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Diabetes > Treatment Goals + Monitoring > Flashcards

Treatment Goals + Monitoring Flashcards

1
Q

Optimal treatment goals for all diabetes patients include…

Management of…

A

Be asymptomatic (avoid hypo/hyperglycemia)
Achieve personalized target glucose levels + address modifiable CV risk factors
Prevent/slow progression of microvascular complications

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2
Q

Personalized target glucose levels can be measured via…

A

A1C, FPG, PPG
Continuous glucose monitoring, or capillary blood glucose

As well as time in target range

Essential component of diabetes management (as well as self-management)

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3
Q

A1C is described as…

A

A measure of glycemic control over the previous 3 months

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4
Q

A1C is the % of…

How A1C works?

A

% of hemoglobin A that has been irreversibly glycosylated

Glucose attatches to RBC’s when present in high levels in the blood; more glucose = more glycated hemoglobin, higher A1C.

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5
Q

Certain conditions may affect A1C, such as factors including…

RBC’s! Glucose!

A

Disease states involving erythropoiesis, altered hemoglobin or glycation, or erythrocyte destruction

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6
Q

The key A1C target to reach for most adults with T1DM or T2DM is…

A

A1C < 7.0%

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7
Q

Adults with T2DM may be warranted to reach this A1C target to reduce risk of CKD + retinopathy, if risk of hypoglycemia is low…

A

A1C <6.5%

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8
Q

Selected adults with T2DM, that may have potential for remission to normoglycemia will want to reach this A1C target…

A

A1C <6.0%

Minimal risk of hypoglycemic events

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9
Q

An A1C between 7.1-8.5% may be warranted the patient is…

Risks? Their future?

A

Functionally dependent
Recurrent severe hypoglycemia +/- unawareness
Limited life expectancy; frail, elderly +/- dementia

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10
Q

An A1C above 8.5 should be avoided, since we want to minimize…

A

Minimize risk of symptomatic hyperglycemia, as well as acute/chronic conditions

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11
Q

For most patients, achieving an A1C < 7.0% correlates to a preprandial plasma glucose of…

A

4.0-7.0 mmol/L

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12
Q

For most patients, achieving an A1C < 7.0% correlates to a 2 hour postprandial plasma glucose of…

A

5.0-10.0 mmol/L

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13
Q

If A1C < 7.0% is not achieved despite reaching adequate plasma glucose concentrations, patients should aim to meet this preprandial plasma glucose:

A

4.0-5.5 mmol/L

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14
Q

If A1C < 7.0% is not achieved despite reaching adequate plasma glucose concentrations, patients should aim to meet this 2 hour postprandial plasma glucose:

A

5.0-8.0 mmol/L

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15
Q

An A1C <7.0% was notable in multiple studies, because…

A

It was associated with strong risk reductions in microvascular complications, and may also provide macrovascular benefit if achieved early enough

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16
Q

More intensive BG lowering may not always be better due to…

A

Risk of severe hypoglycemia

17
Q

Capillary blood glucose (CBG) is used to…

A

Determine glucose level in capillary blood via finger stick - tells BG level at a particular point in time

Provides immediate feedback - useful when actionable

18
Q

People with diabetes will need to know the following when conducting CBG’s…

Directions? Interpretation? Trends?

A

HOW to perform, how often and when
Meaning of various BG levels
How behaviour and actions can affect CBG results

19
Q

FPG obtained from CBG reflects glucose derived from…

A

Hepatic production

20
Q

PPG obtained from CBG reflects how…

A

Meals affect glucose

21
Q

CBG should be performed…

Insulin? Meals?

A

At least as many times as insulin is injected, and both pre + post prandial

22
Q

Less intensive CBG can be done when a patient is…

A

Not on insulin, or condition is relatively stable

23
Q

More intensive CBG is necssary when a patient is…

A

Not reaching targets

24
Q

Intermittently scanned continuous glucose monitoring (isCGM) measures glucose levels via…

A

Measuring glucose levels in the SC interstitial fluid via sensor inserted into the skin

Scan using app

25
Q

isCGM is applied to the back of the arm how often?

A

Every 14 days

26
Q

isCGM involves glucose lag, which means that…

A

Capillary glucose must diffuse into the interstitial fluid, which may lag behind capillary levels by 5-15 minutes

Therefore think of trend as “important message”, not point accuracy

27
Q

Real-time continuous glucose monitoring is similar to isCGM, except the following…

A

Continuous data is visible 24/7 and can be accessed in real-time.
Can also be integrated with insulin pumps

Info can be “pushed” via transmitter

28
Q

How often are glucose readings measured and stored with isCGM’s?

A

Measured every minute and readings are stored every 15 minutes

29
Q

rtCGM sensors are replaced on the abdomen, back arm, or upper buttocks, how often?

A

10 days for DexCom and 7 days for Guardian

30
Q

Evidence has supported beneficial effects of CGM such as…

A

Decreased hypoglycemia incidence, improved time-in-range, and A1C levels

Also improved QoL for many

31
Q

Time in Range refers to…

A

The amount of time spend in the target BG range

CGM good for this because we can know glucose levels 24/7

32
Q

Most PWD should aim for a TIR of…

A

> 70%

TIR is usually 3.9 - 10.0 mmol/L

17/24 hrs each day

33
Q

70% TIR equates to about an A1C of…

A

7%

34
Q

For older adults/people at high risk of hypoglycemia, TIR target is…

A

> 50%

35
Q

Every 10% increase in TIR corresponds to A1C drops of…

2.4 hours/day

A

0.5%

36
Q

Ketones are formed as a by-product, when the body’s fat stores…

A

Have to be accessed for energy

37
Q

Urine or blood ketone testing may still be used in unique situations, such as…

A

Acute illness/stress
Preprandial readings >14 mmol/L
DKA symptoms present
Pregnancy

38
Q

Ketones usually occur when an individual is…

A

Not eating enough
Going too long, or skipping meals
Not eating well/throwing up

Diabetes (5 decks)

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