Diabetes Monitoring

Question 1

Why monitor?

Answer 1

Understand nature of disease
Optimum timing for initiating therapeutic intervention
Adjustment of treatment

Question 2

What are the 3 targets?

Answer 2

HbA1c
BP
Lipids

Question 3

What are the 8 core care processes?

Answer 3

HbA1c
Lipids
BMI
BP
Smoking status
Foot examination
Albumin = creatine ratio
Serum creatinine

Question 4

How often should you get your HbA1c (blood glucose) checked?

Answer 4

Annually

Question 5

How often should you get your BP checked?

Answer 5

Annually

Question 6

How often should you get your cholesterol checked?

Answer 6

Annually

Question 7

How often should you get retinal screening?

Answer 7

Annually

Question 8

How often should you get foot examinations?

Answer 8

Annually

Question 9

How often should get your weight checked?

Answer 9

Patient should be encouraged often at home
BUT annually

Question 10

What is HbA1c?
(Glycosylated haemoglobin)

Answer 10

3 month indication of how diabetes is going
= 50% from last month
= 25% month before
= 25% month before that

Question 11

When can HbA1c be inaccurate?

Answer 11

Those with haemolytic diseases
eg. sickle cell, possible anaemia/blood loss

Question 12

When to self monitor blood glucose?

Answer 12

Fasting
Pre-prandial (before meal)
Post-prandial (after meal)

Question 13

Who should monitor urine ketones?

Answer 13

T1DM

Question 14

What is the target for BP?

Answer 14

130/80mmHg if signs of retinopathy, neuropathy or nephropathy
IF NO SIGNS = 140/80mmHg

Question 15

What is the target for lipids?

Answer 15

LDL <2.0 mmol/L
TC <4.0 mmol/L
Triglycerides <1.7 mmol/L
HDL >1.0mmol/L (men)
>1.3 mmol/L (women)

Question 16

What monitoring should be done associated with drug therapy?

Answer 16

LFTs
U+Es
FBC
Amylase
Lactate

Question 17

What is problem with smoking?

Answer 17

More likely to develop diabetes
Worsen peripheral vascular disease, CKD, retinopathy + neuropathies
Make diabetes hard to control
Increase CVD risk

Question 18

What are the steps to towards healthy feet?

Answer 18

Annual foot review
Check feet every day - any changes in shape?
Aware of any losses in sensation (don’t go barefoot/extreme temperatures)
Touch toes test (ask family member to feel)
Look after toe nails (don’t cut down sides = ingrown)
Avoid using corn removing blades
Wear well-fitting shoes
Maintain good glucose control

Question 19

What is a good range for eGFR?

Answer 19

> 90
60-89 also good
BUT any below = NOT good

Question 20

What is a good range for ACR?

Answer 20

<3

Question 21

What is the HbAc1 target for no glucose lowering medication?

Answer 21

48mmol/mol

Question 22

What is the HbAc1 target for single glucose lowering medication - low hypoglycaemic risk?

Answer 22

48mmol/mol

Question 23

What is the HbAc1 target for single glucose lowering medication - high hypoglycaemic risk?

Answer 23

53mmol/mol

Question 24

What is the HbAc1 target for more than one glucose lowering agent?

Answer 24

53mmol/mol

Question 25

What is the blood glucose monitoring for T1DM?

Answer 25

Test at least 4x/day

Question 26

When should T1DM check glucose for up to 10 times?

Answer 26

Increase hypoglycaemia Legal requirement (DVLA) Illness Before, during + after sport Pregnancy planning Impaired hypo awareness

Question 27

What is the blood glucose monitoring for T2DM?

Answer 27

Only self-monitoring if on insulin/evidence of hypoglycaemic episodes

Question 28

When should you only consider short term self-monitoring for T2DM?

Answer 28

Starting treatment with oral/IV corticosteroids

Question 29

If a T2DM patient is carrying out self-monitoring what should be done?

Answer 29

Structured assessment: - monitoring skills - quality + frequency of testing - knows how to interpret results - impact on QoL - continued benefit - equipment used

Question 30

What should happen with driving?

Answer 30

Bring treats Don't delay meals Take breaks Check blood sugars 5mmol/L = okay

Question 31

What happens if you're below target? Driving (>4mmol/L)

Answer 31

Pull over Switch off engine Take fast-acting carbs Don't drive until 45mins in range

Question 32

Who is ketone testing for?

Answer 32

T1DM

Question 33

What is CGM?

Answer 33

Continuous glucose monitoring

Question 34

Who is offered CGM?

Answer 34

T1DM

Question 35

What do you offer to T2DM patients on multiple daily insulin injections?

Answer 35

Intermittently scanned continuous glucose monitoring (isCGM) Real time continuous glucose monitoring (rtCGM)

Question 36

What is time in range (TIR)?

Answer 36

% of time that a person spends with their blood glucose levels in target range

Question 37

Describe a closed loop insulin delivery system

Answer 37

Sensor under skin automatically measures blood glucose Readings sent to pump that calculates amount of insulin required Can monitor on phones