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PHAR152 > Diabetes 2 > Flashcards

Diabetes 2 Flashcards

1
Q

What are the treatment goals of diabetes?

A

be symptom free (avoid hyper/hypoglycemia)
achieve personalized target glucose levels
address modifiable CV risk factors
prevent or slow the progression of microvascular complications
empowerment to self-manage

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2
Q

What are examples of monitoring glucose control?

A

blood glucose lab evaluations
hemoglobin A1C
capillary blood glucose (CBG)
continuous glucose monitoring (CGM)
-intermittently scanned CGM (isCGM)
-real time CGM (rtCGM)
ketone testing

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3
Q

What is hemoglobin A1C?

A

measure of glycemic control over a defined period of time
-previous 3 months
glucose attaches to RBCs when present in high levels, and A1C is the % of Hb that has been irreversibly glycosylated
-more glucose in blood=higher A1C

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4
Q

What are normal A1C levels?

A

4-6%

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5
Q

How often should A1C levels be checked?

A

q3 months, 6 months if stable

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6
Q

What are some deficiencies that may cause increased A1C levels?

A

B12 deficiency
iron deficiency

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7
Q

What are the A1C targets?

A

<6.0: T2DM with potential for remission to normoglycemia
<6.5: T2DM to reduce risk of kidney dz and retinopathy if at
low risk of hypoglycemia
<7: most adults with T1DM or T2DM
7.1-8.0: functionally dependent
7.1-8.5: recurrent severe hypoglycemia/unawareness
limited life expectancy
frail elderly and/or with dementia

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8
Q

What is the desired PrPG and 2hrPoPG for most patients?

A

preprandial: 4.0-7.0
postprandial: 5.0-10.0

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9
Q

What is the desired PrPG and 2hrPoPG if A1C<7.0 not achieved?

A

preprandial: 4.0-5.5
postprandial: 5.0-8.0

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10
Q

What are the take away points from the trials that tried to push A1C lower?

A

lowering A1C to <7% provides strong benefit for microvascular complications and, if achieved early enough may also provide macrovascular benefits
more intensive BG lowering is not always better
rather than causing CV AEs, severe hypoglycemia may be a marker of vulnerability for such events

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11
Q

What are the limitations of A1C?

A

only tells you the average
-not the highs and lows
doesnt tell you day to day variability
doesnt tell you whats happening right now

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12
Q

What is the use of capillary blood glucose?

A

determines the glucose level in capillary blood via a finger stick
tells you BG at a particular point in time
-immediate feedback
is a tool, useful when actionable (usefulness differs from person to person)

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13
Q

What do PWD need to know about CGB?

A

how to perform CBG
how often and when to perform CBG
the meaning of various BG levels
-FPG: reflects glucose derived from hepatic production
-PPG: how meals affect glucose
how behaviour and actions affect CBG results
-interpretation of trends

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14
Q

How often should CBG be tested if using insulin?

A

perform at least as many times times as insulin is injected
-perform both pre and post prandial measurements
-CBG is an essential component of self-management if using
insulin > once per day

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15
Q

True or false: CBG testing for T2DM is as intense as it is in T1DM

A

false
less intensive when not on insulin/stable
more intensive CBG when not reaching targets

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16
Q

Describe the Sask Drug Plan test strip quantity policy.

A

managing diabetes with insulin:
-3650 strips
managing diabetes with medication with higher risk of causing low blood sugar:
-400 strips
managing diabetes with medication with lower risk of causing low blood sugar:
-200 strips
managing diabetes through diet/lifestyle:
-200 strips

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17
Q

What is intermittently scanned CGM?

A

measures glucose levels in sq interstitial fluid via a sensor that is inserted into skin
applied to back of arm q14 days-scan with phone or device
can help decrease hypoglycemia, and improve TIR

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18
Q

Who gets a covered benefit under the SK Drug Plan for isCGM?

A

4-17yo managed with insulin or hyperinsulinism

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19
Q

What are some devices that use isCGM?

A

FreeStyle Libre: approved for use in adults
FreeStyle Libre 2: approved for those >4yo, alarms for high/low
Libre 3: coming soon

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20
Q

What is glucose lag?

A

capillary glucose must diffuse into the interstitial fluid, may lag capillary levels by 5-15 minutes
occurs with all sensor-based technology

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21
Q

What are some key points to understanding the glucose graph from Libres?

A

8hrs after first scan, the first complete graph appears
-plots an 8hr history of glucose lvls (device reads q1min)
-important that patient targets are set
-helps them see how much time was spent in target
-helps them reflect on why above or below
-effects of their self-management decisions

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22
Q

What is LibreView?

A

glucose readings from Libre are uploaded to the cloud and can be use by PWD, caregivers, and HCPs to help make decisions
-glucose statistics and targets
-ambulatory glucose profile
-time in ranges
-daily glucose profile

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23
Q

What are examples of real-time continuous glucose monitoring?

A

Dexcom G6
Medtronic Guardian Connect

24
Q

Describe rtCGM.

A

available as stand-alone systems or integrated with insulin pumps
measure glucose levels in sq interstitial fluid via sensor that is inserted into the skin
provides real-time and historical data, as well as trends
pushes info to the user/caregiver

25
Q

What does Medtronic require before treating lows or delivering insulin to correct highs?

A

calibration with CBG

26
Q

What are the beneficial effects of rtCGM?

A

beneficial effects on:
-A1C
-TIR
-hypoglycemia
-QOL
in those with T1DM or T2DM on basal-bolus insulin

27
Q

What is time in range?

A

amount of time spent in target BG range
-PWD that use CGM can monitor this

28
Q

What is the TIR that most PWD should aim for?

A

3.9-10.0mmol/L of >70%
-70% TIR equates to about an A1C of 7%
-aim is to be within range ~17/24hr

29
Q

When are ketones used for blood glucose testing?

A

times of acute illness or stress
when preprandial readings >14mmol/L (T1DM)
DKA symptoms present
pregnancy
no longer part of standard self-management

30
Q

What is the cornerstone of diabetes care?

A

diet
-can effectively lower BG
-can be 1st line treatment (with exercise) for TD2M

31
Q

True or false: there is a diabetic diet

A

false
individualized nutrition therapy

32
Q

What are some important points on diet?

A

access to a dietitian if possible
individualize diet based on patient goals and preferences
-be mindful of cultural importance
some current diets that are popular:
-mediterranean
-vegan/vegetarian
-low CHO (50-130g/d) or very-low CHO (<50g/d)
-DASH
-intermittent fast

33
Q

If weight loss is a goal, how much weight loss provides health benefits?

A

5-10%

34
Q

What are the forms of carbohydrates?

A

starches
sugars
fibre

35
Q

How much of our total energy should come from each macronutrient?

A

carbs: 45-60%
protein: 10-35%
fat: 20-35%

36
Q

What does the glycemic index measure?

A

assesses the quality of CHO foods based on ability to increase BG
-whole foods and less refined foods > processed foods
-fast food and sugar drinks are not preferred

37
Q

What are some food groups with little or no carbohydrate?

A

meat & alternatives (except some beans)
vegetables (except squash, parsnips, and peas)
fats

38
Q

What is the DRI of fibre for 19-50 men and women? What about men and women older than 51?

A

19-50yrs:
-men 38g/d
-women 25g/d
>51yrs:
-men 30g/d
-women 21g/d

39
Q

What are the effects of soluble fibre?

A

slows gastric emptying
delays sugar absorption in small intestine

40
Q

When counting carbs, what do we do with fibre?

A

subtract g of fibre from total g of CHO
the body cant digest fibre

41
Q

What some recommendations from Canada’s food guide?

A

eat a variety of healthy foods each day
make water your drink of choice
have plenty of vegetables and fruits
choose whole grain foods
eat protein foods (plant>)
limit highly processed foods

42
Q

What does the Mediterranean diet focus on?

A

fish and seafood
whole grains
water, wine in moderation
fresh fruits and vegetables
being physically active

43
Q

What are recommendations for proportions of different food groups using your hands?

A

grains and starches: size of fist
fruits: size of fist
meat & alternatives: size of palm and thickness of pinky
vegetables: as much as you can hold in both hands
fats: size of thumb tip

44
Q

What are the recommendations for diabetics if Ramadan is occuring?

A

encourage consultation with dietitians/diabetic educators 2 months before
non-insulin therapy: choosing meds with low risk of hypoglycemia are best, need to consider AE profile, risk of dehydration, etc
adjust all meds to try and minimize risk of low BG
t1DM: advise against fasting

45
Q

Which diabetics are not recommended to participate in Ramadan?

A

poorly controlled T1DM (pre-Ramadan A1C > 9%)
severe hypoglycemia within 3 months or recurrent
ketoacidosis within 3 months
advanced microvascular complications
pregnant or GDM

46
Q

True or false: snacks between meals is essential for diabetics to prevent hypoglycemia

A

false
snacks between meals may or may not be necessary

47
Q

How much of the daily energy intake should consist of sugar for diabetics?

A

up to 10%
-artificial sweeteners are fine to use within the ADI values from
Health Canada

48
Q

True or false: routine vitamin supplementation is not necessary for diabetics

A

true

49
Q

What is the verdict on coffee drinking with diabetes?

A

fine in moderation

50
Q

What is the verdict on alcohol use with diabetes?

A

alcohol can decrease hepatic production of glucose and mask the symptoms of hypoglycemia
-for people with T1DM, T2DM on insulin or sulfonylureas,
alcohol can cause delayed hypoglycemia
-hypoglycemia can occur at blood alcohol levels of mild
intoxication and persist for up to 24hrs following the last drink
-take steps against this (check BG, take with food, adjust
insulin)

51
Q

How many drinks are considered safe when diabetic?

A

new recommendations: no amount is safe
2 drinks per week (low risk)
its a continuum of risk

52
Q

What are the health benefits beyond goals of weight loss and glycemic control for diabetics?

A

increased cardio/respiratory fitness
decreased insulin resistance
improves lipids, blood pressure
psychological
physical activity has been proven to improve A1C in T2 and kids with T1, evidence on A1C less clear in adults with T1

53
Q

What are the recommendations regarding exercise for diabetics?

A

> 150 mins of moderate-vigorous intensity aerobic exercise/week
-spread over > 3 days/week
-no more than 2 consecutive days of no activity
resistance training > 2x/week
tips:
-smaller amounts are still beneficial
-aim for > 10 min at a time
-moderate intensity is 50-70% max HR
-resistance: 3 sets of 8
-limit sedentary activity

54
Q

How should exercise be initiated in diabetes?

A

start slow
brisk walking easiest to initiate
*assess for conditions that can predispose to injury before beginning (neuropathy, CAD, retinopathy)

55
Q

What are the effects of low-moderate intensity aerobic exercise on blood glucose?

A

decreases BG during & after exercise due to increased insulin sensitivity
30 min of exercise can improve insulin sensitivity for next 48hrs

56
Q

What are the effects of very intense aerobic exercise on blood glucose?

A

increased BG during & after exercise due to increased glucose production that > increases in glucose disposal

57
Q

What are some strategies regarding exercising in T1DM?

A

inject insulin at a non-exercise site
consume extra CHO before/during/after exercise
decrease dose of bolus insulin that is most active at time of exercise
perform resistance or max intensity exercise before aerobic exercise or intermittently
reducing basal insulin overnight by 20% after exercise

PHAR152 (21 decks)

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