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CDCES > Special population mgmt (soc 7,8 obesity & tech) > Flashcards

Special population mgmt (soc 7,8 obesity & tech) Flashcards

1
Q

What is diabetes technology?

A

Software
Hardware
Devices
to help PWD manage their condition

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2
Q

What are barriers to pt and provider use of DM technology?

A
  • complexity

- rapid change of available tech

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3
Q

What resource is available to help pts/providers make initial device choices?

A

DiabetesWise.org (nonprofit organization)

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4
Q

What should be considered when deciding to recommend DM tech?

A
  • availability of devise
  • pt needs
  • pt skills
  • pt desire
  • cost
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5
Q

When should PWD on intensive insulins be encouraged to SMBG?

A
  • before meals/snacks
  • @ bedtime
  • b4 exercise
  • if suspecting hypo
  • after tx low BG
  • until normoglycemic
  • prior to and possibly during critical tasks (driving)
  • occasionally postprandially
  • may be 6-10 x/day
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6
Q

When may SMBG in those not on insulin be helpful?

A
  • altering diet
  • altering PA
  • using oral meds that may cause hypo
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7
Q

Evaluating SMBG

A
  • evaluate technique, results, and pt ability to use the data to adjust tx
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8
Q

What common meds or supplements may interfere with glucometer accuracy?

A

Vitamin C/ascorbic acid

Acetaminophen

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9
Q

What should patients know about glucometers and test strips?

A
  • only use FDA approved glucometers

- only use unexpired strips that are purchased from pharmacy/licensed distributor

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10
Q

Why should PWD SMBG?

A
  • evaluate response to tx
  • assess if glycemic targets are being met
  • assess if targets are met safely
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11
Q

What is SMBG helpful for?

A
  • Guiding MNT- how to adjust food intake
  • PA
  • Preventing hypo
  • adjusting meds
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12
Q

What should dictate frequency, timing and consideration for use of CGM?

A

Pt needs and goals

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13
Q

What is SMBG accuracy impacted by?

A
  • glucometer used

- user technique

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14
Q

Increased frequency of SMBG in T1DM is associated with

A

lower A1c esp. in kids/adolescents

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15
Q

How often should need for SMBG be evaluated?

A

Every visit

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16
Q

SMBG in insulin users NOT on intensive insulin regimen

A
  • those on basal benefit from SMBG; lowered A1c

- no set recommendation on frequency

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17
Q

Should PWD on oral meds only SMBG?

A

Evidence shows limited benefit;SMBG alone does not lower A1c; info must be integrated into practice

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18
Q

What are 2 major factors that affect BG meter readings?

A
  • Glu oxidase rxn- sensitive to oxygen levels. High oxygen (like on oxygen tx or arterial blood oxygen) –> false low. Low oxygen (hypoxia, venous readings, high altitude) –> false highs
  • Glu dehydrogenase rxn- not sensitive to oxygen
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19
Q

Does temperature affect glucometer?

A

Yes

will receive error message if at unacceptable temp

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20
Q

What are common interfering substances for glucose oxidase meters?

A

Uric acid
Ascorbic acid
L-dopa
Acetaminophen

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21
Q

What are common interfering substance with glu dehydrogenase monitors?

A

peritoneal dialysis

icodextrin

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22
Q

Just because meter is FDA approved does not mean it’s accurate. Why?

A
  • only has to meet standards of past initial time of approval for FDA (not current standards)
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23
Q

What is the ISO

A

International Organization of Standardization

Meter must meet current ISO standards

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24
Q

How many meters meet DM tech society BG monitoring system surveillance program standards?

A

6/18

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25
Q

What is needed for CGM rx?

A

DM education, training, support. Need to be able to calibrate device and verify readings if they don’t match current s/s

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26
Q

What is useful for lowering A1c & hypo in T1DM?

A
  • Real time CGM + intermittently scanned CGM along with insulin therapy
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27
Q

How often should real time CGM be used?

intermittently scanned?

A

real time- daily

intermittent- scan at least q 8 hours

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28
Q

Why should pregnant women use real time CGM

A

improve A1c
improve BG TIR
improve neonatal outcomes

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29
Q

What can blinded CGM do?

A
  • ID and correct HYPER and HYPO

in T1DM + T2DM when used w/ DSME & medication adjustment

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30
Q

What’s the difference b/w finger sticks and CGM?

A

Finger stick -plasma glucose

CGM- interstitial fluid

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31
Q

What’s the difference b/w adjunctive CGM and non-adjunctive?

A

Adjunctive- require SMBG confirmation

Non-adjunctive- do not require SMBG

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32
Q

What data does CGM provide?

A
  • TIR
  • GLU variability
  • Time above & below range
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33
Q

If intermittently scanned CGM is used in T2DM what can it do?

A
  • reduce A1c

- doesn’t reduce hypo

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34
Q

Real time CGM in T1DM effectiveness

A
  • effective in reducing A1c & hypo in adults
  • limited research in kids/adolescents
  • may be more helpful if kid wore it 6-7 days/week
  • parents love it
35
Q

What is a side effect of CGM use?

A

dermatitis

associated w/ skin sensitizer isobornyl acrylate

36
Q

When may insulin pen vs. syringe be helpful?

A

dexterity issues
needle phobia
vision issues

37
Q

Insulin syringe

- size

A 
1 ml= up to 100 units
0.5 ml= up to 50 units
0.3 ml=up to 30 units
generally meant for 1x/use but may be reused if cleaned well 
u500 insulin has special syringe
38
Q

insulin pens

A

combined syringe & vial in 1 devise
convenient
cartridges may be disposable or reusable

39
Q

insulin needles

A
  • duller needle= more pain, associated w/ reused needles
  • thicker needle= dose given more quickly
  • thinner needle= less pain
  • size- 22-33 (higher number is thinner)
  • length- 4 mm-12 mm
  • shorter needles= less risk of injecting IM
40
Q

Who is a candidate for insulin pump?

A

All adults, kids, adolescent w/ T1DM who can safely manage the device

41
Q

Who is most likely to use pumps?

A

higher socioeconomic status

  • race/ethnicity
  • private health insurance
  • family income
  • education
42
Q

What can pump therapy do?

A
  • modestly lower A1c

- reduce severe hypo

43
Q

aspects of pump therapy

A
  • assess pt/family readiness
  • select pump type & settings
  • education for pump complications- DKA,infusion set failure
  • transition from multiple daily injections
  • advanced pump settings
44
Q

complications of pumps

A
  • pump can get dislodged or occluded –> DKA
  • lipohypertrophy
  • lipoatrophy (not common)
  • pump site infection
45
Q

Common reasons pumps are d/c

A
  • $$
  • wearability
  • dislike of pump
  • suboptimal glycemic control
  • mood disorders
46
Q

barriers to using pump in kids

A
  • physical interference
  • physical discomfort
  • financial burden
  • effectiveness?
47
Q

sensor augmented pumps

A

suspend insulin when glu is low or predicted to go low within 30 minutes
- reduced nocturnal hypo without increasing A1c

48
Q

automated insulin delivery systems

A
  • increase and decrease insulin delivery based on sensor derived glu level/trends
  • consist of 3 parts:
    • insulin pump, continuous glu sensor, algorithm that determines insulin delivery
  • requires user bolus for meals;must announce meals
49
Q

DIY insulin delivery system

A
  • not FDA approved yet
  • contains pump, real time CGM w/ controller, algorithm to automate insulin delivery
  • insulin doses adjusted based on set basal rate, CHO ratio, correction dose, insulin activity
  • ensure pt has back up plan if system fails
50
Q

Insulin pump calculations
CHO to carb ratio
correction factor

A

1:15 insulin:CHO ratio to start

1 unit of insulin needed for every 30-50 pts above target

51
Q

calculating insulin needs

A

1/2 TDD as bolus; other 1/2 basal
0.5 x kg in body weight= TDD/day
1/2 as bolus, 1/2 as basal
for basal rate/24 hours

52
Q

Insulin drip in hospital

A
  • usually 60-80% for basal dose
  • 1cc= 1 unit of insulin; 100 cc bags
  • rate based on BW- 0.05 units/kg/hr
  • monitor BG q 1-2 H
  • inject insulin subq 2-4 hours before stopping the insulin drip
53
Q

insulin sensitivity factor (ISF)

A

AKA correction factor
ISF= how much 1 unit of insulin drops BG
NOT reliable for T2DM

54
Q

1500 rule

A

Used for those on short acting insulin (regular insulin)
1500/TDD
ex: 1500/50= 30. 1 unit of regular insulin would drop this person’s BG by 30 pts

55
Q

1800 rule

A

for those on rapid acting insulin
1800/TDD
ex: 1800/30= 60. 1 unit rapid would lower BG by 60 pts

56
Q

500 rule

A

500/TDD= insulin:CHO ratio

500/50 units (this persons TDD)= 1:10. 1 unit of insulin covers 10 g CHO

57
Q

Insulin:CHO ratio

A

how many g CHO 1 unit insulin covers
higher ratio= more insulin sensitive
1:15 common, sometimes 1:10
1:15, ate 45 g CHO= 3 units to cover it

58
Q

Asian overweight

Asian obesity

A

OV- 23-27.4

OB-27.5 or higher

59
Q

VLCD for T2DM

A

<800 kcal, 3 month intervention, medically supervised for carefully selected pts
decrease A1c <6.5% & FPG <126 w/o meds

60
Q

modest & sustained WL in T2DM –>

A

improve glycemic control, reduces need for DM meds

5% WL

61
Q

high intensity intervention for WL

A

> /=16 sessions x 6 months; once wt loss achieved, offer at least 1 year of weight maintenance

62
Q

wt maintenance

A

weigh at least weekly

200-300 mins/PA per week

63
Q

modest WL in T2DM

A

improve BG, A1c, TG

64
Q

greater WL in T2DM

A

improve BP, LDL, HDL, reduce need for meds to control BG/BP/lipids

65
Q

when to recommend WL meds

A
  • BMI >27 + DM

- BMI >25 + DM in Asians

66
Q

When to recommend bariatric surgery

A

BMI 30+ DM

BMI27.5 or more + DM + Asian

67
Q

Look AHEAD

A
  • population- OV/OB T2DM
  • outcome: did not reduce CV events
  • at 8 years 1/2 maintained 5%, 1/4 maintained 10% WL; mean WL 5%
  • median WL 5%
  • improved QOL- physical and sexual function, mobility
  • reduced risk factors w/ less meds
68
Q

Need what % WL for minimum clinical benefit

A

3-5%

69
Q

energy deficit for WL

A

500-750

70
Q

When to d/c WL med

A
  • <5% loss x 3 months

- tolerability issues

71
Q

A1c goal achievement

A

NOT BMI dependent

72
Q

wt neutral DM meds

A

DPP4i

Metformin

73
Q

weight loss DM meds

A 
Metformin?
GLP1-RA
SGLT2-i
a-glucosidase inhibitor
amylin mimetics
74
Q

weight gain DM meds

A

insulin
sulfonylureas/meglinitides
TZD

75
Q

other wt gain meds

A
  • antipsychotic (end in ine), antidepressant (SSRI, triclyclic, MAOI), anticonvulsant, glucocorticoids/steroids, injectable progestins
76
Q

WL meds in DM- efficacy

A

nearly all prescription WL meds delay progression from pre-DM –> T2DM & improve glycemic control in T2DM

77
Q

prescription WL meds- how often to assess pt response?

A

assess monthly 1st 3 months

78
Q

medical devices for WL

A

$$$$$$
limited insurance coverage
lack of research in T2DM

79
Q

metabolic surgery to treat T2DM

A
  • Morbid obesity or >37.5 in Asians
  • class II obesity or 32.5-37.4 in Asians who did not lose weight or improve co-morbidities w/ nonsurgical methods
  • class I Obesity or >27.5 Asian American if they tried all other options and didn’t work
80
Q

why bariatric surgery in T2DM?

A

superior glycemic control and reduction in CV risk factors
reduce microvascular dz
better QOL
cost effective

81
Q

T2DM remission after bariatric surgery

A

30-60% 1-5 years
erosion of remission over time
35-50% remission pts experience recurrence
median dz free years is 8
most have improved glycemia for 5-15 years or more

82
Q

who is most likely to experience T2DM remission and reduced risk of regain following bariatric surgery?

A 
younger age
shorter duration DM (<8 years)
non-insulin user
maintained WL
better baseline BG
83
Q

mortality rate w/ bariatric surgery

A

0.1-0.5%

84
Q

LT s/s of bariatric surgery

A 
dumping syndrome
vitamin/mineral deficiencies
anemia
osteoporosis
rare- severe hypo (Roux en Y)
MH issues, alcoholism
additional surgery/revision
suicidal ideation

CDCES (13 decks)

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