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!!
If fingertip testing cannot be done, where’s the next best place to use for testing?
Palm of the hand near the base of the thumb
75 percent of incorrect readings are due to what in SMBG?
Insufficient sample size
Why MUST you wash hands prior to SMBG rather than use alcohol swabs??
Study showed that even hours after peeling fruit BG readings were way higher!! Even with alcohol results were much higher!!
Note: if cannot wash hands MUST use the SECOND drop of blood not the first.
How does altitude affect BG monitoring?
Can UNDERESTIMATE BG levels by 1-2% for every 1000 feet OR depending on meter OVERESTIMATE. 😡. Take home message is to for patients going to extremes of temperature or elevation to check with manufacturers
How does hematocrit affect readings for SMBG??
Hematocrit higher=BG underestimated!!
Hematocrit lower=BG will be overestimated!
Note: most test strips make allowances for this. Can check strip literature for acceptable hct ranges
When CAN urine ketone testing be recommended?
In pregnancy to ensure baby and mothers nutritional needs are being met
What is the lag time between CGMS and SMBG readings?
15-20minutes
When is SMBG not USUALLY required? 2
D treated with only lifestyle and targets are being met
Pre D
What are alternative sites to fingertip testing?
blood samples taken from the palm near the base of the thumb (the thenar area) demonstrate a closer correlation to fingertip samples at all times of day and during periods of rapid change in BG levels
*thigh and forearm are other sites
when has fingertip testing been shown to be more accurate?
during periods of rapid change in BG levels (e.g. after meals, after exercise and during hypoglycemia),
- more accurately reflect glycemic status than forearm or thigh
Which device requires calibration with CBG?
RtCGM OR isCGM?
RtCgm. isCGM OR flash is factory callibrated
Why should people with diabetes avoid galactose and xylose?
They can interfere with SOME BG meters and strips giving false readings.
Some dialysis solutions contain maltose. Why is this a problem?
Some BG monitors cannot distinguish between maltose and glucose. Must check with manufacturer to see if meter is compatible to be used for dialysis patients.
In type one rtCGM has five benefits
Increase TIR Decreased A1C Reduces hypo incidence and duration. Improved QOL Increased tx satisfaction
Which monitoring system is best for pts with type one who are hypoglycaemia unawares?
rtCGM to reduce incidence and time in hypo.
Is there a benefit in type 2 to use rtCGM and isCGM?
If a patient is started on meds that can cause HYPERglycenia, how often should they SMBG
Greater than twice a day
