Exam 3 lecture 8

Question 1

Which readings is ahead in terms of time BG finegr prick or ISF glucose?

Answer 1

BG may lead ISF by a few minutes
This is referred to as the lag

Question 2

Why is there a lag bn ISF and BG testings

Answer 2

Glucose enters blood stream before it enters the interstitial fluid.

Question 3

When will there be big differences between BG and cgm

Answer 3

sfter food, after insulin, after exercise

Question 4

4 different types of CGM

Answer 4

real-time, intermittently scanned, professional, unblinded

Question 5

AGP acronym

Answer 5

Ambulatory glucose profile

Question 6

GMI acronym

Answer 6

Glucose management indicator

Question 7

What are some real time CGMs

Answer 7

G6, G7

Question 8

What are some intermittently scanned CGMs

Answer 8

Freestyle libre 2

Question 9

what is an AGP report

Answer 9

Combines input from multiple days on one graph to see trend

Question 10

What is a GMI

Answer 10

conversion of CGM, derived mean glucose to an estimate of current A1c

Question 11

What is TIR? goal in normal vs High risk pts?

Answer 11

Time in range
between 70-180
goal>70% TIR
High risk goal- 50%

Question 12

TBR? goal in normal vs high risk pts?

Answer 12

% 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

Question 13

TAR? Goal in normal vs high risk pts?

Answer 13

% of time > 180
% of time >250

> 180 goal <25%, high risk < 50%
250 goal <5%, high risk <10%

Question 14

Which of the dexcome or libres require fingerstick calibration?

Answer 14

None of them

Question 15

How to review CGMs

Answer 15

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

Question 16

freestyle libre 2
Reader?
how long worn?
warming period?
finger stick required?
Interactions?

Answer 16

Has smart phone and reader
14 days worn
1 hour warming period
no finger stick calibrations
Vitamin C interactions

Question 17

difference between libre 2 and 3

Answer 17

3 only works on smart phones, does not have any reader available

Question 18

which CGMs do not need to be scanned

Answer 18

Libre 3, G7 and G6

Question 19

G6 receiver?

Answer 19

smartphone and reader
(only one approved for use on abdomen)

Question 20

Dexcom G6 and G7 worn for how long

Answer 20

10 days

Question 21

warm up time for G6

Answer 21

2 hours

Question 22

dexcom G7 warm up time

Answer 22

30 mins
other than that it is similar to G6

Question 23

medtronic guardian warm up period?
how long worn?
finger stick calibration

Answer 23

2 hour warm up period
7 days worn
need finger stick calibration

Question 24

frequency of testing for A1c

Answer 24

If meeting requirements- 6 months
If not meeting requirements-3 months

Question 25

A1c goal for elderly should be <7%

Answer 25

No, should be higher

Question 26

in cases of severe hypoglycemia, what do we use

Answer 26

glucagon injection
Baqsimi (dry nasal powder)
glucagon hypokit injection

Question 27

types of insulin pumps

Answer 27

Open loop- wearer communicated BG to delivery system
hybrid closed loop- BG level sensed by CGM and is communicated to pump and gives insulin

Question 28

Two modes of hybrid closed loop

Answer 28

Manual mode and auto mode

Question 29

difference between manual vs auto mode

Answer 29

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

Question 30

What are the different types of basal rates and their uses

Answer 30

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

Question 31

what are some pros of insulin pumps

Answer 31

Acts as pancrease
lowers hypoglycemia risk and improves hypoglycemic awareness
Specificity of goals (different rates/goals)

Question 32

Cons of insulin pump

Answer 32

Cost
DKA
inj site rxns
infusion site falling off

Question 33

Who would be a good candidate for pumps

Answer 33

Ppl who have multiple daily injections
financially capable
maintain regular appointments/ checks
poor bolus/basal control