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S3 Case 4 - Endocrine > Diabetes Monitoring > Flashcards

Diabetes Monitoring Flashcards

1
Q

Why monitor?

A

Understand nature of disease
Optimum timing for initiating therapeutic intervention
Adjustment of treatment

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2
Q

What are the 3 targets?

A

HbA1c
BP
Lipids

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3
Q

What are the 8 core care processes?

A

HbA1c
Lipids
BMI
BP
Smoking status
Foot examination
Albumin = creatine ratio
Serum creatinine

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4
Q

How often should you get your HbA1c (blood glucose) checked?

A

Annually

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5
Q

How often should you get your BP checked?

A

Annually

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6
Q

How often should you get your cholesterol checked?

A

Annually

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7
Q

How often should you get retinal screening?

A

Annually

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8
Q

How often should you get foot examinations?

A

Annually

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9
Q

How often should get your weight checked?

A

Patient should be encouraged often at home
BUT annually

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10
Q

What is HbA1c?
(Glycosylated haemoglobin)

A

3 month indication of how diabetes is going
= 50% from last month
= 25% month before
= 25% month before that

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11
Q

When can HbA1c be inaccurate?

A

Those with haemolytic diseases
eg. sickle cell, possible anaemia/blood loss

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12
Q

When to self monitor blood glucose?

A

Fasting
Pre-prandial (before meal)
Post-prandial (after meal)

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13
Q

Who should monitor urine ketones?

A

T1DM

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14
Q

What is the target for BP?

A

130/80mmHg if signs of retinopathy, neuropathy or nephropathy
IF NO SIGNS = 140/80mmHg

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15
Q

What is the target for lipids?

A

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)

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16
Q

What monitoring should be done associated with drug therapy?

A

LFTs
U+Es
FBC
Amylase
Lactate

17
Q

What is problem with smoking?

A

More likely to develop diabetes
Worsen peripheral vascular disease, CKD, retinopathy + neuropathies
Make diabetes hard to control
Increase CVD risk

18
Q

What are the steps to towards healthy feet?

A

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

19
Q

What is a good range for eGFR?

A

> 90
60-89 also good
BUT any below = NOT good

20
Q

What is a good range for ACR?

A

<3

21
Q

What is the HbAc1 target for no glucose lowering medication?

A

48mmol/mol

22
Q

What is the HbAc1 target for single glucose lowering medication - low hypoglycaemic risk?

A

48mmol/mol

23
Q

What is the HbAc1 target for single glucose lowering medication - high hypoglycaemic risk?

A

53mmol/mol

24
Q

What is the HbAc1 target for more than one glucose lowering agent?

A

53mmol/mol

25
Q

What is the blood glucose monitoring for T1DM?

A

Test at least 4x/day

26
Q

When should T1DM check glucose for up to 10 times?

A

Increase hypoglycaemia
Legal requirement (DVLA)
Illness
Before, during + after sport
Pregnancy planning
Impaired hypo awareness

27
Q

What is the blood glucose monitoring for T2DM?

A

Only self-monitoring if on insulin/evidence of hypoglycaemic episodes

28
Q

When should you only consider short term self-monitoring for T2DM?

A

Starting treatment with oral/IV corticosteroids

29
Q

If a T2DM patient is carrying out self-monitoring what should be done?

A

Structured assessment:
- monitoring skills
- quality + frequency of testing
- knows how to interpret results
- impact on QoL
- continued benefit
- equipment used

30
Q

What should happen with driving?

A

Bring treats
Don’t delay meals
Take breaks
Check blood sugars
5mmol/L = okay

31
Q

What happens if you’re below target?
Driving (>4mmol/L)

A

Pull over
Switch off engine
Take fast-acting carbs
Don’t drive until 45mins in range

32
Q

Who is ketone testing for?

A

T1DM

33
Q

What is CGM?

A

Continuous glucose monitoring

34
Q

Who is offered CGM?

A

T1DM

35
Q

What do you offer to T2DM patients on multiple daily insulin injections?

A

Intermittently scanned continuous glucose monitoring (isCGM)
Real time continuous glucose monitoring (rtCGM)

36
Q

What is time in range (TIR)?

A

% of time that a person spends with their blood glucose levels in target range

37
Q

Describe a closed loop insulin delivery system

A

Sensor under skin automatically measures blood glucose
Readings sent to pump that calculates amount of insulin required
Can monitor on phones

S3 Case 4 - Endocrine (17 decks)

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