diabetes therapies Flashcards
what is A1C ?
series of minor hemoglobin components that are formed slowly and non enzymaticall
from Hgb and glucose
what is proportional to the rate of formation for A1C
proportional to glucose concentration
what do we use A1C for?
- predicts the risk for complications
- glycemic history for 2-3 months
what do these : GSA and GSP stand for ?
when do we use?
- glycosylated serum albumin
- glycosylated total serum proteins
- use when A1C cant be measures OR hemolytic anemia
what are the A1C targets for:
0) normal, no diabetes
1) adults with t2dm if at low risk for hypos
2) most adults with T1 or T2
3) functionally dependent, recurrect hypo, limited life, frail, elder
4) end of life
0) 5.4-5.7
1) less than or equal to 6.5
2) less than or equal to 7
3) 7.1-8.0=for functionally dependent, 7.1-8.5= other
4) end of life: A1C not recommended.
When explaining A1C to patients, what is important for them to know?
that they A1C value is NOT the blood glucose value that you see on the machine
7% is BG of 9.5
12% is BG of 19.5
if you want to achieve an A1C of less than or equal to 7, for most patients, what should be there preprandial BG and they 2hPP?
PRE: 4.0-7.0 mmol/L
post: 5.0-10 mmol/L
name 5 factors that can affect A1C
1) anemia – increases A1C if there is B12 or Fe def.
2) altered hemoglobin
3) altered glycation - increases A1C if there is chronic renal failure and erythrocyte ph that decreases
4) erythrocyte destruction - splenectomy increases A1C
5) assays- hyperbilirubinermia, ETHOH and chronic opiates increases A1C
what are the pediatric glycemic targets? and why
A1c: less than or equal to 7.5
FBG: 4-8
2hPP: 5-10
why: caution needed to minimize hypoglycemias. and accept higher targets if children or ados have frequent hypos.
name three ways to measure plasma glucose
1) blood glucose meter
2) CGM
3) flash glucose monitor
what is ambulatory glucose profile ?
ABG: average of the 7 days of a CGM or flash one.
what are different CGM targets for :
1) T1/T2
2) obese T1/T2
3) Pregnancy T1
4) Pregnancy gestational or t2
1) more than 70% (70-180 mg/ml)
2) more than 50% (70-180 mg/ml)
3) more than 70% (62-140 mg/ml)
4) more info needed to get a target range BUT we want to be on target for a majority of time.
What is the initail choice of therapy if the target is 7 and :
1) A1C is less than 1.5% over target
2) A1C more than 1.5% over target
1) start with behaviour and eating changed and if not on target in 3mo start metformin OR start metformin with the eating behaviours
2) start metformin with healthy behaviour interventions AND consider second agent as well.
Name the function of Biguanides.
Name 3 benefits and 3 risks.
-it is to improve insulin sensitivity, and decrease neogluconeogenesis
- negligible risk as monotherapy, no weight gain and improved CV outcomes in OW patients
- GI side effects, B12 deficiency, creatinine clearance: contraindicated if hepatic failure.
What type of medication is metformin.
Name a
Biguanide
like glucophase or glumetza
Name the function of Insulin secretagogues .
Name 3 benefits and 3 risks.
- stimulate pancreatic insulin prod.
- rapid onset of response, decreases microvascular risks and 0.7-0.8% reduction
- all associated with risk of hypoglycemia.
- weight gain!-esp glyburide
- only taken prior to meals and not at bed.
