health solutions GmbH

The company SINOVO health solutions GmbH is a manufacturer of software as a medical device and specializes in solutions for diabetes treatment. Founded by Jan Filip and Alf Windhorst in July 2005, SINOVO is one of the pioneers in telemedicine with innovative digital solutions. In cooperation with the team of Prof. Dr. med. Bernhard Teupe, SINOVO has developed a therapy app for type 1 diabetics based on anonymized data sets from more than 15,000 test subjects.  

Press contact

SINOVO health solutions GmbH, Tanja Schönfeld, Willy-Brandt-Str. 4, 61118 Bad Vilbel, Tel.: +49 6101 590 90 00, E-Mail: presse@sinovo.de, Web: sinovo.de, sidiary.org