Targets

Question 1

When would you target 7.1- 8.5 A1C?

Answer 1

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.

Question 2

How much of the A1C number is made from the last 30days of BG?

Answer 2

50%

Question 3

How often should A1C be tested?

Answer 3

Every 3 months if not at goal

Every 6 months if at goal

Question 4

For what three reasons or circumstances would you use SMBG. For type 2 not on insulin

Answer 4

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.

Question 5

Which patient type would benefit from a lower than 7 A1C target?

Answer 5

Most D patients to reduce micro vascular and if early enough also macrovascular

Question 6

What are the targets for children with type 2

Answer 6

A1C less than 7

Question 7

What’s the targets for type 1 children age 6-12?

Answer 7

A1C less than 7.5.

FBG 4-10

Question 8

What should a pre pregnancy target A1C be?

Answer 8

Less than 7

Less than 6.5 if can manage. Safely

Question 9

What Is the target FBG and 1 and 2 hour PP during pregnancy?
A1C?

Answer 9

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.

Question 10

If a person has iron deficiency anemia would an A1C be falsely elevated or reduced?

Answer 10

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.

Question 11

Could a blood transfusion falsely increase or reduce an A1C?

Answer 11

Could reduce if transfusion is from a non diabetic

Question 12

If a D is on antiretroviral therapy, is A1C accurate?

Answer 12

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.

Question 13

How does hyperbilirubinemia affect A1C?

Answer 13

Increases

Question 14

How does hypertrigliceridemia affect A1C?

Answer 14

Increases

Question 15

When should fructosamine testing be used instead of a1c?

Answer 15

Fructosamine is not affected by hemoglobin abnormalities.

Question 16

What are the BG targets for before and during surgery and after surgery.

Answer 16

Most surgical situations 5 to 10
CABG 5.5-10
Post surgery ICU 8-10

Question 17

When would you target A1C < 6.5

Answer 17

To reduce risk of CKD and retinopathy IF low risk of hypo

Particularly in younger and shorter duration of diabetes

Question 18

How do SMBG targets change if cannot get to A1C of <7 with FBG of 4-7 and PP 5-10?

Answer 18

FBG 4-5.5
PPG 5-8
May be conaidered but balanced against hypo risk

Question 19

When A1C values are higher, the major contribution is the ——— levels. As A1C approaches target the major contribution is from —— values.

Answer 19

FBG

PPG

Question 20

Are A1C values higher or lower than estimated MEAN glucose.

Answer 20

Lower

Question 21

When would it be appropriate to measure A1C MORE frequently than every 3 months.

Answer 21

Pregnancy

When significant changes are being made to therapy

Question 22

The prior 90-120 days contributes to what percentage of the A1C value?

Answer 22

10%

Question 23

How can a B12 deficiency affect A1C

Answer 23

Increased A1C

Question 24

If a patient has a decrease is erythropoesis, how is A1C affected?

Answer 24

Falsley high

Question 25

If a person uses erythropoietin or B12 or Iron. Hiw can this affect A1C?

Answer 25

Lower

Question 26

A person with chronic liver disease can have a higher or lower A 1C?

Answer 26

Lower

Question 27

Can you use a POC A1C to diagnose D?

Answer 27

No. None are approved for this.