# Interference of Intravenous Acetaminophen with Continuous Glucose Monitoring System

## TL;DR

Intravenous acetaminophen can cause falsely high glucose readings in continuous glucose monitoring systems, risking incorrect insulin delivery in diabetes management.

## Contribution

This study reports the first case of intravenous acetaminophen interfering with CGM accuracy in a type 1 diabetes patient using a sensor-augmented pump.

## Key findings

- Intravenous acetaminophen caused rapid, falsely elevated CGM readings without a corresponding blood glucose increase.
- CGM discrepancies were greatest at lower glucose levels, with discrepancies of 55 to 114 mg/dL observed.
- Such interference could lead to inappropriate insulin delivery and hypoglycemia in automated insulin delivery systems.

## Abstract

Sensor-augmented pumps (SAPs) and automated insulin delivery (AID) systems are innovative technologies for diabetes management. Accurate continuous glucose monitoring (CGM) is crucial for their safe and effective use; however, certain commonly used drugs can interfere with CGM accuracy. Although acetaminophen is known to cause falsely elevated CGM glucose values, previous CGM studies have primarily focused on its oral administration, with limited data on intravenous use. We report a case of a CGM reaction after the intravenous administration of acetaminophen in a boy with type 1 diabetes using SAP. The patient received repeated doses of intravenous acetaminophen (15 mg/kg for 15 min) for pain relief. After administration, we recorded a rapid increase in his CGM readings without a corresponding increase in blood glucose levels. The CGM glucose peaked at 29.2 ± 1.9 min (mean ± standard deviation) after administration and an estimated discrepancy of 55 to 114 mg/dL compared with capillary blood glucose measurements. Discrepancies between measured blood glucose and CGM readings were significantly greater at lower glucose levels. These falsely elevated CGM readings could potentially trigger an inappropriate autocorrection bolus in AID systems and increase the risk of hypoglycemia. Medical professionals should be fully aware of acetaminophen-induced CGM interference, particularly the potential risks in patients using AID systems.