Monitoring and Screening Flashcards
How often should a blood glucose meter be compared to lab value?
How much can the meter be “out” with the NEW guidelines coming into place for BG meters?
Annually OR when A1C is not matching SMBG readings.
When FBG is greater than 4.2 meter can have a < 15 percent
When should ketones be tested? Type 1 and 2
During acute illness where BG remains > 14. OR if there are signs of DKA such as N/V abdominal pain
Urine ketone test is testing what substance?
Acetone levels.
Blood ketone testing is testing what substance?
Betahydroxybutyric acid which is formed during DKA.
Why is blood ketone testing preferred over urine testing?
Urine ketone testing does not show onset or resolution of DKA as quickly. Despite effective treatment being given, urine testing can show acetone levels still increasing whereas betahydroxybutyric acid levels are coming down.
What are continuous glucose monitoring systems measuring?
Interstitial fluid
Can continuous glucose monitoring replace SMBG?
No. For SOME CGM SMBG is still needed to :
1- calibrate CGM
2-confirm any hypo
3-confirm any readings prior to changing therapy.
For others, only need SMBG if alerts and readings do not match symptoms.
If you simultaneously test lab FBG and home machine it should have less than what percentage difference?
Less than 15% if BG if greater than 4.2
What is the benefit of A1C lowering beyond 7
Reduced microvascular risks. NO further reduction of macrovascular
How does stress affect glycemic levels?
“For the person with diabetes, stress may lead to either hyperglycemia or hypoglycemia (13); it
may trigger the release of counterregulatory hormones and result in elevated BG levels, but the
response is often unpredictable. Severe stress may also lead to less optimal diabetes self-care,
including missed meals or forgotten medication
Describe screening for nephropathy for type 1, 2 in kids and adults and pregnancy.
Type 2. Kids and adults both at dx and yearly.
Type one kids start after age 12 and 5 years after dx. Then yearly.
Adults are 5 years after dx. Then yearly.
Pregnancy: prior to pregnancy use eGFR! During P use SCr and ACr EVERY trimester!
Describe screening for retinopathy for type 1, 2 in kids and adults and pregnancy.
Type 2 at dx and yearly kids and adults same
Type one. RARE before puberty. Start screening 5 years after dx and over age 15.
Describe screening for neuropathy for type 1, 2 in kids and adults and pregnancy.
Type two kids and adults at diagnosis and yearly.
Type one, 5 years after dx and over age 12.
Nothing in P
Describe screening for dyslipidemia for type 1, 2 in kids and adults
Type 2 adults and kids same at dx and yearly.
Type one, KIDS: at ages 12 and 17. OR less than 12 if risk factors*
Adults: 5 years after dx and post puberty
*obese
Family Hx of Dyslipidemia or premature CVD
Once diagnosed they are treated as adults!
Describe screening for hypertension for type 1, 2 in kids and adults
Type 2 adults and kids at dx and at every visit. For kids, at least twice yearly.
Type one at least twice a year.
Which type needs to be screened for thyroid disorder and how often? (2)
Type ONE at dx and every 2 years!!
Pregnancy: 6-8 weeks postpartum!
Why is it important to not choose certain meters for pts on dialysis?
Some meters will give incorrect readings if pt is on maltose based dialysis IV. Some meters cannot distinguish between maltose and glucose.
What two parameters need to be stable for a period of time in order to
Establish a valid pattern to work with in BG monitoring?
Food and exercise!
Pts newly trained on meters should be reevaluated for their testing skills when?
At 1 and 6 months. To rule out operator error when interpreting numbers. Eg. Readings can be off if insufficient sample size, pts not washing hands, check memory to
See if if lines up with log book (pts often won’t write down “bad” numbers).
How does A1C compare to FBG?
FBG is always a higher number. The difference is greater as the A 1C is higher. A1C. FBG 6. 7 6.5. 7.8 7. 8.6 9. 11.8 10. 13.4
How accurate is A1C for a pt on dialysis?
A1C UNDERESTIMATES control in pts on dialysis as they are typically receiving erythropoietin which increases erythrocyte survival
Ie: a1c will be higher!
What constitutes a “pattern” in BG monitoring.
A consistent trend in BG numbers over 2-3 days when CHO and activity level are consistent.
What should be adjusted for first? Highs or lows?
Lows
What are 4 things that can interfere with some blood glucose monitoring devices?
Maltose and xylitol tolerance tests
IV immunoglobulin Ie; RhoGam
Renal dialysis solutions.
*some meters cannot distinguish between maltose and glucose ALWAYS check with manufacturer!!
