BC ADM Technology in Diabetes 3 — Questions and Answers
Question 1: A closed-loop system increases basal insulin delivery yet the patient's postprandial glucose rises to 280 mg/dL consistently. The MOST likely explanation is:
- The CGM is reading falsely low
- The patient is not pre-bolusing for meals (Correct answer)
- The algorithm's basal adjustments are too aggressive
- The correction factor is set too high
Correct answer: The patient is not pre-bolusing for meals
Closed-loop systems optimize basal insulin but rely on patient-entered meal boluses; skipping pre-bolus causes postprandial spikes the algorithm cannot fully correct in real time.
Question 2: Which factor MOST significantly impairs CGM accuracy during rapid glucose changes?
- Sensor placement on the abdomen
- Physiological lag between interstitial and blood glucose (Correct answer)
- Inadequate sensor warm-up time
- Presence of scar tissue under the sensor
Correct answer: Physiological lag between interstitial and blood glucose
Interstitial glucose lags behind blood glucose by approximately 5–10 minutes, causing CGM readings to underestimate or overestimate during rapid changes.
Question 3: What does a coefficient of variation (CV) >36% on a patient's CGM report indicate?
- Consistently elevated glucose
- High glycemic variability requiring management (Correct answer)
- Poor CGM sensor calibration
- Insufficient sensor wear time
Correct answer: High glycemic variability requiring management
A CV >36% reflects high glycemic variability, which is associated with increased hypoglycemia risk and poor metabolic control independent of mean glucose.
Question 4: A patient with type 2 diabetes on basal insulin is considering a connected insulin pen. Which benefit is MOST relevant to their diabetes management?
- Automatic dose calculation without fingerstick
- Dose logging and reminders to reduce missed or duplicate injections (Correct answer)
- Real-time CGM integration for closed-loop control
- Bluetooth-enabled basal rate programming
Correct answer: Dose logging and reminders to reduce missed or duplicate injections
Connected insulin pens record dose timing and amount, helping patients and clinicians identify missed or duplicate injections that drive glucose variability.
Question 5: According to the AGP (Ambulatory Glucose Profile) report, which metric best reflects overnight hypoglycemia burden?
- Time below range <54 mg/dL (Level 2 low) (Correct answer)
- GMI (Glucose Management Indicator)
- Mean sensor glucose
- Time in range 70–180 mg/dL
Correct answer: Time below range <54 mg/dL (Level 2 low)
Time below range <54 mg/dL (Level 2 hypoglycemia) is the metric most directly reflecting serious hypoglycemia burden, with a target of <1%.
Question 6: Which CGM site is FDA-approved for the Dexcom G6 sensor placement?
- Upper arm only
- Abdomen and back of upper arm (Correct answer)
- Thigh and abdomen
- Abdomen only
Correct answer: Abdomen and back of upper arm
The Dexcom G6 is FDA-approved for placement on the abdomen (adults) and the back of the upper arm (ages 2–17).
Question 7: A patient using an insulin pump develops unexplained hyperglycemia. After ruling out illness, the FIRST troubleshooting step should be:
- Switch to a new insulin vial
- Administer a correction dose via syringe and change the infusion site (Correct answer)
- Increase the basal rate by 20%
- Perform a pump settings review with the manufacturer
Correct answer: Administer a correction dose via syringe and change the infusion site
Infusion site occlusion or failure is the most common pump-related cause of unexplained hyperglycemia; correcting by syringe and changing the site addresses both diagnosis and treatment.
BC ADM Technology in Diabetes 3
A closed-loop system increases basal insulin delivery yet the patient's postprandial glucose rises to 280 mg/dL consistently.
The MOST likely explanation is: