monitoring control in diabetes

Question 1

at what points do you assess diabetic/glycaemic control

Answer 1

diagnosing diabetes, day to day, initating/altering treatment, evaluate long term control, in emergency diabetic ketone acidosis, hyperglycemia

Question 2

what are the biochemical investigation available to do with diabetes control

Answer 2

hba1c, random glucose test, fasting glucose test, urine glucose,Oral Glucose Tolerance Test (OGTT), albumin creatinine ratio, ketones

Question 3

what is the goal of blood glucose monitoring

Answer 3

maintain glucose within target range

Question 4

what are some immediate benefits of monitoring blood glucose

Answer 4

identify highs and lows and prevent and treat them, also some people are unaware when they are hypo

Question 5

what are the long term benefits of monitoring blood glucose

Answer 5

prevent long term complications e.g cvd and macrovascular and microvascular

Question 6

what is a POCT

Answer 6

test at the point of care, (glucometers to measure blood glucose),

Question 7

what are the pros of doing poct

Answer 7

life threatening conditions can be stabilized more quickly, immediate risk stratification, smaller sample volume, better patient compliance, reduce repeat clinical visits, less time in hospital and better disease control. accuracy of them is generally acceptable

Question 8

what is turnaround time TAT

Answer 8

time taken for test result to come back and treatment initiated, poct significantly quicker as traditional methods the sample has to go back to the lab, be organised and sent back to the patient care unit.

Question 9

what are the cons of poct

Answer 9

the person doing the poct may be incomptetent, equipment may not be maintained well, cost is usually greater than in the lab,
analytical info can be poorer than lab, and needs lab to back it u, poor patient info

Question 10

how does capillary glucose testing work

Answer 10

prick finger with lancet, apply blood to reagent strip, record results.

Question 11

POCT represents glucose in what compartment of the blood

Answer 11

PLASMA

Question 12

why does plasma have more glucose dissolved in it than blood

Answer 12

because it has a higher water content so more glucose dissolves there, becomes significant when centrifuging

Question 13

why does glucose concentration in blood fall by 0.5mmol over 3 hours

Answer 13

because of glycolysis in rbc, it can be inhibited with fluoride oxalate to improve accuracy of test

Question 14

a woman who is pregnant has glucose in her blood should I be concerned?

Answer 14

no small amounts of glucose in pregnant women is normal however consistent glycosuria can indicate gestational diabetes

Question 15

what are the disadvantages of urine glucose

Answer 15

it is retrospective, cannot be used to diagnose diabetes, fluid intake affects urine conc, renal threshold can differ

Question 16

if you want to look at long term blood glucose control what entities do we look at

Answer 16

glycated haemoglobin(1-3 months) and serum fructosamine (2weeks)

Question 17

Advantages of HbA1c for diagnosis

Answer 17

patients don’t have to fast, acute stress does not effect test, small biological variation, better index of overall glycaemia, stable in vitro

Question 18

disadvantages of HbA1c for diagnosis

Answer 18

cost, misleading in patients with shorter lifespan for rbc, renal failure and anaemia, increases with age, ethnicity, glycation rate differs between individuals

Question 19

Situations where HbA1c must not be used

Answer 19

in symptomatic children and young people, symptoms that suggest type 1 diabetes,
patients with meds causing rapid glucose rise, pancreatic issues, also hba1c will not detect acute rapidly raised glucose levels

Question 20

what can intefere with hba1c measurement

Answer 20

variants to hb, hbf elevated in diabetes can elevate and hbs and hbc can lower,

altered red blood cell survival, vitamin c can lower, and drugs can modify hb effecting hba1c

Question 21

how do you measure hba1c

Answer 21

boronate affinity chromatography, run blood over , glycated hb binds and non hb elutes at first peak.
glycated hb elutes as second peak

Question 22

what is fructosamine

Answer 22

Fructosamine is essentially glycated albumin

Question 23

why is fructosamine analysis for glucose control more useful than hba1c in a pregnant woman

Answer 23

Measure of long-term control over lifetime of
serum albumin – about 2 weeks (useful when
control changing quickly e.g. pregnancy)

Question 24

how do you measure fructosamine

Answer 24

Usually measured with colourimetric assay

Reference range ~200-285 mmol/l

Question 25

The future of blood glucose monitoring

Answer 25

Ideal glucose monitoring device
Minimally invasive or non-invasive
Continuous sensing

Question 26

what is continous glucose montoring (cgm)

Answer 26

Measures glucose in the tissue
Lags behind blood glucose (5-15 min)
Provides “real time” glucose readings
Glucose concentration
Direction / rate of change
Alarms to warn of high or low blood sugars

Question 27

what are pros of cgm

Answer 27

Frequency of testing = more data to work with

Viewing of trends allowing easier predictions and fine tuning of
treatment

Less frequent need for finger sticks

Less likelihood of complications because of uncontrolled
diabetes

Helps detect hypoglycaemic unawareness

Question 28

what does post prandial mean

Answer 28

after eating a meal

Question 29

what are cons of cgm

Answer 29

implanted sensor is not designed for long term use, efficiency and accuracy, cost