es-cgm-not-available-fallback

name	es-cgm-not-available-fallback
description	If CGM is not available, continue monitoring blood glucose with point-of-care testing as an alternative option. Trigger phrases include: "CGM is not available, what should we use for glucose monitoring?"

Fallback to POC-BG when CGM unavailable

STEP 1 — Gather Information

Assess availability of continuous glucose monitoring (CGM) device and determine if the patient requires glucose monitoring for insulin dosing adjustments.

STEP 2 — Rule In / Rule Out

Is CGM available and functional?

• Yes → Proceed with CGM plus confirmatory point-of-care blood glucose (POC-BG) for insulin adjustments.
• No → Proceed to Step 3.

STEP 3 — Classify or Stratify

Classify the patient as insulin-treated (type 1 or type 2 diabetes) requiring regular glucose monitoring to guide insulin therapy.

STEP 4 — Decide

If CGM is unavailable, monitor blood glucose using point-of-care testing (POC-BG) at least before meals and at bedtime, or per institutional protocol, to inform insulin dosing adjustments.

Clinical Guardrails / Mimics / Pitfalls

Do not delay glucose monitoring while awaiting CGM replacement; ensure POC-BG is performed using validated hospital meters and proper technique. Avoid relying solely on symptoms for glucose assessment. Recognize that POC-BG may miss trends and hypoglycemia; increase frequency if patient is at high risk for hypoglycemia (age ≥65, BMI ≤27 kg/m2, TDD ≥0.6 U/kg, CKD stage ≥3, etc.).

Concrete Clinical Example

A 68‑year‑old woman with type 2 diabetes on basal‑bolus insulin is admitted for community‑acquired pneumonia. Her CGM sensor fails on day 2. The nursing team obtains POC‑BG before meals and at bedtime, uses the results to adjust prandial and basal insulin, and maintains glucose within 100‑180 mg/dL.

Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278