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IPFC 3 Midterm 1 > Goals of therapy > Flashcards

Goals of therapy Flashcards

1
Q

What are the 3 overall goals of therapy of diabetes

A
  1. Reduce the risk of chronic complications
    - microvascular
    - Macrovascular
  2. Avoid symptoms of hyperglycemia
  3. Avoid or minimize the risk of acute complications
    - hypoglycemia
    - hyperglycemic emerg (DKA)
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2
Q

What do microvascular and macrovascular complications include?

A

microvascular:
- neuropathy
- retinopathy
- nephropathy

Macrovascular:
- cerebrovascular disease
- coronary heart disease
- peripheral vascular disease

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3
Q

What is the ABDCDESSS of diabetes care

A

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

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4
Q

What value is the primary indicator of blood glucose control?

A

A1C

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5
Q

What is the trend with FPG and PPG levels as you get closer to the A1C target?

A

As you get closer to A1C target

PPG needs more management, FPG needs less management

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6
Q

Which value contributes more to A1C when it is high? PPG or FPG

A

FPG

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7
Q

What is the A1C Target for functionally dependent people
- based on class of antihyperglycemic medications and persons characteristics

A

7.1-8.0%

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8
Q

Which people have an A1C target of 7.1 - 8.5%

A
  • Recurrent severe hypoglycemia or hypoglycemia unawareness
  • Limited life expectancy
  • Frail elderly or dementia
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9
Q

What is the measurement for End of life palliative patients

A

A1C measurement not recomended
- avoid symptomatic hyperglycemia and any hypoglycemia

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10
Q

What are the BG levels for preprandial and post-prandial

A

Pre: 4-7
Post: 5-10

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11
Q

What are the BG levels for preprandial and post-prandial if A1C under 7.0% is not achieved?

A

Pre: 4-5.5
Post: 5-8

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12
Q

What does the fructosamine test test

A

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

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13
Q

What does the serum glycated albumin test?

A

Tests amount of glucose bound to albumin
- not affected by RBC turnover or EPO
- glucose marker for the past 2-3 weeks

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14
Q

What does 1,5 Anhydroglucitol test

A

Tests the removal of glucose by kidneys

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15
Q

What do we need to teach patients when monitoring BG with meaning (4)

A
  1. How and when to perform CBG
  2. How to record the results
  3. Meaning of various BG levels
  4. How behaviour and actions affect CBG levels
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16
Q

When should the fingertip site be used for CBG? Why?

A
  • if suspected hypoglycemia
  • following exercise
  • following insulin admin
  • post-prandial BG

Why? Changes in BG appear most rapidly at this site

17
Q

What are some alternate testing sites that have less blood flow

A
  • Palm
  • Forearm
  • Thigh
18
Q

SMBG # recommendation for:
Basal-bolus insulin therapy

A

4+ times/day

19
Q

SMBG # recommendation for:
insulin less than 4 times/day

A

As much as insulin being given

20
Q

SMBG # recommendation for:
Pregnancy
Hospitalized or acutely ill

A

4+ times/day

21
Q

SMBG # recommendation for:
Starting a new med associated w/ hyperglycemia
Experiencing an illness

A

2+ times/day

22
Q

SMBG # recommendation for:
someone not meeting glycemic targets

A

2+ times/day

23
Q

SMBG # recommendation for:
Newly diagnosed diabetic (under 6 months ago)

A

at least once 1+/day

24
Q

SMBG # recommendation for:
diabetic treated with healthy behaviour interventions, antihyperglycemic agent and meeting glycemic targets

A

1-2x/week

25
Q

How do you verify your glucometer accuracy?
What is the standard readings for verifcation for conc lower than 5.6 mmol/L?
Higher than 5.5 mmol/L?

A

Comparing your FPG glucometer reading with lab value in less than 5 min interval

Lower than 5.6 mmol/L: must be within +/- 0.83 mmol/L

5.5+ mmol/L: must be within +/- 15%

26
Q

What do continuous glucose monitoring measure

A

measure glucose concentration in interstitial fluid

27
Q

What value is glucose management indicator (GMI) closest to? Target?

A

A1C
- however could differ as it tests for last 14 days

Target? 7% or under

28
Q

Target for:
Glycemic variability
Why?

A

36% or under
- Lower %CV risk associated with reduced hypoglycemia

29
Q

Target for:
Time in range for 3.9-10.0

A

more than 70% of times in range
- each 10% TIR equates to about 0.5% change in A1C

30
Q

Target for:
Time below range
3.0-3.8
<3.0

A

3.0-3.8 : <3%
<3.0: <1%

31
Q

Target for:
Time above range
high 10.1-13.9
Very high 13.9+

A

high 10.1-13.9: <20%
Very high 13.9+: <5%

32
Q

Target for:
Time in range for 3.9-10.0
for older/high risk adults

A

50%

33
Q

Target for:
Time below range in older/high risk adults
<3.9

A

<1.0%
** big priority if using insulin or sulfonylurea

34
Q

Target for:
Time above range for older/high risk adults
high 10.1-13.9
Very high 13.9+

A

high 10.1-13.9: n/a, acceptable
Very high 13.9+: <10%

IPFC 3 Midterm 1 (8 decks)

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