Diabetes - Part 2 Flashcards
What are the treatment goals for diabetes?
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
What are the personalized target glucose levels?
Hemoglobin AlC
Fasting glucose levels
Postprandial glucose levels
Time in range
How is glucose control monitored?
Blood glucose lab evaluations
Hemoglobin A1C
Capillary blood glucose (cBG)
Continuous glucose monitoring (CGM)
- intermittently scanned CGM (isCGM)
- real-time CGM (rtCGM)
Ketone testing
What is glycosylated hemoglobin?
AlC
- measure of glycemic control over a defined period of time (the previous 3 months)
How does an A1C test work?
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
What are normal A1C levels?
4-6%
What factors may affect A1C?
Erythropoiesis
Altered hemoglobin
Altered glycation
Erythrocyte destruction
Assays
What is the A1C target for most adults with type 1 or type 2?
</= 7.0
When would the A1C target be <6.0?
For selected adults with type 2 diabetes with potential for remission to normoglycemia
When would the A1C target be </= 6.5?
For adults with type 2 diabetes to reduce the risk of chronic kidney disease and retinopathy if at low risk of hypoglycemia
When would the A1C target be 7.1-8.5?
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
Fill in table on slide 9
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What did the diabetes control and complications trial(DCCT) show?
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
What are the takeaway points from the trials?
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
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?
</= 6.5%
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?
</= 7%
What is capillary blood glucose? (CBG)
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
What do PWD need to know about CBG?
How to perform CBG
How often to perform CBG
The meaning of the various BG levels
How behaviour and actions affect CBG results
What is intermittently scanned CGM? (IsCGM)
Measures glucose levels in the subcutaneous interstitial fluid via a sensor that is inserted into the skin (sensor-based technology
Which isCGMs can be used for each age?
Freestyle liber: approved for adults
“ “ 2: approved for 4yo and orders
How is the isCGM used?
Applied to the back of the arm every 14 days and can provide info through phone
What us real time continuous glucose monitoring? (rtCGM)
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
What are the brands for rtCGM?
Deacon G6 and Medtronic Guardian Connect
What are the differences between rtCGM and isCGM?
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
