Diabetes Self-Care

True or False: you should not promote the use of micronutrient, herbal, and other supplements to aid in glycemic management

true

What type of cinnamon is commonly sold in north America to be used?

cassia

What is the MOA of cassia cinnamon?

polyphenolic polymers such as hydroxychalcone found in cassia cinnamon seems to potentiate insulin action

True or False: cinnamon increases insulin sensitivity by increasing phosphorylation of the insulin receptor

true

True or False: cinnamon lowers baseline glucose levels

false

What were the significant results from the cassia cinnamon meta-analysis?

FBG decreased by ~ 17 mg/dL

A1C decreased by 0.5%

no significant effects on insulin levels

What cinnamon dosage was used in the trials?

500 mg cinnamon extract 3x/day for 12 weeks

What were the results of the trials regarding aloe vera?

showed a marginal improvement FPG and a significant reduction in A1C

What were the results of the meta-analysis on megnesium?

higher magnesium intake was associated with a 22% reduction in the risk of developing T2DM

What is the MOA of chromium picolinate?

reduces fat cravings, food intake and hunger; affects the brain’s hunger receptors, sensitizes insulin-sensitive gluco-receptors in the brain

True or False: a systematic review concluded the evidence was insufficient to recommend chromium for DM management

true

What are probiotics?

live microorganisms, typically bacteria; found naturally in fermented foods such as yogurt, kimchi, and sauerkraut

What results came from the meta-analysis regarding probiotics?

significant decrease in FPG and A1C

but need mutiple strains for > 8 weeks

What products should be suggested to diabetics to use for cold and cough?

if possible, sugar free products

True or False: use of non-diabetic products for 5-6 days in patients with controlled blood glucose is okay

true

What medication is recommended for diabetics with a cough?

dextromethorphan

What is recommended for diabetics with a cold?

neti pot or saline nasal sprays

What is recommended for diabetics with a sore throat?

sugar free cough drops, APAP, numbing sprays/lozenges

What ate exclusions to self-care, specific to diabetes?

diabetic foot ulcer, fungal skin infections, urinary incontinence, vulvovaginal disorders, warts

What is the FDA accuracy requirement for blood glucose monitors?

15-20%

What is electrochemical meter technology?

measures current through a small portion of the entire sample; only a small sample is needed

What is coulometric meter technology?

measures the total electrical charge over the entire sample; time to get reading is related to amount of sugar in the sample; requires VERY SMALL amount of blood

Which meter technology system is more accurate?

coulometric

What are the different types of test strips?

glucose oxidase, glucose dehydrogenase, and hexokinase

What is a glucose oxidase test strip?

very specific to glucose; strips will expire; sensitive to heat/light; overestimate at high altitude/low temp

What is a glucose dehydrogenase test strip?

not as specific to glucose (also reads sorbitol, mannitol)

What is a hexokinase test strip?

very unstable; individually packaged; good specificity for glucose

What meters use glucose oxidase?

onetouch, accuchek

What meters use glucose dehydrogenase?

freestyle, bayer contour

What meters use hexokinase?

older accu-check, not used often

What environmental factors affect accuracy of glucose meters?

temperature, light, humidity, altitude

What operational factors affect accuracy of glucose meters?

volume of blood sample, re-using test strips

What physiological factors affect accuracy of glucose meters?

pH, prandial state, hematocrit level, pre/post exercise

What drugs can affect accuracy of glucose meters?

acetaminophen, vitamin C, mannitol, maltose, dopamine, ascorbate

What effects will acetaminophen have on glucose values?

falsely higher blood glucose values at low blood glucose levels

What effects will dopamine have on glucose values?

falsely higher blood glucose values at low blood glucose levels

What effects will furosemide have on glucose values?

falsely lower blood glucose values

What are the broaddd steps of meter training?

1. explain new parts

2. set up lancet device

3. set up glucometer

4. control solution

5. perform the test & get result

6. disposal of strips and lancets

What is MARD?

mean absolute relative difference

What is a CGM?

continuous glucose monitoring

Which CGM has the lowest MARD?

Libre 3

Which CGM has the highest MARD?

Libre 2

What are the different types of freestyle Libre devices?

Libre 2, Libre 2 plus, Libre 3, Libre 3 plus, Lingo

What is the senor duration for Libre sensors?

12 days (Lingo), 14 days (2,3), 15 days (2 plus, 3 plus)

How often are freestyle libres measuring glucose?

every minute, but stores in 15 min intervals

Will freestyle libre sensor readings match a fingerstick reading?

NO

What kind of technology does the freestyle libre use?

coulometric

True or False: an advantage of using freestyle libres is that there is no acetaminophen interference

true

Do freestyle libres require calibration?

no

True or False: Freestyle Libres can not be worn during an MRI, CT scan, x-ray, or diathermy treatment

false

Where must freestyle libre sensors be worn?

upper back of the arm

What CGM is available as an OTC device without a prescription?

Dexcom stelo

What is Dexcom stelo approved for?

adults not on insulin

T2DM or prediabetes and are not at risk for hypoglycemia

those interested in tracking their glucose

What are the outcomes related to dexcom stelo?

reduction A1C

users spend more time in range and more time in tight range

improvement in glucose and CV risk reduction measures

What is a potential disadvantage of Freestyle libres?

cost and coverage

What are the advantages of the Dexcom stelo?

easy to use, affordable, no Rx required, tracks glucose spikes

What are the disadvantages of the Dexcom stelo?

no low blood sugar alerts, limited app features, cant view long term data, not covered by insurance

What results were concluded from the impact trial?

enrolled T1DM on MDI, reduced time spent in hypoglycemia; no impact on A1C

What results were concluded from the replace trial?

enrolled T2DM on MDI, reduced time spent in hypoglycemia; no impact on A1C

Do you know how to read an AGP report?

of courseeee