CDE Monitoring Techniques 5 — Questions and Answers
Question 1: Which condition can cause falsely ELEVATED blood glucose readings on most electrochemical glucose meters?
- Severe anemia
- High altitude (above 10,000 feet)
- Elevated hematocrit (polycythemia) (Correct answer)
- Hyperbilirubinemia
Correct answer: Elevated hematocrit (polycythemia)
High hematocrit (polycythemia) can cause falsely elevated glucose readings on some meters because excess red cells trap glucose in the sample.
Question 2: A diabetes educator reviews a patient's logbook and notices glucose readings cluster in the 200–250 mg/dL range every day at 3:00 AM. What phenomenon should be investigated first?
- Dawn phenomenon
- Somogyi effect (rebound hyperglycemia)
- Insulin waning
- Nocturnal hypoglycemia followed by rebound (Correct answer)
Correct answer: Nocturnal hypoglycemia followed by rebound
Consistent early-morning hyperglycemia after nocturnal hypoglycemia (Somogyi effect) should be ruled out by checking a 3 AM glucose to determine if a true low precedes the high.
Question 3: A patient asks how to confirm CGM accuracy at home without a clinic visit. The recommended approach is:
- Compare CGM to another CGM sensor simultaneously
- Perform a fingerstick glucose when the CGM shows a stable (flat trend arrow) glucose and compare the values (Correct answer)
- Recalibrate the CGM sensor daily with a urine glucose strip
- Trust the CGM and avoid fingersticks unless symptomatic
Correct answer: Perform a fingerstick glucose when the CGM shows a stable (flat trend arrow) glucose and compare the values
Comparing CGM to a simultaneous fingerstick during stable (non-changing) glucose conditions provides the most reliable accuracy check.
Question 4: Which of the following SMBG testing schedules is most appropriate for a patient with type 2 diabetes who is well-controlled on diet and metformin alone?
- Before every meal and at bedtime daily
- As recommended by their provider, often periodic structured testing or less frequent monitoring (Correct answer)
- No testing is needed since they take no insulin
- Every morning fasting and 2 hours after dinner daily
Correct answer: As recommended by their provider, often periodic structured testing or less frequent monitoring
ADA guidelines support individualized, less frequent SMBG for non-insulin-treated type 2 diabetes, with structured periodic testing to assess patterns when needed.
Question 5: A patient's CGM sensor warm-up period has just completed and the first reading is 55 mg/dL, but she feels fine with no hypoglycemia symptoms. What is the appropriate next step?
- Treat immediately with 15g of fast-acting carbohydrates
- Perform a confirmatory fingerstick glucose before treating (Correct answer)
- Discard the sensor—first readings are always inaccurate
- Wait 30 minutes and recheck CGM
Correct answer: Perform a confirmatory fingerstick glucose before treating
CGM readings during the warm-up initialization period may be inaccurate; a confirmatory fingerstick should be performed before treating a suspected low.
Question 6: What is the primary purpose of performing structured SMBG testing using a '7-point profile' (before and 2 hours after each meal plus bedtime)?
- To replace the HbA1c test
- To identify specific meal-related glucose patterns for targeted therapy adjustments (Correct answer)
- To meet insurance requirements for CGM coverage
- To detect nocturnal hypoglycemia exclusively
Correct answer: To identify specific meal-related glucose patterns for targeted therapy adjustments
A 7-point structured profile reveals which meals cause the greatest glucose excursions, enabling targeted dietary or medication adjustments.
Question 7: A diabetes educator is teaching a patient to use the 'Rule of 15' for hypoglycemia management. Which monitoring action is essential 15 minutes after initial treatment?
- Recheck blood glucose to confirm it has risen above 70 mg/dL (Correct answer)
- Eat a full meal regardless of glucose level
- Administer glucagon if still symptomatic
- Recheck HbA1c at the next clinic visit
Correct answer: Recheck blood glucose to confirm it has risen above 70 mg/dL
The Rule of 15 requires rechecking blood glucose 15 minutes after consuming 15g of fast-acting carbohydrate to confirm adequate glucose recovery above 70 mg/dL.
CDE Monitoring Techniques 5
Which condition can cause falsely ELEVATED blood glucose readings on most electrochemical glucose meters?