6- diabetes Flashcards
The leading cause of death in patients with diabetes
cardiovascular disease- including both coronary heart disease and cerebrovascular disease
the most common cause of new cases of blindness among adults of working age
diabetes
how long does it take to get retinopathy in DM?
after 5 years:
controlled: 24%
uncontrolled: 40%
after 15 years:
DM1: almost all
DM2: 67%
what % of people with diabetes develop diabetic nephropathy
20-40%
can someone with DM2 develop DKA?
yes If the insulin deficiency is severe enough
Hyperosmolar Hyperglycemic State
acute episode for DM2
mortality- 15%
severe dehydration
Plasma glucose levels are usually >600 mg/dL.
underlying causes of HHS
most common- infection + decreased fluids
others: stroke, MI, PE
typical mortality rate for DKA
2% for patients under 65 years old,
but as high as 22% for patients over 65 years old.
typical plasma glucose level for DKA
250 mg/dL.
In the absence of the above risk factors, screening should begin at what age for DM? according to ADA
45, then every 3 years if nl
diagnosis criteria for DM
- A random glucose > 200 mg/dL plus symptoms of hyperglycemia: polyuria or unexplained weight loss, or hyperglycemic crisis.
- A fasting plasma glucose > 126 mg/dL.
- HgBA1C >6.5%.
- Oral Glucose Tolerance Test (OGTT) is more sensitive and a little more specific than a fasting glucose, but it is difficult to do and poorly reproducible, so it is not recommended for routine clinical use.
findings on fundoscopic exam in severe, non-proliferative retinopathy
- Retinal hemorrhages
- Cotton wool spots
- Microaneurysms
- Neovascularization
- Retinal hemorrhages
are dark blots with indistinct borders that indicate partial obstruction and infarction.
Cotton wool spots
are white spots with fuzzy borders and they indicate areas of previous infarction. They accompany hemorrhages.
Microaneurysms
are more punctate dark lesions that indicate vascular dilatation.
how often should diabetics get foot exam
annual
foot exam in diabetics entails
- testing for loss of protective sensation
- vibration using 128-Hz tuning fork
- pinprick sensation
- ankle reflexes (Achilles necessary, but patellar not needed) - Assessment of pedal pulses (dorsalis pedis and posterior tibial arteries
- inspection- breaks in the skin, pressure calluses that precede ulceration, existing ulceration and infection, and bony abnormalities
Recommended Diabetes Follow-Up Laboratory Studies
A. Hemoglobin A1c
C. Spot urine albumin/creatinine ratio
E. Serum creatinine and calculated GFR
F. Serum B12 levels (metformin s/e, neuropathy r/o)
G. Thyroid-stimulating hormone (TSH)
H. Fasting lipid profile (total cholesterol, LDL- and HDL-cholesterol and triglycerides)
when should you measure HgbA1c
initial A1C testing at diagnosis,
follow-up testing at least two times a year in patients who are stable and meeting goal of A1C < 7;
quarterly when therapy is changing or they are not meeting goal.
which HTN medication should be started for diabetic preferentially?
ACEI or ARB
when should a diabetic get a moderate-intensity statin?
patients 40-75 yrs old with LDL-c >70 mg/dl
when should a diabetic get a high-intensity statin?
patients 40-75 yrs old with LDL-c >70 mg/dL and ≥ 7.5% estimated 10-year ASCVD risk
Consider aspirin therapy (75-162 mg/day) as a primary prevention strategy when…
those with type 1 or type 2 diabetes who are at increased cardiovascular risk (10-year risk >10%).
This includes most men or women with diabetes aged ≥50 years who have at least one additional major risk factor
if aspirin allergy, what should you use?
clopidogrel
