Targets Flashcards
When would you target 7.1- 8.5 A1C?
1- Limited life expectancy 2- Functional dependency *7.1-8 3- Frail and/or dementia 4- History of recurrent severe hypo or Hypo Unawareness 5- End of life.
How much of the A1C number is made from the last 30days of BG?
50%
How often should A1C be tested?
Every 3 months if not at goal
Every 6 months if at goal
For what three reasons or circumstances would you use SMBG. For type 2 not on insulin
Only way to confirm and treat hypo.
Can provide feedback on lifestyle or drug intervention.
Can increase patient empowerment and adherence.
***SMBG is most effective in first 6 months after diagnosis.
Which patient type would benefit from a lower than 7 A1C target?
Most D patients to reduce micro vascular and if early enough also macrovascular
What are the targets for children with type 2
A1C less than 7
What’s the targets for type 1 children age 6-12?
A1C less than 7.5.
FBG 4-10
What should a pre pregnancy target A1C be?
Less than 7
Less than 6.5 if can manage. Safely
What Is the target FBG and 1 and 2 hour PP during pregnancy?
A1C?
FBG less than 5.3
1 hrpp less than 7.8
2hrpp less than 6.7
<= 6.5 but <=6.1 if can manage safely to lower risk of still birth.
If a person has iron deficiency anemia would an A1C be falsely elevated or reduced?
Elevated. If you’d body is deficient it will hang onto whatever hemoglobin it can longer. Thus it is around longer for sugar to “stick” to it.
Could a blood transfusion falsely increase or reduce an A1C?
Could reduce if transfusion is from a non diabetic
If a D is on antiretroviral therapy, is A1C accurate?
Antiretrovirals seem to cause a macrocytosis which can cause A1C to UNDERESTIMATE hyperglycemia in HIV patients. Ie: their A1C could read normal when really it’s higher.
How does hyperbilirubinemia affect A1C?
Increases
How does hypertrigliceridemia affect A1C?
Increases
When should fructosamine testing be used instead of a1c?
Fructosamine is not affected by hemoglobin abnormalities.
What are the BG targets for before and during surgery and after surgery.
Most surgical situations 5 to 10
CABG 5.5-10
Post surgery ICU 8-10
When would you target A1C < 6.5
To reduce risk of CKD and retinopathy IF low risk of hypo
Particularly in younger and shorter duration of diabetes
How do SMBG targets change if cannot get to A1C of <7 with FBG of 4-7 and PP 5-10?
FBG 4-5.5
PPG 5-8
May be conaidered but balanced against hypo risk
When A1C values are higher, the major contribution is the ——— levels. As A1C approaches target the major contribution is from —— values.
FBG
PPG
Are A1C values higher or lower than estimated MEAN glucose.
Lower
When would it be appropriate to measure A1C MORE frequently than every 3 months.
Pregnancy
When significant changes are being made to therapy
The prior 90-120 days contributes to what percentage of the A1C value?
10%
How can a B12 deficiency affect A1C
Increased A1C
If a patient has a decrease is erythropoesis, how is A1C affected?
Falsley high
If a person uses erythropoietin or B12 or Iron. Hiw can this affect A1C?
Lower
A person with chronic liver disease can have a higher or lower A 1C?
Lower
Can you use a POC A1C to diagnose D?
No. None are approved for this.
