Aquifer Case 6: Diabetes Flashcards
what are the common manifestations of end organ damage caused by DMII?
- cerebrovascular disease
- coronary heart disease
- nephropathy
- neuropathy
- retinopathy
what are the main characteristics of HHS?
- dehydration
- ketones are absent/mildly elevated
- plasma glucose is 600+
- no metabolic acidosis
- 15% mortality rate
what is the main characteristic of DKA?
- 2% mortality under 65 but as high as 22% for those 65+
- metabolic gap acidosis
- glucose usually around 250
- ketosis
what is the LEARN model to understanding a patient’s experience of their illness?
Listen to your patients perception
Explain your perception of the problem
Acknowledge differences and similarities between these perceptions
Recommend treatment; keep patient’s beliefs in mind
Negotiate an agreement
who should be screened for DMII?
overweight or obese adults who have 1+ risk factors:
- first degree relative with DM
- high risk race = AA, latino, NA, asian, Pacific Islander
- history of CVD
- HTN
- HDL <35 and/or TG >250
- PCOS
- physical inactivity
patients with prediabetes (A1C > 5.7) should be tested yearly
women with GDM should have testing every 3 years
for everyone else, testing should start at 45 and repeat every 3 years
what is the diagnostic criteria for DMII?
- random glucose 200+ with symptoms of hyperglycemia like polyuria or unexplained weight loss
- fasting glucose 126+
- A1C > 6.5%
- 2 hr plasma glucose 200+ during an oral glucose tolerance test
diagnosis requires 2 abnormal test results from the same sample or in two separate test samples
which ethnicities are at higher risk for DMII?
- hispanics
- african americans
- asian americans
- native americans
what is the definition of prediabetes?
impaired fasting glucose = 100-125 mg/dl
impaired glucose tolerance = 2 hr oral glucose 140-199 mg/dl
what is the most frequent cause of new blindness in adults?
diabetic retinopathy
laser photocoagulation treatment can slow the progression but it doesn’t restore lost vision
what are the findings of diabetic retinopathy on fundoycopic exam?
- retinal hemorrhages
- cotton wool spots
- micro aneurysms
what are the parts of a diabetic foot exam?
- asses skin for color and temperature change, hair loss and scaling
- elicit Achilles reflex
- evaluate feet for sensation to touch and vibration
- inspect feet for abrasions, callus formation, ulceration and infection
- inspect feet for bony abnormalities
- palpate dorsalis pedis and posterior tibial pulses
which lab tests do you order at DMII followup visit?
- fasting lipid
- A1C
- serum B12
- serum creatinine and GFR
- spot urine albumin/creatinine ratio
which interventions improve CVD outcomes in patients with DMII?
- adding high intensity statin for patients 40-70 years old with LDL-c >70 and >7.5% estimated 10 year ASCVD risk
- adding a moderate intensity statin for patients 40-75 years old with LDL-c > 70
- lowering BP in patients with BP > 140/90
- treating dyslipidemia through lifestyle modification: diet and exercise
- using aspirin as secondary prevention in DMII patients with a history of CVD
what medications do you add to metformin if the patient has ASCVD?
GLP-1 receptor agonist or SGLT2 inhibitor
what medications do you add to metformin if the patient has HF or CKD?
SGLT2 inhibitors
