Learning Activities 1. 2. 3. How does glycemic control differ across life stages

Question

Learning Activities 1. 2. 3. How does glycemic control differ across life stages? Identify three measurements that can help a patient maintain glycemic control, How does daily self-monitoring blood glucose (SMBG) differ for various kinds of patients (e.g. patients with T1DM, pregnant women taking insulin, patients with T2DM who are taking insulin versus those not taking insulin)? 4. What kind of data should the health care team monitor in the patient with diabetes? 5. Identify the times of day for regulating blood glucose levels. 6. List the symptoms of hypoglycemia and the appropriate treatment responses 7. List the symptoms and treatment responses for diabetic ketoacidosis (DKA) 8. What types of measures contribute to maintaining optimal metabolic outcomes? 9. List the tips for maintaining glucose and insulin levels during illness 10. Suggest dietary adjustments for the patient at risk for or experiencing gastroparesis 11. Discuss blood glucose goals during pregnancy and the nutritional adjustments for meeting those goals

Explanation / Answer

Q1)  Glycemic control refers to control of levels of blood sugar (or glucose) in a person with diabetes mellitus. Carbohydrate foods are the body’s main energy source, when they are digested, they break down to form glucose in the bloodstream. If we eat meals at regular intervals the level gets maintained, as a result body's energy level also maintained ,without causing large rises in the blood sugar levels. glycemic is in control means glucose level in body is normal ( that is70–130 mg/dl).

Blood glucose levels changes with age and are usually lower in newborn babies ,than in older children and adults. When babies are just 1 hour to 2 hours old, the normal level is just under 2 mmol/L or 30 mg/dl, but it rises to adult levels (over 3 mmol/L) or 45mg/dl, within two to three days. In children at the age of 0-5 it remains in a range of 100-200 mg/dl, in the age group of 5-11 years it's range is 70-150 mg/dl , in children above 12 years it is equal to adults that is before food range is 72-108 and post food rises upto 140.

Based on the body requirement of energy for various metabolic activities the blood sugar level keeps changing in different stages of life.

Q2) Three measurements that can help a patient maintain glycemic control.

They are i)  Frequent measurements of blood glucose, and ii) measurement of glycohemoglobin (A1c).iii) Urine -blood ketone testing.

i) Frequent measurement of blood glucose level:- A diabetic patient can measure blood glucose level four times a day, that is early , morning , before foods and before bed time and ocassionally at night 2.00 am if advised by doctor, to check how the glycemic level remains at night, by seeing these measurements one can change his insulin intake, diet and exercise or life style pattern and keep the glycemic in control.

ii) Measurement of Glycohaemoglobin (A1c)-  people with diabetes go through a blood test called that is hemoglobin A1c or glycohemoglobin , it is usallly done in a laboratory, this shows patients overall blood sugar level,in a particular period of time. if blood sugar level is high during last 2-3 months the test will show high A1c level.people with type-1 diabetis requires this test in 3-4 months, that is more frequently than people with type-2 diabetis.

iii) Urine- Blood ketone testing- Ketone testing is another important test to monitor soecially in type 1 diabetic patients, in pregnancy with pre-existing diabetes, and in gestational diabetes. The presence of ketones may indicate ketoacidosis, a condition which requires immediate medical attention. Patients with type 1 diabetes should test for ketones during acute illness or stress or when blood glucose levels are usually high (that is more than 300 mg/dl, and if during pregnancy, or when any symptoms of ketoacidosis, like nausea, vomiting, or abdominal pain, are present the test should be done.

Q3) Self monitoring Blood Glucose test for patients with T1DM and Patients with T2DM who are taking insulin:-

Determination of immediate blood glucose control properly done by SMBG, because this gives timely information of hyperglycemia and hypoglycemia.so SMBG is a method to treat and avoid out-of-range glucose values.

Frequent and accurate blood glucose monitoring and associated adjustment of insulin to carbohydrate intake and exercise helps in treating Type 1 diabetes mellitus (T1DM) and in insulin-treated type 2 diabetes mellitus (T2DM).

The frequency of SMBG is linked with improved HbA1c levels in patients with T1DM. This might be due to better insulin adjustment for food consumed and an improved ability to quickly correct out-of-target glucose values. besides this ,early detection of lower glucose values before symptomatic hypoglycemia also allows correction.

SMBG during pregnancy- Self-monitoring of blood glucose (SMBG) is a major component of diabetes therapy during pregnancy and should be included in the management plan. Daily SMBG two hours after meals instead of one hourn and SMBG done before eating is the most useful parameter to determine proper insulin dose. Evaluating glycemic levels during the night is also recommended to diagnose and prevent nocturnal hypoglycemia.

Fingerstick SMBG is best in pregnancy, since alternate site testing may not identify rapid changes in glucose concentrations factors of pregnant women with diabetes. SMBG allows the patient to evaluate her response to the therapy and assess whether glycemic targets are maintained or not . Frequent sampling is best in pregnancy , because there is increase chancee of rapid occurence of hypoglycemia in the absence of food or presence of exercise, and the bad situation created by hyperglycemic response to food ingestion, psychological stress, and frequent illness. SMBG before and after meals and occasionally at nighttime is helpful to maintain the glycemic level.

SMBG in T2DM who are not taking insulin:-

The available evidence,shows that SMBG has not much clinical importance on glycemic control for type 2 diabetic patients who are not treated with insulin.

Related Questions

Navigate

• Browse (All)
• Browse L
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.