Diabetes Monitoring Flashcards
Why monitor?
Understand nature of disease
Optimum timing for initiating therapeutic intervention
Adjustment of treatment
What are the 3 targets?
HbA1c
BP
Lipids
What are the 8 core care processes?
HbA1c
Lipids
BMI
BP
Smoking status
Foot examination
Albumin = creatine ratio
Serum creatinine
How often should you get your HbA1c (blood glucose) checked?
Annually
How often should you get your BP checked?
Annually
How often should you get your cholesterol checked?
Annually
How often should you get retinal screening?
Annually
How often should you get foot examinations?
Annually
How often should get your weight checked?
Patient should be encouraged often at home
BUT annually
What is HbA1c?
(Glycosylated haemoglobin)
3 month indication of how diabetes is going
= 50% from last month
= 25% month before
= 25% month before that
When can HbA1c be inaccurate?
Those with haemolytic diseases
eg. sickle cell, possible anaemia/blood loss
When to self monitor blood glucose?
Fasting
Pre-prandial (before meal)
Post-prandial (after meal)
Who should monitor urine ketones?
T1DM
What is the target for BP?
130/80mmHg if signs of retinopathy, neuropathy or nephropathy
IF NO SIGNS = 140/80mmHg
What is the target for lipids?
LDL <2.0 mmol/L
TC <4.0 mmol/L
Triglycerides <1.7 mmol/L
HDL >1.0mmol/L (men)
>1.3 mmol/L (women)
What monitoring should be done associated with drug therapy?
LFTs
U+Es
FBC
Amylase
Lactate
What is problem with smoking?
More likely to develop diabetes
Worsen peripheral vascular disease, CKD, retinopathy + neuropathies
Make diabetes hard to control
Increase CVD risk
What are the steps to towards healthy feet?
Annual foot review
Check feet every day - any changes in shape?
Aware of any losses in sensation (don’t go barefoot/extreme temperatures)
Touch toes test (ask family member to feel)
Look after toe nails (don’t cut down sides = ingrown)
Avoid using corn removing blades
Wear well-fitting shoes
Maintain good glucose control
What is a good range for eGFR?
> 90
60-89 also good
BUT any below = NOT good
What is a good range for ACR?
<3
What is the HbAc1 target for no glucose lowering medication?
48mmol/mol
What is the HbAc1 target for single glucose lowering medication - low hypoglycaemic risk?
48mmol/mol
What is the HbAc1 target for single glucose lowering medication - high hypoglycaemic risk?
53mmol/mol
What is the HbAc1 target for more than one glucose lowering agent?
53mmol/mol
What is the blood glucose monitoring for T1DM?
Test at least 4x/day
When should T1DM check glucose for up to 10 times?
Increase hypoglycaemia
Legal requirement (DVLA)
Illness
Before, during + after sport
Pregnancy planning
Impaired hypo awareness
What is the blood glucose monitoring for T2DM?
Only self-monitoring if on insulin/evidence of hypoglycaemic episodes
When should you only consider short term self-monitoring for T2DM?
Starting treatment with oral/IV corticosteroids
If a T2DM patient is carrying out self-monitoring what should be done?
Structured assessment:
- monitoring skills
- quality + frequency of testing
- knows how to interpret results
- impact on QoL
- continued benefit
- equipment used
What should happen with driving?
Bring treats
Don’t delay meals
Take breaks
Check blood sugars
5mmol/L = okay
What happens if you’re below target?
Driving (>4mmol/L)
Pull over
Switch off engine
Take fast-acting carbs
Don’t drive until 45mins in range
Who is ketone testing for?
T1DM
What is CGM?
Continuous glucose monitoring
Who is offered CGM?
T1DM
What do you offer to T2DM patients on multiple daily insulin injections?
Intermittently scanned continuous glucose monitoring (isCGM)
Real time continuous glucose monitoring (rtCGM)
What is time in range (TIR)?
% of time that a person spends with their blood glucose levels in target range
Describe a closed loop insulin delivery system
Sensor under skin automatically measures blood glucose
Readings sent to pump that calculates amount of insulin required
Can monitor on phones
