Monitoring Diabetes Mellitus

Question 1

Goal of blood glucose monitoring

Answer 1

Maintain glucose within target range

Question 2

Immediate benefit of blood glucose monitoring

Answer 2

Identify, treatment and prevention of highs and lows

Question 3

Long term benefit of blood glucose monitoring

Answer 3

Prevention of long term complications

Question 4

Challenge

Answer 4

Getting correct result every time

Question 5

Point of care test is

Answer 5

Any test performed on patient out side the laboratory

Question 6

Point of care test advantages

Answer 6

Faster stabilisation of threatening crises

Immediate result

Small sample volume

Better compliance

Reduce length of hospital stay
Reduce repeat visits
Better control of disease

Question 7

POCT results in

Answer 7

Way shorter waiting times

Question 8

POCT disadvantage

Answer 8

Analytical performance can be inferior to lab

Cost is higher than lab

Risk of poor operator competence
Risk of poor quality patient information
Risk of poor equipment maintenance

Question 9

Capillary glucose testing?

Answer 9

Often- decided by treatment

Test - for self management

More frequent test is associated with better control

Question 10

Measuring plasma glucose is

Answer 10

More accurate but must go to lab

Question 11

Difference between whole blood and plasma glucose

Answer 11

Whole blood glucose is q9-15% lower than plasma

Question 12

POCT results are converted to

Answer 12

Plasma equivalent

Question 13

Normal glucose % in urine

Answer 13

0.1%

Also small amount during pregnancy

Question 14

Urine glucose disadvantages

Answer 14

Test is retrospective

Hydration affected results

Not diagnositic

Question 15

Urine dipstick test disadvantage

Answer 15

Visual reading is subjective

Question 16

Long term control of blood glucose

Answer 16

Glycated haemoglobin ( measure of glucose over 1-3 months)

Serum fructosamine (mean glucose control over 2 preceding weeks)

Question 17

Glycated haemoglobin

Answer 17

HBA1C- addition of glucose to N terminal valine of B chain of HB

Question 18

Advantages of using HBA1C

Answer 18

Standardised
No patient preparation
Not influenced by stress
Small biological variation

Question 19

Disadvantage of HBA1C

Answer 19

Expensive
Increases with age misleading if anaemia or renal failure
Ethnicity

Question 20

Situations in which HbAqc must not be used

Answer 20

HbA1c reflects glycaemia over the preceding 2 – 3 months so may not be raised if blood glucose levels have risen rapidly All symptomatic children and young people Symptoms suggesting Type 1 diabetes (any age) Short duration diabetes symptoms Patients at high risk of diabetes who are acutely ill Taking medication that may cause rapid glucose rise e.g. corticosteroids, antipsychotics Acute pancreatic damage/pancreatic surgery

Question 21

What can interfere with HBA1C

Answer 21

Haemoglobin variants

Anaemia

Chemicallly altered hb (carbamylation/ acylation)

Reduced glycated not process

Question 22

Ketone measured in

Answer 22

Blood

Question 23

Ketones measured how

Answer 23

Boood test for hydroxybutyrate

Question 24

Define microalbuminuria

Answer 24

24 hour collection- 30-300 mg/24hr

Question 25

Microalbuminuuria can be detected by

Answer 25

Not urine dipstick test

Question 26

Diagnosis of microalbuminuria cannnot be made

Answer 26

In presence of an acute metabolic crisis and patients should not be screened during inter current illness

Question 27

Ideal glucose monitoring device

Answer 27

Minimally invasive/ non invasive

Continuous sensing

Question 28

Continuous glucose monitoring how

Answer 28

Subcutaneous implanted enzyme electrode

Question 29

Continuous glucose monitoring measures what

Answer 29

Glucose in the tissue

Lags behind blood glucose 5-15 minutes

Question 30

Advantages of cg

Answer 30

Frequency of testing

Viewing of trends

Less need for finger sticks

Question 31

Disadvantages of cgm

Answer 31

Safety- implanted sensor designed to be used for short amount of time

Efficiency and accuracy - can be rejected by immune system initially

Expensive