1. Continuous Glucose Monitoring Thomas Repas D.O. Diabetes, Endocrinology and Nutrition Center, Affinity Medical Group, Neenah, Wisconsin Member, Inpatient Diabetes Management Committee, St. Elizabeth’s Hospital, Appleton, WI Member, Diabetes Advisory Group, Wisconsin Diabetes Prevention and Control Program Website: www.endocrinology-online.com

2. MiniMed Continuous Glucose Monitoring System (CGMS)

3. F Interstitial fluid glucose (G2) is almost always comparable with blood glucose (G1) Interstitial Fluid Measurement

4. Continuous Glucose Monitoring Midnight Noon 0 50 100 150 200 250 300 400 Meal Type 1 Normal 2-day tracing

5. Elevated glycosylated hemoglobin (HbA1c)Elevated glycosylated hemoglobin (HbA1c) Hypoglycemic episodes and unawarenessHypoglycemic episodes and unawareness Hyperglycemic episodesHyperglycemic episodes Diabetic ketoacidosisDiabetic ketoacidosis Unexplained blood glucose excursionsUnexplained blood glucose excursions GastroparesisGastroparesis Gestational diabetes, preconception, pregnancy and nursingGestational diabetes, preconception, pregnancy and nursing Evaluation of therapeutic changes to medication regimenEvaluation of therapeutic changes to medication regimen Evaluation of behavioral modifications affecting glycemic controlEvaluation of behavioral modifications affecting glycemic control Patients undergoing erythropoietin therapy or with hemolytic disorders because HbA1c may be unreliablePatients undergoing erythropoietin therapy or with hemolytic disorders because HbA1c may be unreliable While the system may be used effectively with all diabetes patients, it may be of particular use in evaluating the following conditions and situations: CGMS Indications

6. Snapshot vs. Continuous 4 times/day

7. Snapshot vs. Continuous 288 times/day

10. CGMS Pilot Study HbA1c (%) Bode, et al., Diabetes Research and Clinical Practice, 1999, 46:183-190. p=0.0006p=0.021, from Baseline N=9