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PHAR 152 > Diabetes - Part 2 > Flashcards

Diabetes - Part 2 Flashcards

1
Q

What are the treatment goals for diabetes?

A

Be symptom free
Achieve personalized target glucose levels
Address modifiable CV risk factors
Prevent or slow the progression of micro vascular complications
Empowerment to self-manage

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2
Q

What are the personalized target glucose levels?

A

Hemoglobin AlC
Fasting glucose levels
Postprandial glucose levels
Time in range

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3
Q

How is glucose control monitored?

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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4
Q

What is glycosylated hemoglobin?

A

AlC
- measure of glycemic control over a defined period of time (the previous 3 months)

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5
Q

How does an A1C test work?

A

Glucose attaches to RBCs when present in high levels in the blood, and A1C is the % of hemoglobin A that has been irreversibly glycosylated
- the more glucose there is in the blood = the higher the AlC will be

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6
Q

What are normal A1C levels?

A

4-6%

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7
Q

What factors may affect A1C?

A

Erythropoiesis
Altered hemoglobin
Altered glycation
Erythrocyte destruction
Assays

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8
Q

What is the A1C target for most adults with type 1 or type 2?

A

</= 7.0

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9
Q

When would the A1C target be <6.0?

A

For selected adults with type 2 diabetes with potential for remission to normoglycemia

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10
Q

When would the A1C target be </= 6.5?

A

For adults with type 2 diabetes to reduce the risk of chronic kidney disease and retinopathy if at low risk of hypoglycemia

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11
Q

When would the A1C target be 7.1-8.5?

A

7.1-8.0%: functionally dependent
7.1-8.5%: recurrent severe hypoglycemia and/or hypoglycemia unawareness, limited life expectancy, frail elderly and/or with dementia

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12
Q

Fill in table on slide 9

A

**

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13
Q

What did the diabetes control and complications trial(DCCT) show?

A

The intensive (>3 injections/day) decreased the A1C more.
Also decreased risk for retinopathy, neuropathy, and microalbuminuria
BUT increased severe hypoglycemia
There was also a decrease in CV events

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14
Q

What are the takeaway points from the trials?

A

Lowering A1C values to <7% provides strong benefits for micro vascular complications and, if achieved early enough may also provide macro vascular benefit
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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15
Q

There is a 39 year old person with a new diagnosis of type 2 diabetes, has overweight, PCOS, and no other medical conditions. What A1C target would you recommend?

A

</= 6.5%

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16
Q

There is a 24 year old person with a history of T1 for 10 years, and no other medical conditions. What A1C target would you recommend?

A

</= 7%

17
Q

What is capillary blood glucose? (CBG)

A

It determines the glucose level in capillary blood via a finger stick
Tells you the BG level at a particular point in time - provides immediate feedback

18
Q

What do PWD need to know about CBG?

A

How to perform CBG
How often to perform CBG
The meaning of the various BG levels
How behaviour and actions affect CBG results

19
Q

What is intermittently scanned CGM? (IsCGM)

A

Measures glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin (sensor-based technology

20
Q

Which isCGMs can be used for each age?

A

Freestyle liber: approved for adults
“ “ 2: approved for 4yo and orders

21
Q

How is the isCGM used?

A

Applied to the back of the arm every 14 days and can provide info through phone

22
Q

What us real time continuous glucose monitoring? (rtCGM)

A

They measure glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin
- continuous dats visibility 24/7
- “pushes” info to the user/caregiver

23
Q

What are the brands for rtCGM?

A

Deacon G6 and Medtronic Guardian Connect

24
Q

What are the differences between rtCGM and isCGM?

A

rtCGM:
-applied on abdomen, back of upper arm or upper bum
-push info via a transmitter
-measures glucose every 5 minutes and can access anytime
-more expensive
-can be integrated system
isCGM:
-applied on back of arm
-pull info via scanning
-measures glucose every minute and stores reading every 15 minutes - data downloaded after 14 days
-stand alone system

25
Q

What is time in range?

A

The amount of time spent in the target BG range
And most PWD should aim for a TIR of >70% or 17/24hr/day

26
Q

What is the A1C for a TIR of >70%?

A

7.0%

27
Q

For every increase of 10% in TIR what will happen to the A1C?

A

It will decrease by 0.5%

28
Q

Why might there be ketones in blood or urine?

A

Ketones usually occur because you are either: not eating enough total calories, going too long between meals, skipping meals/snacks, nauseous, or not eating well/throwing up

29
Q

What are non-pharm treatments?

A

Diet - can be 1st line treatment (with exercise) for T2
Exercise - can decrease insulin resistance, decreases risk of CVD and stroke

30
Q

What % of total energy should people consume from CHO?

A

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

31
Q

What are the DRIs for fibre?

A

19-50: 25g/d(women) 38g/d(men)
>50: 21g/d(women) 30g/d(men)

32
Q

What do we need to do for fibre when calculating CHO?

A

Need to subtract fibre from total CHO because its a type of CHO the body can digest

33
Q

What can alcohol do to diabetics?

A

Can decrease hepatic production of glucose and mask the symptoms of hypoglycemia
- can cause delayed hypoglycemia for T1 and for T2 on insulin or sulfonylureas

34
Q

What is the alcohol recommendation for PWD?

A

2 drinks per week

35
Q

What are the exercise recommendations for PWD?

A

> /= 150 mins of moderate to vigorous intensity aerobic exercise/week
- spread over >/= 3 days/week
- no more then 2 consecutive days of no activity
Resistance training >/= 2x/week

36
Q

How does exercise affect blood glucose?

A

Low-moderate intensity (aerobic): lowers BG during and after exercise due to increase insulin sensitivity
Very intense exercise (anaerobic): increases BG during and after exercise to to increase glucose production that increases in glucose disposal (increase secretion of stress hormones)

37
Q

What are some strategies to minimize the risk of hypoglycemia when exercising for T1?

A

Consume extra CHO before/during/after
Decrease dose of bonus insulin that is most active at time of exercise
Reducing basal insulin overnight by 20% after exercise

PHAR 152 (10 decks)

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