Diabetes (Slide Deck 2)

Question 1

What is A1C

Answer 1

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

Question 2

What is the process of A1C (MOA kind of)

Answer 2

Glucose attaches to RBCs when present in high levels in the blood, and A1C is the % of hemoglobin A that has been irreversibly glycosylated

Question 3

The more glucose there is in the blood?

Answer 3

The higher the A1C will be

Question 4

What is the normal A1C levels?

Answer 4

4-6%

Question 5

How often should A1C be checked?

Answer 5

every 3 months

Question 6

What is the target range of A1C for adults with type 2 diabetes with potential for remission to normoglycemia?

Answer 6

<6.0

Question 7

What is the target range of A1C for adults with type II diabetes to reduce the risk of CKD and retinopathy if at low risk of hypoglycemia?

Answer 7

<6.5

Question 8

What is the target range for most adults with T1 or T2 diabetes? A1C

Answer 8

<7.0

Question 9

What circumstances would we have someone with higher A1C targets?

Answer 9

Functionally dependant
Recurrent severe hypoglycemia or hypoglycemia unawareness
Limited life expectancy
Frail elderly and/or with dementia

Question 10

Why should we typically avoid higher A1C targets?

Answer 10

Hyperglycemia risk

Question 11

To achieve a A1C of <7.0 what should the preprandial plasma glucose be at?

Answer 11

4.0-7.0

Question 12

To achieve a A1C of <7.0 what should the 2 hour postprandial plasma glucose level be?

Answer 12

5.0-10.0

Question 13

Why is a target of less then <7.0 usually achieved for A1C levels?

Answer 13

Any lower higher risk of hypoglycemia, Though some people who are more responsible can manage better

Question 14

Why would death be associated with lower A1C <6?

Answer 14

Higher chances of hypoglycemia

Question 15

Lower A1C provides strong ___ to microvascular complications

Answer 15

benefits

Question 16

How long is the glucose lag seen on the electronic monitors?

Answer 16

THe electronic monitors lag a little more since the capillary glucose must diffuse into the interstitial fluid – which may lag capillary levels by 5 to 15 minutes

Question 17

What are some of the benefits of using a rtCGM

Answer 17

Sends alerts if outside target range (and before if predicted to go out of range)

Measures glucose every 5
minutes – can access any time

Sensor replaced up to every 10 days (G6) and 7 days (Guardian)

Question 18

What are some of the benefits of isCGM

Answer 18

Measures glucose every minute and stores readings every 15 min – the data is downloaded after 14 days

Stand-alone system

Applied on back of arm

Question 19

What causes an increase in ketones primarily?

Answer 19

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

Question 20

What is the non-pharmacological treatment of T2DM

Answer 20

Diet, exercise

Question 21

How do we measure total CHO?

Answer 21

Refer to nutrition facts, subtract the fibre as it cannot be digested

Question 22

What can alcohol cause in T1dm or T2DM

Answer 22

Delayed hypoglycemia

Question 23

What are the exercise recommendation for PWD

Answer 23

• ≥150 mins of moderate to vigorous intensity aerobic exercise/week
• Spread over ≥ 3 days/week
• No more than 2 consecutive days of no activity