Association of Diabetes Care & Education Specialists

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Top Commenters: Recognizing Exceptional Insight

Jan 25, 2017

Each quarter the most helpful, insightful and/or eye-opening comments are voted on by our team of Online Community Contributors (volunteer members dedicated to facilitating conversations on MY AADE NETWORK) who pick two comments that truly stand out.

Congratulations to this quarter’s winners, Molly McElwee-Malloy, RN, CDE and Suzanne Povinelli, RN, BSN, CDE!

Commenter: Molly McElwee-Malloy, RN, CDE
Thread: Petition to FDA to Expand Intended Use of CGMs to Include Dosing Insulin
Topic: Diabetes Technology COI Discussions

“Although I understand the trepidation here on dosing off CGM, I think it’s important to look at the evidence the FDA reviewed. I’ve attached links below to both the study design from and the summary for the FDA. In my conversations with FDA peeps, it’s agreed that they came to the conclusion that you 'COULD' dose, they haven’t issued a final approval. So I guess that’s to say, it’s looking positive, but it’s not a done deal yet.

One thing to consider that may be very beneficial to our Medicare patients. Currently, CGM isn’t reimbursed because it requires another device (BG meter) in order to use it and isn’t labeled for dosing insulin. With a new product label that COULD eliminate fingersticks, this could open the door for Medicare to reimburse CGM. Let’s say that the new product label reads that it’s factory calibrated (like the freestyle libre) and doesn’t require fingersticks for use. This could be the thing that requires Medicare to use it over fingersticks, which – in my opinion – should be the gold standard of care for all persons on MDI/ pump therapy.”

Read the full thread.

Commenter: Suzanne Povinelli, RN, BSN, CDE
Thread: Help with Unusual Bolus Situation
Topic: Office & Clinic Based COI Discussions

“I have seen patients that do this but in my opinion it is dangerous. What about the person who happens to not test and has a BG less than 100 (or possibly even higher) and doses rapid acting insulin without eating and knowing BG. There is of course, a real possibility of hypoglycemia even though this client has not apparently experienced this. Considering the possibility of hypoglycemia unawareness, maybe the person has been hypoglycemic but luckily not low enough to cause them to pass out or have a seizure! Possibly this client feels hungry due to dropping BG and happens to eat, but who knows? In another scenario possibly the client has a higher pre-meal BG from snacking or drinking carbohydrate containing beverages… and then the insulin dosed covers it. It is impossible to know why this is working for the client unless you know what the person’s typical day looks like including food intake (diet history), medications and timing, physical activity and BG testing schedule. To say from one client’s experience that this method of insulin dosing can be extrapolated to a broader population of people with diabetes seems irresponsible. It seems that the researcher should complete a scientific research study to verify this method. However, based on current practice and knowledge this would seem to put participant’s health and lives at risk! Or is the researcher actually the patient and has played this roller coaster for a while w/o adverse effects?”

Read the full thread.

The top commenter contest continues in 2017, so if you know of someone who gives exceptional advice, insight or help on MY AADE NETWORK, send us a tip! That member’s comment will be entered into the contest for the quarter in which it was posted.

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