BC ADM Technology in Diabetes 4 — Questions and Answers
Question 1: Which interoperability standard allows diabetes devices from different manufacturers to communicate and share data?
- Bluetooth Low Energy (BLE)
- HL7 FHIR
- Open Protocol for AID (iCGM + ACE pump standards) (Correct answer)
- DICOM
Correct answer: Open Protocol for AID (iCGM + ACE pump standards)
The FDA's iCGM and ACE (Alternate Controller Enabled) pump designations enable interoperability between devices from different manufacturers within automated insulin delivery systems.
Question 2: A patient reports that her CGM readings are consistently 30–40 mg/dL lower than fingerstick values during the first day of sensor wear. The MOST likely cause is:
- Sensor placed over a vein
- Sensor initialization lag during the first 24 hours (Correct answer)
- Acetaminophen interference with the enzyme electrode
- Extreme cold weather affecting the sensor
Correct answer: Sensor initialization lag during the first 24 hours
Many CGM sensors have a 'break-in' period during the first 24 hours where readings may be less accurate as the sensor equilibrates with interstitial fluid.
Question 3: Which medication is known to cause falsely elevated glucose readings on CGM sensors using glucose oxidase technology?
- Metformin
- Acetaminophen (at therapeutic doses) (Correct answer)
- Ibuprofen
- Hydroxyurea
Correct answer: Acetaminophen (at therapeutic doses)
Acetaminophen at standard doses can oxidize on glucose oxidase-based sensors and cause falsely elevated CGM readings, a known limitation addressed in newer sensor generations.
Question 4: What is the primary advantage of implantable CGM sensors (e.g., Eversense) over transcutaneous sensors?
- Lower cost per day of use
- Extended wear duration of up to 180 days (Correct answer)
- No need for a transmitter
- Greater accuracy during rapid glucose changes
Correct answer: Extended wear duration of up to 180 days
Implantable CGM sensors like the Eversense E3 can be worn for up to 180 days, significantly reducing sensor change frequency compared to 7–14 day transcutaneous options.
Question 5: When reviewing a patient's pump download, you notice multiple 'no delivery' alarms clustered in the early morning. The MOST appropriate clinical action is:
- Reduce overnight basal rates to prevent occlusion
- Investigate for kinked cannulas, tunnel lipohypertrophy, or insulin precipitation (Correct answer)
- Recommend switching to a tubeless pump
- Add a correction factor to the morning meal bolus
Correct answer: Investigate for kinked cannulas, tunnel lipohypertrophy, or insulin precipitation
Clustered no-delivery alarms suggest recurrent occlusion, which can result from kinked tubing, lipohypertrophy at the site, or insulin aggregation in the cartridge.
Question 6: A BC-ADM is counseling a patient on the GMI reported on their CGM. How does GMI differ from HbA1c?
- GMI is calculated from the last 7 days of CGM data, while HbA1c reflects 90 days
- GMI is derived from mean sensor glucose over at least 14 days and does not account for red blood cell turnover (Correct answer)
- GMI requires calibration with HbA1c to be valid
- GMI measures glycemic variability while HbA1c measures average glucose
Correct answer: GMI is derived from mean sensor glucose over at least 14 days and does not account for red blood cell turnover
GMI is a formula-derived estimate of average glucose from CGM data that bypasses HbA1c's dependence on red blood cell lifespan, making it useful when hemoglobin variants distort HbA1c.
Question 7: Which automated insulin delivery system feature is specifically designed to help prevent exercise-induced hypoglycemia?
- Carbohydrate announcement mode
- Activity or exercise mode that temporarily raises the glucose target (Correct answer)
- Pre-programmed basal reduction 30 minutes before exercise
- Dual-wave bolus delivery
Correct answer: Activity or exercise mode that temporarily raises the glucose target
Exercise mode (available in several AID systems) temporarily increases the target glucose set point, causing the algorithm to withhold or reduce insulin delivery during physical activity.
BC ADM Technology in Diabetes 4
Which interoperability standard allows diabetes devices from different manufacturers to communicate and share data?