Assessing Blood
Glucose, Blood Lipid, and Blood Preassure Control
Using assessment levels
to set targets
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| Use the assessment levels
for glucose, lipids, and blood pressure : |
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as an integral part of diabetes care - do not manage diabetes on symptoms alone |
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to indicate need for further intervention |
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as the basis for short-term and longer-term individualized targets |
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as an educational tool to help the person with diabetes |
Ask yourself the following at consultations : |
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Is it possible for the individual to approach each target more closely, without a counter-balancing deterioration in quality of
life? |
Be concerned about targets : |
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Failure to attempt to reach agreed targets is inadequate care, unless this would lead to deterioration in quality of life |
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Assessment
of blood glucose, blood lipid, and blood preassure control
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| Measure : |
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glycated haemoglobin 2-6 monthly |
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the blood lipid profile ( total, LDL, and HDL cholesterol, and triglycerides ) 2-6 monthly if previously above assessment levels ( see next page ), otherwise annually |
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blood pressure at each consultation unless known to be below assessment levels |
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Use the assessment levels ( next page ) to set individual blood glucose, blood lipid and blood pressure targets, depending on overall risk and what it may be possible to achieve within a foreseeable time period |
Modify individual targets at least yearly in the light of past success, and if any change in clinical circumstances |
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Blood glucose control assessment levels
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Low
risk |
Arterial risk |
Microcascular
risk |
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HbA1c (DCCT standardized) |
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%Hb |
<=6.5 |
>6.5 |
>7.5 |
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Venous plasma glucose |
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Fasting /
pre-prandial |
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mmol/l |
<=6.0 |
>6.0 |
>=7.0 |
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mg/dl |
<110 |
>=110 |
>125 |
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Self-monitored blood glucose |
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Fasting /
pre-prandial |
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mmol/l |
<=5.5 |
>5.5 |
>6.0 |
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mg/dl |
<100 |
>=100 |
>=110 |
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Post-prandial
(peak) |
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mmol/l |
<7.5 |
>=7.5 |
>9.0 |
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mg/dl |
<135 |
>=135 |
>160 |
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Fasting capillary blood glucose is around 1.0 mmol/l (18 mg/dl) lower than venous plasma;
post-prandial capillary blood glucose is the same as venous plasma
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Blood
lipid control assessment levels
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Low
risk |
At risk |
High
risk |
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Serum total cholesterol |
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mmol/l |
<4.8 |
4.8-6.0 |
>6.5 |
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mg/dl |
<185 |
185-230 |
>230 |
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Serum LDL cholesterol |
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mmol/l |
<3.0 |
3.0-4.0 |
>4.0 |
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mg/dl |
<115 |
115-155 |
>155 |
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Serum HDL cholesterol |
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mmol/l |
>1.2 |
1.0-1.2 |
>1.0 |
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mg/dl |
>46 |
39-46 |
>39 |
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Serum triglycerides |
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mmol/l |
<1.7 |
1.7-2.2 |
>2.2 |
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mg/dl |
<150 |
150-200 |
>200 |
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Blood
pressure control assessment levels
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| Low risk ( mmHg ) |
<141/85 |
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