APEP Projects

  1. An Audit on the use of Continuous glucose monitor (CGM) or Flash Glucose monitor in patients with Diabetes
  2. An audit on Pump use in patients with type 1 diabetes in Trafford Hospital


Trafford hospital is one of the first hospitals in Manchester to use pumps for better management of Type 1 diabetes. Over the past 18 years, a number of patients have gone onto various pumps and technology to better control diabetes. This is an audit to see if Trafford hospital is following national guidelines for pump use and if we have made a difference to patients using technology

Continuous glucose sensors.

These are small devices worn by patients with diabetes. This allows a continuous pattern of glucose readings which help us  and the patient monitor and control diabetes better. They are usually worn for 10 – 14 days (depending on the life of the sensor) at a time and the readings are moitored using a reader or an app on the patient’s mobile phone


  1. A continuous pattern of interstitial glucose readings are available to help us understand the pattern better..(eg, relation to food, stress, menstrual cycle)
  2. Alarms can be set to warn of current or impending hypoglycemia or hyperglycemia
  3. Remot monitoring of blood sugars are possible

Sensors we use

  1. Dexcom G6, Dexcom One
  2. Guardian 4
  3. Freestyle libre 2 (flash glucose sensor) and Freestyle libre 3 (CGM)



these are highly specialized devices to administer insulin in a predictable, slow manner. They tend to mimic body physiology better and can be adjusted much more quickly compared to regular injections

Insulin regimes

Insulin injection twice daily Injection 4 times daily (Basal Bolus)  Insulin pump
Typical regime  Premix insulin 16 units twice daily  Long acting insulin 12 units once daily

Short acting insulin three times daily with meals

short acting insulin only

0.5 units between 12 MN to 1 AM

0.6 units between 1 AM to 2 AM

0.4 units between 2 AM to 3 AM


Bolus adjustment Difficult to do this adjustment 1 unit for 10 grams of carbohydrates

1 unit brings down blood sugars by 2.5 mmol/l

1 unit for 10 grams of carbohydrates

1 unit brings down blood sugars by 2.5 mmol/l

Monitoring Finger prick testing

Fingerprick testing or CGM

Monitoring HbA1c

Blood glucose record


Blood glucose record, Time in range

Time in range, Time above and below range

Glucose variability, time in closed loop

 Exercise Need to carb load for exercise Carb loading for exercise (un- predicted exercise)

Reduce short acting insulin (if exercise is predicted)

Reduce basal rates – ( Temporary basal rates)


Hypoglycemia Need to cab load to correct hypoglycemia Carb loading Predictive suspend of insulin (automatic)