Goals of therapy Flashcards
What are the 3 overall goals of therapy of diabetes
- Reduce the risk of chronic complications
- microvascular
- Macrovascular - Avoid symptoms of hyperglycemia
- Avoid or minimize the risk of acute complications
- hypoglycemia
- hyperglycemic emerg (DKA)
What do microvascular and macrovascular complications include?
microvascular:
- neuropathy
- retinopathy
- nephropathy
Macrovascular:
- cerebrovascular disease
- coronary heart disease
- peripheral vascular disease
What is the ABDCDESSS of diabetes care
A: A1C under 7
B: BP target under 130/80
C: Cholesterol targets LDL under 2.0 or 50% red
D: Drugs for CV risk: ACE/ARB, Statin, ASA
- SGLT2i/GLP1-RA in high risk T2DM
E: Exercise 150 min/week and 2-3 times resistance exercise/week
S: Screening for Cardiac 3-5, yearly foot, kidney, retinopathy
S: Smoking cessation
S: Self-management, stress, mental health, personal goals
What value is the primary indicator of blood glucose control?
A1C
What is the trend with FPG and PPG levels as you get closer to the A1C target?
As you get closer to A1C target
PPG needs more management, FPG needs less management
Which value contributes more to A1C when it is high? PPG or FPG
FPG
What is the A1C Target for functionally dependent people
- based on class of antihyperglycemic medications and persons characteristics
7.1-8.0%
Which people have an A1C target of 7.1 - 8.5%
- Recurrent severe hypoglycemia or hypoglycemia unawareness
- Limited life expectancy
- Frail elderly or dementia
What is the measurement for End of life palliative patients
A1C measurement not recomended
- avoid symptomatic hyperglycemia and any hypoglycemia
What are the BG levels for preprandial and post-prandial
Pre: 4-7
Post: 5-10
What are the BG levels for preprandial and post-prandial if A1C under 7.0% is not achieved?
Pre: 4-5.5
Post: 5-8
What does the fructosamine test test
Substance resulting from nonenzymatic glycation of serum proteins (mostly albumin)
- glucose marker for the past 2-3 weeks
- useful in patients with unreliable A1C due to blood loss or hemoglobinopathy
What does the serum glycated albumin test?
Tests amount of glucose bound to albumin
- not affected by RBC turnover or EPO
- glucose marker for the past 2-3 weeks
What does 1,5 Anhydroglucitol test
Tests the removal of glucose by kidneys
What do we need to teach patients when monitoring BG with meaning (4)
- How and when to perform CBG
- How to record the results
- Meaning of various BG levels
- How behaviour and actions affect CBG levels
When should the fingertip site be used for CBG? Why?
- if suspected hypoglycemia
- following exercise
- following insulin admin
- post-prandial BG
Why? Changes in BG appear most rapidly at this site
What are some alternate testing sites that have less blood flow
- Palm
- Forearm
- Thigh
SMBG # recommendation for:
Basal-bolus insulin therapy
4+ times/day
SMBG # recommendation for:
insulin less than 4 times/day
As much as insulin being given
SMBG # recommendation for:
Pregnancy
Hospitalized or acutely ill
4+ times/day
SMBG # recommendation for:
Starting a new med associated w/ hyperglycemia
Experiencing an illness
2+ times/day
SMBG # recommendation for:
someone not meeting glycemic targets
2+ times/day
SMBG # recommendation for:
Newly diagnosed diabetic (under 6 months ago)
at least once 1+/day
SMBG # recommendation for:
diabetic treated with healthy behaviour interventions, antihyperglycemic agent and meeting glycemic targets
1-2x/week
