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DIAGNOSTIC TEST
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Blood Test
is the main diagnostic test for diabeticpatient. It measures the glucose in theblood.
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Types of Tests to Diagnose Diabetes
(FBG) Fasting Blood Glucose Test
(HBA1C) / Glycosylated hemoglobin
(RBGT) Random Blood Glucose Test
(OGTT) Oral Glucose Tolerance Test
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Types of Tests to Diagnose
Diabetes (FBG) Fasting Blood Glucose Test
(HBA1C) / Glycosylated hemoglobin (RBGT) Random Blood Glucose Test
(OGTT) Oral Glucose Tolerance Test
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(FBG) Fasting Blood Glucose
Test blood glucose levels are checked afterfasting for between 12 and 14 hours. Youcan drink water during this time, but shouldstrictly avoid any other beverage. Patientswith diabetes may be asked to delay theirdiabetes medication or insulin dose until the
test is completed.
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The fasting blood glucose test will confirm thatthe person has diabetes if it shows that thelevel of glucose in their blood is higher thannormal when they are fasting.
Sometimes the test result of the fasting bloodglucose test is borderline. If this is the case,
an oral glucose tolerance test may beperformed.
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Normal values: 70-110 mg/dl some books 80-120 mg/dl
More than 126ml/dl = DM mgt.
111-125 mg/dl = borderline close monitoring 60-69 mg/dl = borderline
Less than 60 mg/dl = hypoglycemia
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(HBA1C) / Glycosylated
hemoglobin
To check how well an individual controls ormanage the glucose levels for at least 3-4months/ (120 days)
Values:
7.5% & below = good management 9% & above = poor management
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(RBGT) Random Blood Glucose
Test
blood glucose levels are checked at varioustimes during the day, and it doesnt matterwhen you last ate. Blood glucose levels tendto stay constant in a person who doesnt havediabetes.
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(OGTT) Oral Glucose Tolerance
Test
a high-glucose drink is given. Blood samplesare checked at regular intervals for twohours.
This test will confirm diabetes if the personsblood sugar levels stay high for a long timeafter the tests. For a person doesnt have
diabetes, the result will show that their bloodsugar levels fall within the normal range.
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The WHO recommendation is for a 75g oraldose in all adults: the dose is adjusted forweight only in children.The dose should bedrunk within 5 minutes.
Blood sample checked at intervals for twohours.
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Accuracy of Test ResultsDepending on the test used, the level of blood
glucose can be affected by many factorsincluding:
Eating or drinking
Medications
Physical illness or surgery that maytemporarily alter blood sugar levels.
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MANAGEMENT
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Management concentrates on keeping bothshort-term and long-term blood glucose levelswithin acceptable bounds ("euglycemia"). Thiscan usually be accomplished with:
Diet & Exercise Medications
Insulin
Surgery
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Diet & Exercise Modifying eating habits and increasing physical
activity are typically the first steps towardreducing blood sugar levels. Achieving nutrition-
related goals requires a coordinated team effortthat includes the person with diabetes.
However, it is essential that all team membersare knowledgeable about nutrition therapy and
are supportive of the person with diabetes whoneeds to make lifestyle changes.
Avoid: high sugar, high CHO, high FATS
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Medications Pharmacological treatment is indicated if
there is an inadequate response to lifestylemodifications and improved glucose control.The first priority of pharmacological therapyis to lower LDL cholesterol to a target goal of
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Oral Diabetes Medication The medications work in several different
ways. These include improve theeffectiveness of the body's natural insulin,reduce blood sugar production, increaseinsulin production and inhibit blood sugarabsorption. Oral diabetes medications are
sometimes taken in combination with insulin.
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Statin - it is the drug of choice in lowering LDL. Itraises HDL modestly, but a greater increase is
usually achieved with fibrates.
Fibrates are used for a range
of metabolic disorders,mainly hypercholesterolemia (high cholesterol) andare therefore hypolipidemic agents.
Metformin - is generally recommended as a first
line treatment for type 2 diabetes, as there is good
evidence that it decreases mortality. .
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Surgery Pancreas Transplants - have been tried with
limited success in type 1 DM
Gastric Bypass - has been successful in manywith morbid obesity and type 2 DM.
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Insulin Rapid-acting insulin
Begins to work about 5 minutes after
injection, peaks in about 1 hour, andcontinues to work for 2 to 4 hours.
Ex:
Insulin lispro (Eli Lilly),
Insulin aspart (Novo Nordisk)
Insulin glulisine (sanofi-aventis)
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Regular or Short-acting insulin
Usually reaches the bloodstream within 30
minutes after injection, peaks anywhere from2 to 3 hours after injection, and is effective forapproximately 3 to 6 hours.
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Intermediate-acting insulin
Generally reaches the bloodstream about 2 to
4 hours after injection, peaks 4 to 12 hourslater, and is effective for about 12 to 18 hours.
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Long-acting insulin (ultralente)
Reaches the bloodstream 6 to 10 hours after
injection and is usually effective for 20 to 24hours.
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Premixed insulin can be helpful for peoplewho have trouble drawing up insulin out oftwo bottles and reading the correct directionsand dosages. It is also useful for those whohave poor eyesight or dexterity and isconvenient for people whose diabetes has
been stabilized on this combination.
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Characteristics of Insulin Onset is the length of time before insulin
reaches the bloodstream and begins loweringblood glucose.
Peaktime is the time during which insulin is atmaximum strength in terms of lowering bloodglucose.
Duration is how long insulin continues to lowerblood glucose.
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Notes
Regular- clear NPH- cloudy
Steps: air NR withdraw RN
Route: subcutaneous = 45 degrees
Sites: arms, thigh, mostly abdomen Systematic rotation, use 1-1/2 inches
spacing
Can inject again after 2-3 weeks
No to massage, and shakes
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