What is Cystic Fibrosis Related Diabetes (CFRD)?
Cystic Fibrosis Related Diabetes (CFRD) occurs when your body does not use insulin properly. Normally, food is broken into sugar, fat, and protein. As sugar enters your blood it signals the pancreas to release insulin to help cells get energy. People with diabetes either do not have enough insulin (Type 1) or do not respond appropriately to insulin (Type 2), which means that food is not converted into energy. CFRD, which has characteristics of both types, can be a problem all the time or only when patients are sick. Diabetes treatments try to keep blood sugar levels as close to normal as possible. Screening for CFRD
The Cystic Fibrosis Foundation recommends that fasting blood glucose levels be tested each year. During a hospitalization, glucose levels should be measured during fasting and after eating. An oral glucose tolerance test (OGTT) measures blood glucose before and two hours after drinking a very concentrated glucose drink. This test divides patients into four categories: normal glucose tolerance (NGT), impaired glucose tolerance (IGT), diabetes where the blood sugar is normal first thing in the morning but gets high after eating, and diabetes where the blood sugar is always high, even without eating. Patients over 13 years old should have an OGTT each year. Symptoms of CFRD Include:
• Fatigue
• Weight loss
• Increased thirst
• Increased urination
• Unexplained worsening of pulmonary function Contact your CF team if you experience any of these symptoms. Diagnosis of CFRD
Diagnosis of CFRD can be done with a variety of tests: fasting blood sugar, casual (anytime) blood sugar, or an oral glucose tolerance test. The criteria used to diagnose CFRD are the same as for all forms of diabetes:
Diagnosing CFRD
• Casual glucose level
• Two hour plasma glucose
• Fasting (in morning before eating)
• Fasting plus a casual glucose level Treatment for CFRD
Monitoring Blood Sugars
Once CFRD is diagnosed, blood glucose levels should be monitored closely. A glucometer can measure blood sugar with a prick to the finger or arm. Blood sugar should be checked before and after meals to ensure you have enough insulin. An endocrinologist and CF team will help you decide how often to check your blood sugar (see suggested blood sugar goals below).
| Age (Years) | Before Eating | Bedtime | | (no food for 2hours) | (before bedtime snack) | | mg/dL | mg/dL | | 5 -12 | 80 -120 | 100 -160 | | 12 and up | 80 - 120 | 100 - 160 |
Medications
Insulin
Insulin is the main therapy for lowering blood sugar levels. Your body needs a balance of food and insulin, which can be taken through an injection or pump, to work properly. Your endocrinologist and CF team will help you decide which combination works best for you. Oral Hypoglycemic Agents
The pills used to treat type-2 diabetes have not been well-researched in treating CFRD. They are not recommended for CF patients, but this may change as more research is done. Other tests
Hemoglobin A1c
This blood test gives doctors an idea of blood sugar levels during the last three months, which should have a value of less than 7 percent. This helps the endocrinologist and CF team decide if the treatment plan is working.
Urine Microalbumin
This test looks for small amount of protein in the urine and determines how well your kidneys are functioning.
Nutrition
A healthy diet and determining your correct amount of daily insulin are very important in managing CFRD. Avoid sodas as theyre high in sugar and have little nutritional value. Your nutritionist can teach you how to count carbohydrates. Managing Cystic Fibrosis Related Diabetes, a book offered by the CF Foundation, covers CFRD nutrition, low blood sugars, sick days and exercise. Contact your local CF care center or e-mail info@cff.org to request a copy.
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