Example CGM Remote Follow Orders

Supplemental DMMP Orders:

[ ] Remote monitoring of (Patient’s name) Continuous Glucose Monitor for alerts by school nurse and trained staff.

Optional additional information: 
Interventions are required at the following blood glucose numbers:

[ ]  Low Alert: _____mg/dL  - treat for hypoglycemia according to DMMP

[ ]  High Alert: _____mg/dL for more than _______ minutes – treat for hyperglycemia according to DMMP

[ ]  Urgent Low:  55 mg/dL - treat for hypoglycemia according to DMMP

[ ]  No Data Notification: ____ minutes -evaluate reason for loss of data (sensor error, device out of range)

Example Addendum Letter:

Re: (Patient Name, age, School)

To Whom It May Concern,

(Patient name) is cared for at (clinic name) for Type 1 Diabetes.  This is a lifelong chronic disease that affects the endocrine system, specifically eating and blood glucose levels.  Both high and low blood glucose levels impact daily functioning, ability to learn and pose immediate and chronic safety concerns if not identified and treated. During times of low and high blood glucose, people often experience confusion and difficulty concentrating. 

(Patient name) requires that school staff monitor their continuous glucose monitor (CGM) remotely for alerts during the school day and at school sponsored activities.  Also, (patient name) requires remote blood glucose checks at routine times according to their DMMP/school orders. These interventions will minimize disruptions to (patient name) and their classmates, minimize missed class time, and will help keep them safe and fully able to participate in the school day. 

Specific details and settings should be a collaboration between the parent/student, school staff and clinic staff.  We endorse the recent guidance by the ADA on this matter. 

Please do not hesitate to contact our team if you have questions or concerns.

________________________

Name, Degree
Clinic Contact Information