BC ADM Technology in Diabetes 2 — Questions and Answers
Question 1: A patient using a hybrid closed-loop insulin pump system reports frequent nocturnal hypoglycemia despite the system's auto-suspend feature. Which adjustment is MOST appropriate?
- Increase the basal insulin profile manually
- Lower the glucose target set point in the system settings
- Raise the glucose target set point and review carbohydrate ratios (Correct answer)
- Disable the closed-loop mode at night
Correct answer: Raise the glucose target set point and review carbohydrate ratios
Raising the target set point gives the algorithm more headroom to reduce insulin delivery and prevent nocturnal lows.
Question 2: Which CGM accuracy metric is used to assess the proportion of sensor glucose values within ±20% (or ±20 mg/dL) of reference blood glucose?
- MARD
- MAD
- %20/20 (Correct answer)
- CV
Correct answer: %20/20
The %20/20 criterion measures the percentage of paired CGM-reference readings that fall within 20% or 20 mg/dL of the reference, depending on glucose level.
Question 3: A patient's CGM shows a rapid-drop arrow (↓↓) at a glucose of 110 mg/dL before exercise. What is the MOST appropriate immediate action?
- Administer a correction bolus
- Consume 15–30 g of fast-acting carbohydrates (Correct answer)
- Begin exercise as planned and recheck in 30 minutes
- Suspend the insulin pump for 2 hours
Correct answer: Consume 15–30 g of fast-acting carbohydrates
A rapidly falling glucose with a double-down arrow before exercise indicates impending hypoglycemia, requiring preemptive carbohydrate intake.
Question 4: Which feature distinguishes a 'predictive low glucose suspend' (PLGS) system from a basic 'low glucose suspend' (LGS) system?
- PLGS requires manual confirmation before suspending
- PLGS suspends insulin based on a projected future low rather than a current low threshold (Correct answer)
- PLGS only functions with specific CGM brands
- PLGS suspends basal and bolus delivery simultaneously
Correct answer: PLGS suspends insulin based on a projected future low rather than a current low threshold
PLGS uses CGM trend data to predict a future low and suspends insulin delivery before the threshold is actually reached.
Question 5: In time-in-range (TIR) reporting, the international consensus target for adults with type 1 diabetes is TIR >70% in the range of:
- 54–180 mg/dL
- 70–180 mg/dL (Correct answer)
- 70–200 mg/dL
- 80–180 mg/dL
Correct answer: 70–180 mg/dL
The consensus target for adults with T1D is >70% TIR within 70–180 mg/dL.
Question 6: A patient using flash glucose monitoring (FGM) asks why alarms do not alert her to hypoglycemia overnight. The BEST explanation is:
- FGM sensors are less accurate at low glucose values
- Flash glucose monitors do not have real-time alarms; they require active scanning (Correct answer)
- FGM requires fingerstick confirmation before alarming
- The sensor warm-up period disables alarms during sleep
Correct answer: Flash glucose monitors do not have real-time alarms; they require active scanning
Unlike CGM, FGM (e.g., FreeStyle Libre 1) is a scan-on-demand system with no automatic alarms unless the user scans the reader over the sensor.
Question 7: Which insulin pump infusion set change interval is generally recommended to minimize the risk of lipohypertrophy and site infections?
- Every 24 hours
- Every 48–72 hours (Correct answer)
- Every 5–7 days
- Every 10 days
Correct answer: Every 48–72 hours
Infusion sets should be rotated and changed every 48–72 hours to prevent lipohypertrophy, infection, and unexplained hyperglycemia.
BC ADM Technology in Diabetes 2
A patient using a hybrid closed-loop insulin pump system reports frequent nocturnal hypoglycemia despite the system's auto-suspend feature.
Which adjustment is MOST appropriate?