Diabetic Self-Care

what compound is found in cassia cinnamon that seems to potentiate insulin action

polyphenolic polymers such as hydroxychalcone

what did animal studies show for cassia cinnamon?

stimulates a baseline insulin release, doesn’t seem to lower baseline glucose levels, has greater insulin stimulating effect than Ceylon cinnamon

how can aloe vera effect pre-diabetes?

significantly improved FPG levels

how can aloe vera effect T2DM?

showed a marginal improvement in FPG and a significant reduction in HbA1c

magnesium effect on diabetes

higher magnesium intake was associated with a 22% reduction in the risk of developing T2DM, every 100 mg/day increase in magnesium intake there was a 14% decrease in diabetes risk, oral magnesium resulted in modest improvements in FPG and HbA1c levels

MOA of chromium picolinate

works by reducing fat cravings, food intake and hunger

chromium picolinate effects in diabetes

inconsistent effects on glucose metabolism

T/F: probiotics are indicated for diabetics

true

what can diabetics use for a cough?

dextromethorphan (sugar free if possible), guaifenesin is not as good as water for loosening mucus

what should diabetics use for a stuffy nose?

neti pot or saline nasal sprays

what should diabetics use for sore throats?

sugar free cough drops, APAP, numbing sprays/lozenges

diabetic exclusions to self-care:

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

how accurate do BGMs have to be as required by the FDA?

15-20% above or below actual reading

what is electrochemical meter technology?

measures current; only a small sample needed; a current runs through a small portion of the entire sample and reads sugar concentration

what is coulometric meter technology?

measures the total electrical charge over the entire sample, the time to get a reading is related to how much sugar is in the sample, requires very small amounts of blood, a more accurate system

which meters use glucose oxidase?

OneTouch, Accu-Chek

facts regarding glucose oxidase test strips:

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

which meters use glucose dehydrogenase?

Freestyle, Bayer Contour

facts regarding glucose dehydrogenase

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

which meters use hexokinase

older Accu-Chek meters - not really used!

facts regarding hexokinase

very unstable, individually packaged, good specificity for glucose

environmental factors that affect BGM accuracy:

temp, light, humidity, altitude

operational factors that affect BGM accuracy:

volume of blood sample, re-using test strips

physiological factors that affect BGM accuracy:

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

drugs that affect BGM accuracy:

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

which substances/conditions cause falsely higher blood glucose values?

maltose, galactose, xylose, N-acetylcysteine, low hematocrit

which substances/conditions cause falsely lower blood glucose values?

furosemide, high hematocrit

which substances/conditions cause falsely higher blood glucose values at low blood glucose levels?

APAP, dopamine

which substances/conditions cause falsely higher blood glucose values at very low or very high glucose levels?

uric acid

which substances/conditions cause falsely lower or higher blood glucose values?

vitamin C

examples of OTC biosensers

Freestyle Lingo and Dexcom Stelo

Rx CGM examples:

Freestyle Libre, Dexcom G6, Dexcom G7, Medtronic Guardian, Senseonics Eversense

what value is used to determine/rate CGM accuracy and precision?

MARD (Mean Absolute Relative Difference)

which CGM has the best accuracy and precision?

LIbre3

which libre sensors are worn for 14 days?

Libre 2, Libre 3

which Libre sensors are worn for 15 days?

Libre 2Plus and Libre 3Plus

which Libre Sensors are worn for 12 days?

Lingo

age indication for Libre 2

4+

age indication for Libre 2Plus

2+

age indication for Libre 3

4+

age indication for Libre 3Plus

2+

age indication for Libre Lingo

18+

how and where do the Freestyle Libre detect glucose levels?

using enzyme glucose (glucose oxidase) sensing technology of interstitial fluid

uses coulometric technology

advantages of Libre sensors:

available at retail pharmacies, cost, no APAP interference, does not require calibration, sensor is small and discreet, some can be worn for 15 days, has alarms for low or high levels, can remain in place during MRI/CT/X-ray/diathermy treatment

disadvantages of Libre sensors

potentially cost and coverage, must be worn on the upper back of the arm, ascorbic acid daily doses >/= 1000 mg and salicylic acid doses >/= 650 mg daily may decrease sensor readings

when is Libre covered by Medicare

if patient uses basal insulin or has history of severe hypoglycemia - cost should be no more than $75/month

cost of Libre Lingo:

$89/month

facts regarding Dexcom Stelo:

OTC device approved for use in adults 18+ not on insulin, T2DM or prediabetes and are not at risk for hypoglycemia, those interested in tracking their glucose

advantages of Dexcom Stelo

easy to use, affordable, no prescription required, track glucose spikes

disadvantages of Dexcom Stelo

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

which systems are affected by >4 g/day of acetaminophen?

Dexcom G6/G7

which systems are affected by any dose of APAP?

Medtronic, Guardian

which systems are affected by ascorbic acid dosing of > 500 mg/day

Freestyle Libre 14-day, Freestyle Libre 2, and Freestyle Libre 3

which systems are affected by ascorbic acid dosing of > 1000 mg/day

Freestyle Libre 2Plus, Freestyle Libre 3Plus

which systems are affected by hydroxyurea?

Dexcom G6/G7, Medtronic Guardian

which systems are affected by mannitol (IV or as peritoneal dialysis soln)?

Senseonics Eversense

which systems are affected by sorbitol (IV or as peritoneal dialysis soln)?

Senseonics Eversense