Glucose monitoring

Question 1

What factors influence selection of a glucometer?

Answer 1

Insurance coverage, manual dexerity, visual acuity, side/shape, ease of use, optional features, general individual preferences

Question 2

True or false: the DCES/prescriber an appeal to an insurance company for coverage for the medical necessity of a meter

Answer 2

True

Question 3

What Medicare part covers supplies for pt’s with DM?

Answer 3

Medicare part B (meters, strips, lancets, replacement batteries, control solutions)

Question 4

Medicare will only cover SMBG equipment if pt’s have a Rx from their prescriber that includes what information?

Answer 4

Dx of DM, kind of meter and why (eg, special meter b/c of low vision), whether pt uses insulin, and how often pt should check their blood glucose

Question 5

What is current medicare coverage for meters/strips/supplies

Answer 5

Using insulin: 100 glucose monitoring strips and lancets a month and 1 lancing device every 6 months

No insulin:100 glucose monitoring strips/lancets every 3 months and 1 lancing device every 6 month

Coverage of additional strips is possible if requested by prescriber and medical necessity is documented

Question 6

True or false: Most private insurance plans follow medicare guidelines for coverage of DM supplies

Answer 6

True (some plans consider meter and glucose monitoring supplies as part of pt’s pharmacy benefit while others consider it a DME benefit)

Question 7

Once opened, when will testing strips expire?

Answer 7

3-6 months (check manufacturers guide)

Question 8

When should a control solution check be performed?

Answer 8

Every time a new box of test strips are opened

Question 9

How should ADA post prandial “peaks” be described to a patient?

Answer 9

Aiming for a blood glucose no higher than 180 mg/dL 1-2 hours after the start of a meal

Question 10

What is the current consensus on when SMBG should be utilized?

Answer 10

by persons using intensive insulin schedules such as MDI or insulin pump therapy; less consensus for pt’s who are on less intensive insulin schedules or oral meds

Question 11

What do the ADA standards of care recommend re: SMBG (glucose monitoring) for pt’s with DM1 or DM2 on intensive insulin therapy

Answer 11

Blood glucose be checked prior to meals/snacks, occasionally post prandially, at bedtime prior to exercise, when low blood glucose is suspected, after treating hypoglycemic event, and prior to performing critical tasks such as driving (6-10 times per day or more)

Question 12

For pt’s with DM2 using less intensive regimens (such as basal insulin), when should BG be checked?

Answer 12

NO specific frequency but states that studies have indicated fasting SMBG provides guidance for titration of basal insulin

Question 13

For a person with newly dx’d DM, what SMBG schedule may be useful?

Answer 13

3 point: fasting, pre largest meal and post largest meal–> provides info re: reaching glycemic response to the largest meal of the day

Question 14

what is a 5 or 7 point SMBG shcedule?

Answer 14

pre/post prandial + bedtime, repeated for 5-7 days (can provide insight as to when out of target BG are happening on a given day

Question 15

What is a staggered 2 or 3 blood glucose schedule?

Answer 15

1 meal is selected, and pre/postmeal blood glucose checks are performed. A different mealtime is selected on subsequent days.

Question 16

What is structured monitoring?

Answer 16

Refers to a schedule for checking BG that is specifically prescribed to discover effects of food, meds, and physical activity on daily glucose levels

Question 17

How many BG readings are needed to determine a pattern?

Answer 17

3-4 readings

Question 18

What is glucose pattern management?

Answer 18

Process of recognizing, analyzing, and acting on repeated out of target readings to move them into target range

Question 19

What should be considered if fasting BG is higher than bedtime glucose?

Answer 19

Possible nocturnal hypoglycemia or dawn effect

Question 20

What med adjustments should be considered if premeal BG check is out of range?

Answer 20

Assess basal insulin therapy needs

Question 21

What medication adjustment should be considered if post meal BG is out of range?

Answer 21

Assess adequacy of premeal medications (rapid or short acting insulin, orals) in light of meal eaten. If not taking meds, assess effect of meal

Question 22

What medication adjustments may be considered if bedtime glucose is out of range?

Answer 22

Assess effect of evening meal and basal therapy needs

Question 23

What are some factors that may raise blood glucose?

Answer 23

Inadequate insulin/oral med dose, other meds, exercise, stress, dehydration, more CHO that usual

Question 24

What factors may lower blood glucose?

Answer 24

too much insulin/oral med, other meds, physical activity, stress, less CHO that usual

Question 25

In what situations are post prandial blood glucose numbers useful?

Answer 25

Effective for teaching the impact of food portions and meal comp has on BG levels

Question 26

When A1c levels approach 7%, _____ glucose levels contribute more to A1c levels, while ____ glucose levels contribute less

Answer 26

postprandial; fasting (if aiming for A1c <7%, BG monitoring should focus on reaching post prandial glucose targets)

Question 27

Per the ADA, for whom is CGM recommended for?

Answer 27

children, adolescents, and adults with DM1 to decrease risk of hypoglycemia and contribute to improved glycemic stability

Question 28

True or false: use of CGM is associated w/ reduced hypoglycemia compared to BG monitoring

Answer 28

True; when compared to SMBG, CGM provides up to 288 readings/day at no additional financial cost, pain, or user interactions

Question 29

CGM costs are reimbursed for which type of DM <65 years old by most commercial insurance

Answer 29

Type 1 DM

Question 30

What is the recommended target for time in range for pt's wearing CGM?

Answer 30

70%

Question 31

What is the recommended threshold for time below range (TBR) for pt's wearing CGM?

Answer 31

Level one: 54-69 mg/L (4%) | Level two: <54 mg/dL (1%)

Question 32

What is the recommended threshold for time above range (TAR) for pt's wearing CGM?

Answer 32

Level one: 181-250 mg/dL (<25%) | level two: > 250 mg/dL (<5%)

Question 33

What does the 1, 5 anhydroglucitrol blood test measure?

Answer 33

Amount of time over a 2 week period that glucose exceeds the renal threshold >180 mg/L the more often glucose spikes, the lower the 1,5 A results will be

Question 34

When would Fructosamine be used?

Answer 34

To follow up on interventions that have been recently implemented (2-3 weeks) or when there is a discrepancy between A2c and pt's reported BG reading

Question 35

When are ketones produced in the body?

Answer 35

When someone is severely depleted of CHO or has inadequate insulin levels. Level of ketones can be measured in blood or urine

Question 36

Why are urine ketone tests not reliable for diagnosing, monitoring, or treating ketoacidosis?

Answer 36

Level of acetoacetate in urine is influenced by hydration level and may lag a couple hours behind the blood ketone levels

Question 37

What is the most accurate measurement of metabolic status when measuring for ketones?

Answer 37

3 B hydroxybutyrate in the blood

Question 38

What situations is it important to monitoring whether ketones are present?

Answer 38

illness, persistently elevated BG >250 mg/dL with DM1, infections ,and pregnancy. Ketones should be routinely checked during illness by all pt's with DM.

Question 39

Why does ketone spillage occur?

Answer 39

Due to lack of insulin and body burning its own fat, of which ketones are a byproduct Insulin users must be taught they should continue taking their insulin and that additional insulin is often required to treat accompanying hyperglycemia

Question 40

What is the calculation for eAG?

Answer 40

eAG (mg/dL) = (28.7 x A1c) - 46.7