Diabetes
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| What impacts Fasting Blood Glucose? | 1. Hepatic glucose output
2. Basal insulin
3. Fasting glucagon
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| What impacts Postprandial Blood Glucose? | 1. Carb intake + absorption
2. Insulin release (early & late)
3. Peripheral glucose uptake
4. Incretin Effects
5. Glucagon suppression
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| What does Self Management Include? | 1. Learning about the disease
2. Defining personal goals
3. Making informed decisions about treatment
4. Developing skills (physical & behavioral)
5. Evaluating efficacy of plan toward reaching goals
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| What is the objective of DSME and unique outcome measurement? | Behavior Change
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| AADE 7 Self Care Behaviors | 1. Healthy Eating
2. Being Active
3. Monitoring
4. Taking Meds
5. Problem Solving
6. Healthy Coping
7. Reducing Risks
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| How many in the US live with Diabetes? | 29.1 million or 9.3%
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| Describe the Health Belief Model | When a person's belief about the health problem, perceived benefit of action and barriers to action, and self-efficacy explains their level of engagement or lack there of in health-promoting behaviors
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| What should be assessed when following the Health Belief Model? | 1. Patients perceived severity of condition/dx
2. Perceived susceptibility
3. Perceived benefits of action
4. Perceived cost/barriers
5. Perceived competence/ability to perform (self-efficacy)
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| Transtheoretical Model is also known as... | Stages of Change
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| What are the stages of change in the TTM | 1. Precontemplation (not ready)
2. Contemplation (getting ready)
3. Preparation (ready)
4. Action
5. Maintenance
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| When someone is not aware there may be a problem, the CDE would work on building trust/rapport and raise doubts towards the individuals current belief in this stage... | Precontemplation
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| CDE would support and encourage, assist in weighing pros/cons of action/inaction during this stage... | Contemplation
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| CDE can assist/clarify in setting small goals, identifying behaviors to change or focus on in this stage... | Preparation
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| CDE would continue assistance, support, identifying positive rewards, identify ongoing support systems/network during this stage... | Action
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| CDE will continue to affirm, support, help ID long term goals, discuss relapse or barriers that may arise and help plan for during this stage... | Maintenance
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| In this model, the HCP acts as a fascilitator | Empowerment Model
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| OARS stands for what in Motivational Interviewing | Open-ended questions
Affirmations
Reflective listening
Summary
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| The 5 A's of Self Management | 1. Assess - assess beliefs, knowledge, behavior
2. Advise- specific info on health risks & benefits of change
3. Agree - collaboratively set goals
4. Assist - ID personal barriers, strategies, problem solving techniques; support
5. Arrange - f/u
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| How is pre-diabetes diagnosed | A1c: 5.7 - 6.4 %
FPG: 101-125
75gram OGTT 2hour PP 140-199
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| Interventions for pre-diabetes include | Diet and exercise (behavior modification)
Metformin
7% loss of body weight
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| Target Lipid values for Diabetes Management | HDL: women >50 & men >40
LDL: <100 unless pre-existing CVD, then <70
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| Target Blood Pressure for Diabetes Management | < 140/90
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| Target A1c for Diabetes Management | < 7% (ADA) or < 6.5 (AACE)
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| Other diabetes management goals for care (not labs/bp) are? | ASA therapy, smoking cessation, AADE 7
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| Glycolysis | Glucose breakdown, liberating energy, producing water & CO2
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| Glycogenesis | Glucose stored in the muscle and liver as glycogen
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| Gluconeogenesis | Production of glucose from new (non-carb) sources (protein to glucose)
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| Glycogenolysis | Breakdown of glycogen with release of glucose
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| Ketogenesis | Creation of ketone bodies when lipolysis occurs
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| Lipolysis | Breakdown of fat to useable forms of energy (triglycerides and glycerol)
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| What is the calories per gram of carbohydrates, protein, fat and alcohol?? | Carbs 4cal/gr
Protein 4cal/gr
Fat 9cal/gr
Alcohol 7cal/gr
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| What is the recommended fiber intake? | 10-20 gr/day
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| What should be considered when Fasting Hyperglycemia is present? | * Hepatic glucose output
* Basal insulin insufficiency
* Fasting glucagon
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| What should be considered when postprandial hyperglycemia is present? | * Carbohydrate intake & absorption
* Insulin release/timing (early & late)
* Peripheral glucose uptake
* Incretin effects
* Glucagon suppression
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| What meds primarily are used to target FPG? | Metformin
TZD's
Sulfonylureas
Basal Insulin
GLP-1 receptor agonists
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| What meds primarily are used to target Postprandial PG | GLP-1 RA
DPP IV Inhibitors
Meglitinides
Alpha-glucosidase Inhibitors
Prandial Insulins (rapid, regular)
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