dromlakhani Assess use of trend information to adjust insulin doses
STEP 1 — Gather Information
Collect patient’s self‑report on how they use CGM trend arrows (e.g., single, double, or triple arrows) to guide insulin decisions; review recent CGM logs paired with insulin bolus records to see if adjustments align with direction and rate of change; assess frequency of SMBG calibrations; ask about understanding that CGM trend data differ from SMBG spot checks; note any barriers such as vision/dexterity issues, alarm fatigue, or lack of confidence.
STEP 2 — Rule In / Rule Out
Does the patient demonstrate appropriate insulin adjustments based on CGM trend information? (Yes/No)
STEP 3 — Classify or Stratify
If Yes: stratify proficiency as consistent (adjusts for most trends), occasional (adjusts only for obvious extremes), or inconsistent (adjusts unpredictably).
If No: classify barrier type—knowledge deficit (does not know how to interpret arrows), technical (cannot operate device or calibrate), behavioral (relies solely on SMBG or fears over‑correction), or systemic (alarm fatigue, insurance/access issues).
STEP 4 — Decide
If proficient (consistent/occasional): reinforce correct behavior, schedule routine follow‑up, and encourage continued trend‑based adjustments.
If deficient: provide targeted education on trend interpretation and insulin adjustment algorithms, troubleshoot technical issues, adjust alarm settings to reduce fatigue, and arrange a follow‑up visit within 2–4 weeks to reassess.
Clinical Guardrails / Mimics / Pitfalls
Do not assume CGM replaces SMBG for insulin dosing; avoid making large bolus corrections based solely on a single arrow without confirming with SMBG when symptoms disagree; do not ignore calibration requirements, as uncalibrated trend data can be misleading; prevent alarm fatigue by customizing low/high alerts to individual patterns; never adjust insulin based on trend arrows alone if the patient cannot reliably operate the CGM system.
Concrete Clinical Example
A patient with type 1 diabetes sees a double upward arrow (↑↑) indicating a glucose rise >2 mg/dL/min on their CGM, administers an extra 2 units of rapid‑acting insulin to blunt the anticipated hyperglycemia, and rechecks the CGM trend 30 minutes later to confirm stabilization.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2534