Treatment Goals + Monitoring Flashcards
Optimal treatment goals for all diabetes patients include…
Management of…
Be asymptomatic (avoid hypo/hyperglycemia)
Achieve personalized target glucose levels + address modifiable CV risk factors
Prevent/slow progression of microvascular complications
Personalized target glucose levels can be measured via…
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)
A1C is described as…
A measure of glycemic control over the previous 3 months
A1C is the % of…
How A1C works?
% 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.
Certain conditions may affect A1C, such as factors including…
RBC’s! Glucose!
Disease states involving erythropoiesis, altered hemoglobin or glycation, or erythrocyte destruction
The key A1C target to reach for most adults with T1DM or T2DM is…
A1C < 7.0%
Adults with T2DM may be warranted to reach this A1C target to reduce risk of CKD + retinopathy, if risk of hypoglycemia is low…
A1C <6.5%
Selected adults with T2DM, that may have potential for remission to normoglycemia will want to reach this A1C target…
A1C <6.0%
Minimal risk of hypoglycemic events
An A1C between 7.1-8.5% may be warranted the patient is…
Risks? Their future?
Functionally dependent
Recurrent severe hypoglycemia +/- unawareness
Limited life expectancy; frail, elderly +/- dementia
An A1C above 8.5 should be avoided, since we want to minimize…
Minimize risk of symptomatic hyperglycemia, as well as acute/chronic conditions
For most patients, achieving an A1C < 7.0% correlates to a preprandial plasma glucose of…
4.0-7.0 mmol/L
For most patients, achieving an A1C < 7.0% correlates to a 2 hour postprandial plasma glucose of…
5.0-10.0 mmol/L
If A1C < 7.0% is not achieved despite reaching adequate plasma glucose concentrations, patients should aim to meet this preprandial plasma glucose:
4.0-5.5 mmol/L
If A1C < 7.0% is not achieved despite reaching adequate plasma glucose concentrations, patients should aim to meet this 2 hour postprandial plasma glucose:
5.0-8.0 mmol/L
An A1C <7.0% was notable in multiple studies, because…
It was associated with strong risk reductions in microvascular complications, and may also provide macrovascular benefit if achieved early enough
More intensive BG lowering may not always be better due to…
Risk of severe hypoglycemia
Capillary blood glucose (CBG) is used to…
Determine glucose level in capillary blood via finger stick - tells BG level at a particular point in time
Provides immediate feedback - useful when actionable
People with diabetes will need to know the following when conducting CBG’s…
Directions? Interpretation? Trends?
HOW to perform, how often and when
Meaning of various BG levels
How behaviour and actions can affect CBG results
FPG obtained from CBG reflects glucose derived from…
Hepatic production
PPG obtained from CBG reflects how…
Meals affect glucose
CBG should be performed…
Insulin? Meals?
At least as many times as insulin is injected, and both pre + post prandial
Less intensive CBG can be done when a patient is…
Not on insulin, or condition is relatively stable
More intensive CBG is necssary when a patient is…
Not reaching targets
Intermittently scanned continuous glucose monitoring (isCGM) measures glucose levels via…
Measuring glucose levels in the SC interstitial fluid via sensor inserted into the skin
Scan using app
isCGM is applied to the back of the arm how often?
Every 14 days
isCGM involves glucose lag, which means that…
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
Real-time continuous glucose monitoring is similar to isCGM, except the following…
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
How often are glucose readings measured and stored with isCGM’s?
Measured every minute and readings are stored every 15 minutes
rtCGM sensors are replaced on the abdomen, back arm, or upper buttocks, how often?
10 days for DexCom and 7 days for Guardian
Evidence has supported beneficial effects of CGM such as…
Decreased hypoglycemia incidence, improved time-in-range, and A1C levels
Also improved QoL for many
Time in Range refers to…
The amount of time spend in the target BG range
CGM good for this because we can know glucose levels 24/7
Most PWD should aim for a TIR of…
> 70%
TIR is usually 3.9 - 10.0 mmol/L
17/24 hrs each day
70% TIR equates to about an A1C of…
7%
For older adults/people at high risk of hypoglycemia, TIR target is…
> 50%
Every 10% increase in TIR corresponds to A1C drops of…
2.4 hours/day
0.5%
Ketones are formed as a by-product, when the body’s fat stores…
Have to be accessed for energy
Urine or blood ketone testing may still be used in unique situations, such as…
Acute illness/stress
Preprandial readings >14 mmol/L
DKA symptoms present
Pregnancy
Ketones usually occur when an individual is…
Not eating enough
Going too long, or skipping meals
Not eating well/throwing up
