CDE Technology in Diabetes 4 — Questions and Answers
Question 1: Which statement best describes the role of a 'bolus calculator' or 'insulin-on-board' (IOB) feature on an insulin pump?
- It tracks total daily insulin use for insurance reporting
- It estimates active insulin from recent boluses to prevent stacking (Correct answer)
- It calculates the patient's A1C from CGM data
- It determines the carbohydrate content of foods automatically
Correct answer: It estimates active insulin from recent boluses to prevent stacking
The IOB feature tracks insulin still active from recent boluses and subtracts it from correction calculations to prevent insulin stacking and hypoglycemia.
Question 2: A patient asks about implantable CGM options. Which device is an implantable CGM with a wear period of up to 180 days?
- Dexcom G7
- Abbott FreeStyle Libre 3
- Senseonics Eversense E3 (Correct answer)
- Medtronic Guardian 4
Correct answer: Senseonics Eversense E3
The Senseonics Eversense E3 is an implantable CGM worn subcutaneously for up to 180 days, requiring professional insertion and removal.
Question 3: Which technology allows patients to share real-time CGM data with caregivers or healthcare providers remotely?
- Bluetooth Low Energy (BLE) only within 10 feet
- CGM cloud-based sharing platforms (e.g., Dexcom Follow, LibreLinkUp) (Correct answer)
- NFC-based tap sharing at clinic visits only
- SMS text alerts sent directly from the sensor
Correct answer: CGM cloud-based sharing platforms (e.g., Dexcom Follow, LibreLinkUp)
Cloud-based sharing platforms like Dexcom Follow and Abbott LibreLinkUp allow real-time CGM data to be shared with followers across any distance via internet.
Question 4: When reviewing pump settings with a new insulin pump user, what does the 'carbohydrate ratio' (ICR) determine?
- How much insulin lowers glucose per mg/dL
- How many grams of carbohydrate one unit of insulin will cover (Correct answer)
- The maximum daily dose of insulin allowed
- The time of day when basal insulin increases
Correct answer: How many grams of carbohydrate one unit of insulin will cover
The insulin-to-carbohydrate ratio (ICR) specifies the number of grams of carbohydrate that one unit of insulin covers at mealtime.
Question 5: A diabetes educator is helping a patient interpret their CGM glucose variability. A coefficient of variation (CV) above what threshold is considered high glycemic variability?
- 18%
- 26%
- 36% (Correct answer)
- 45%
Correct answer: 36%
A CV above 36% is generally considered high glycemic variability and is associated with increased hypoglycemia risk regardless of mean glucose.
Question 6: A patient uses an insulin smart pen. Which key advantage does a smart pen provide over a standard insulin pen?
- It automatically injects insulin without patient input
- It records the dose amount and time of each injection (Correct answer)
- It calculates carbohydrate counts from a camera scan of food
- It pairs with a CGM to form a closed-loop system
Correct answer: It records the dose amount and time of each injection
Smart insulin pens automatically record the dose amount and timestamp of each injection, which can be synced to an app to help track insulin-on-board.
Question 7: Which patient population has the strongest evidence for benefit from CGM use, even without insulin pump therapy?
- Type 2 diabetes managed with diet alone
- Type 1 diabetes on multiple daily injections (MDI) (Correct answer)
- Gestational diabetes in the first trimester
- Prediabetes with no pharmacological treatment
Correct answer: Type 1 diabetes on multiple daily injections (MDI)
Multiple randomized controlled trials (including DIAMOND and GOLD) demonstrate A1C reduction and hypoglycemia reduction in type 1 patients using CGM with MDI.
CDE Technology in Diabetes 4
Which statement best describes the role of a 'bolus calculator' or 'insulin-on-board' (IOB) feature on an insulin pump?