Tech and Electronic Support Flashcards
4 ways to monitor glucose
Urine dipstick
Self monitored blood glucose
Continuous glucose monitoring
Flash glucose monitoring
3 pros and 3 cons to using A1C
Pros: reliable estimate of mean BG, 3 month average, indicator of complication risk
Cons: Lab test, doesn’t capture trends in variability, can be misleading
2 pros and 1 con to self monitored blood glucose
Pros: continuous real-time glucose values, easily measured at home
Con: depends on patient adherence and frequency and timing of measurement
2 pros and 3 cons to continuous glucose monitoring
Pros: continuous real-time glucose values, built in glucose alarms/alerts
Cons: complex interpretation of data, accessibility, cost
2 pros and 2 cons for flash glucose monitoring
Pros: comprehensive view of glucose patterns over past 2 weeks, visual summary
Cons: accessibility, cost
What 4 things do you need to teach patients about glucose monitoring?
How and when to perform SMBG
How to record the results
Meaning of various BG levels
How behaviour and actions affect SMBG results
5 factors that influence glycemic variability
Insulin variability Metabolic variability Meal variability Glucose monitoring variability Lifestyle and compliance
What is bad about glycemic variability?
Increase in acute phase markers, oxidative stress, endothelial dysfunction, prothrombosis
Increased risk of coronary artery diseases
Continuous glucose monitoring
Sensors monitor glucose level in the interstital fluid
The sensor stays in place for several days to a week and then must be replaced
Need to calibrate with a glucose meter
Glucose levels should be confirmed with a capillary test before making a change in treatment
Alarms can be programmed to alert when glucose levels are too low or high
Dawn phenomenon
4 counter regulatory hormones (glucagon, epi, GH, cortisol) tend to rise early in the morning
Bolus vs vasal insulin
Bolus: facilitates glucose uptake after meals
Basal: suppresses glucose production between meals and overnight
Insulin pump therapy
Rapid acting analogue insulin in a cartridge
Delivers basal and bolus insulin
Basal rates adjusted for time of day
Boluses prior to meals, adjusted according to intake and current glucose level
Insertion site changed every 2-3 days
Indications for the insulin pump
T1D mainly
Need to normalize glucose (high A1C, glucose excursions, frequent hypoglycemia, dawn phenom)
Need for flexibility (irregular schedules, exercise, children)
People who do well on the pump are mature and motivated
Insulin sensitivity factor
The estimated decrease in blood glucose by 1 unit of rapid acting insulin
Each of us has our own level of sensitivity
Hybrid closed loop system
Continuous glucose monitor that measures glucose levels for up to 7 days
Insulin pump that delivers insulin
Glucose meter used to calibrate the CGM
Monitors glucose and automatically adjusts the delivery of insulin based on interstitial glucose readings
