Case 6 - 57 yo with diabetes Flashcards

1
Q

Diagnosing diabetes

A
  • HBA1c>6.5%
  • fasting plasma >126
  • random glucose >200
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2
Q

Diabetes screening recommendations

A
  • american diabetes recommendatoin: obese or overweight adults with additional risk factor
  • in absence of risk factors, start at age 45
  • USPTF - screen in asx adults with bp greater than 135/80
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3
Q

End organ manifestations of disease

A
  • cardiovascular disease - risk for MI
  • retinopathy and blindness
  • glaucoma
  • neuropathy
  • nephropathy
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4
Q

Familismo

A

Family viewed as primary source of support

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5
Q

Respeto/simpatia

A

Special respect should be shown to elders and authority figures

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6
Q

Personalismo

A

Hispanic patients value warm friendly relationships over impersonal or institutional formality

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7
Q

Fatalismo

A

Holding belief that control of disease is external to self

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8
Q

Diabetes medical history

A

age of onset, characterisitics of onset, previous treatment, current treatment, microvascular complications, macrovascular complications

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9
Q

Diabetic physical exam

A
  • eye examination
  • thyroid
  • heart
  • skin - acanthosis nigricans
  • comprehensive foot examination
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10
Q

Diabetes studies

A
  • HbA1c - measures glycosylated hemoglobin, shows glucose levels over the last 1-3 months
  • EKG
  • Spot urine:creatinine to test for microalbuminuria
  • B12 (could cause neuropathy)
  • TSH
  • fasting lipid profile
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11
Q

Management of diabetes

A

Step 1: lifestyle changes + metformin
Stage 2: add a sulfonylurea or basal insulin
Stage 3: Reassessment, add additional management if needed

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12
Q

Glycemic control

A
  • goal is <7% a1c
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13
Q

Barriers for insulin treatment

A
  • patients afraid of needles
  • patients have perception that insulin causes side effects that are in fact caused by co-morbidities of diabetes
  • physicians are reluctant due to lack of support staff
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14
Q

Eye care

A
  • Eye exam should be done every year
  • Type 1 Diabetics should start 5 years after diagnosis
  • Type 2 Diabetics should start as soon as they are diagnose (20% have retinopathy at diagnosis)
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