BC ADM Technology in Diabetes 5 — Questions and Answers
Question 1: A patient with type 1 diabetes on a closed-loop system is planning a 4-hour drive. Which action is MOST appropriate regarding insulin delivery?
- Disable the closed-loop mode for the entire drive
- Set a temporary higher glucose target or activity mode during driving (Correct answer)
- Administer a preemptive 10-gram carbohydrate snack every 2 hours without CGM monitoring
- Suspend the pump for the duration of the drive
Correct answer: Set a temporary higher glucose target or activity mode during driving
Setting a higher glucose target or activity mode reduces insulin delivery risk during prolonged sedentary activity and accounts for any risk of hypoglycemia while driving.
Question 2: Which factor is MOST important when selecting a CGM system for a patient with chronic kidney disease on hemodialysis?
- Waterproof sensor casing
- Potential for glucose reading inaccuracies due to uremia and dialysis-related glucose fluctuations (Correct answer)
- Sensor warm-up time compatibility with dialysis scheduling
- Availability of a 90-day sensor
Correct answer: Potential for glucose reading inaccuracies due to uremia and dialysis-related glucose fluctuations
Uremia and hemodialysis can impair CGM accuracy; clinicians should counsel patients and use CGM data cautiously, especially peri-dialysis.
Question 3: A patient's Dexcom CGM requires two fingerstick calibrations daily. Which generation of the Dexcom system does this describe?
- Dexcom G4 Platinum
- Dexcom G5 Mobile (Correct answer)
- Dexcom G6
- Dexcom G7
Correct answer: Dexcom G5 Mobile
The Dexcom G5 Mobile required two fingerstick calibrations per day; the G6 and G7 are factory-calibrated and require no routine calibration.
Question 4: Which CGM glucose alert setting is most directly linked to reducing severe hypoglycemia events while minimizing alarm fatigue?
- Setting the low alert at 80 mg/dL with a 5-minute snooze
- Setting the low alert at 70 mg/dL with a 30-minute snooze (Correct answer)
- Enabling the urgent low soon alert at 55 mg/dL with a 60-minute snooze
- Disabling all low alerts and relying on trend arrows
Correct answer: Setting the low alert at 70 mg/dL with a 30-minute snooze
A 70 mg/dL low alert with a 30-minute snooze balances early hypoglycemia warning with reduced alarm fatigue, aligning with standard hypoglycemia thresholds.
Question 5: A patient reports her insulin pump's reservoir only delivers 80% of the programmed dose. After ruling out occlusion, the MOST likely technical cause is:
- Incompatible insulin concentration in the reservoir
- Air bubbles in the reservoir or tubing causing delivery errors (Correct answer)
- Low battery power reducing motor efficiency
- Incorrect basal programming by the patient
Correct answer: Air bubbles in the reservoir or tubing causing delivery errors
Air bubbles in the reservoir or infusion tubing are a well-known cause of under-delivery in insulin pumps, as the motor displaces air rather than insulin.
Question 6: Which finding on an AGP report would prompt immediate clinical concern for nocturnal hypoglycemia requiring intervention?
- Time below 70 mg/dL (Level 1) of 3% overall
- Time below 54 mg/dL (Level 2) of 2% between midnight and 6 AM (Correct answer)
- Mean sensor glucose of 150 mg/dL
- CV of 35%
Correct answer: Time below 54 mg/dL (Level 2) of 2% between midnight and 6 AM
Time below 54 mg/dL >1% (especially concentrated overnight) exceeds the international consensus threshold and requires immediate intervention to prevent serious hypoglycemia.
Question 7: Which BEST describes the role of 'smart insulin pens' compared to connected insulin pens in diabetes technology?
- Smart pens calculate and deliver precise doses automatically; connected pens only log doses
- Smart pens include a dose calculator using CGM data; connected pens primarily record what was delivered (Correct answer)
- Smart pens are only compatible with rapid-acting insulin analogs
- Smart pens replace the need for basal insulin; connected pens supplement it
Correct answer: Smart pens include a dose calculator using CGM data; connected pens primarily record what was delivered
Smart pens integrate with CGM and insulin-on-board data to calculate suggested doses; connected pens focus primarily on dose capture and logging.
BC ADM Technology in Diabetes 5
A patient with type 1 diabetes on a closed-loop system is planning a 4-hour drive.
Which action is MOST appropriate regarding insulin delivery?