Exam 3 lecture 8 Flashcards
Which readings is ahead in terms of time BG finegr prick or ISF glucose?
BG may lead ISF by a few minutes
This is referred to as the lag
Why is there a lag bn ISF and BG testings
Glucose enters blood stream before it enters the interstitial fluid.
When will there be big differences between BG and cgm
sfter food, after insulin, after exercise
4 different types of CGM
real-time, intermittently scanned, professional, unblinded
AGP acronym
Ambulatory glucose profile
GMI acronym
Glucose management indicator
What are some real time CGMs
G6, G7
What are some intermittently scanned CGMs
Freestyle libre 2
what is an AGP report
Combines input from multiple days on one graph to see trend
What is a GMI
conversion of CGM, derived mean glucose to an estimate of current A1c
What is TIR? goal in normal vs High risk pts?
Time in range
between 70-180
goal>70% TIR
High risk goal- 50%
TBR? goal in normal vs high risk pts?
% of time below 70 (lvl 1)
% of time below 54 (lvl 2)
<70= goal <4% for most, high risk <1 %
<54= goal< 1% for most, 0% for high risk
TAR? Goal in normal vs high risk pts?
% of time > 180
% of time >250
> 180 goal <25%, high risk < 50%
250 goal <5%, high risk <10%
Which of the dexcome or libres require fingerstick calibration?
None of them
How to review CGMs
DATAA
D- download data (download AGP and talk to pt about what they have learned)
A- Assess safety( hypoglycemia, identify TBR, possible causes/solutions)
T- TIR- ( identify days/times in range)
A- areas to improve( hyperglycemia, identify TAR
A action plan- develop action plan
freestyle libre 2
Reader?
how long worn?
warming period?
finger stick required?
Interactions?
Has smart phone and reader
14 days worn
1 hour warming period
no finger stick calibrations
Vitamin C interactions
difference between libre 2 and 3
3 only works on smart phones, does not have any reader available
which CGMs do not need to be scanned
Libre 3, G7 and G6
G6 receiver?
smartphone and reader
(only one approved for use on abdomen)
Dexcom G6 and G7 worn for how long
10 days
warm up time for G6
2 hours
dexcom G7 warm up time
30 mins
other than that it is similar to G6
medtronic guardian warm up period?
how long worn?
finger stick calibration
2 hour warm up period
7 days worn
need finger stick calibration
frequency of testing for A1c
If meeting requirements- 6 months
If not meeting requirements-3 months
A1c goal for elderly should be <7%
No, should be higher
in cases of severe hypoglycemia, what do we use
glucagon injection
Baqsimi (dry nasal powder)
glucagon hypokit injection
types of insulin pumps
Open loop- wearer communicated BG to delivery system
hybrid closed loop- BG level sensed by CGM and is communicated to pump and gives insulin
Two modes of hybrid closed loop
Manual mode and auto mode
difference between manual vs auto mode
Auto- basal is automatically adjusted every 5 mins and a CGM is required
Manual- basal rates are pre-programmed by provider and can be used without a CGM
What are the different types of basal rates and their uses
Square- delivers bolus over long periods of time, mostly used for snacking
Blue (tranditional bolus)- used for normal meals
Dual wave- is a combination of these two. delivers initial triangle followed by square
what are some pros of insulin pumps
Acts as pancrease
lowers hypoglycemia risk and improves hypoglycemic awareness
Specificity of goals (different rates/goals)
Cons of insulin pump
Cost
DKA
inj site rxns
infusion site falling off
Who would be a good candidate for pumps
Ppl who have multiple daily injections
financially capable
maintain regular appointments/ checks
poor bolus/basal control
