Cases 6-10 Flashcards
Name 4 common end-organ damage manifestations caused by DM
- Cardiovascular disease
- Retinopathy
- neuropathy (defined by a decrease in ankle jerk reflex)
- nephropathy (DM is #1 cause of kidney failure)
which type of DM does DKA typically occur?
type 1
which type of DM does HHS typically occur
DM 2
At what age should someone without risk factors be screened for DM? (USPSTF)
40 - 70 years
What are the diagnostic criteria for DM?
- random glucose of 200mg/dL+ AND symptoms of hyperglycemia
- fasting blood glucose 126mg/dL or greater (needs confirmation)
- A1C greater than 6.5% (needs confirmation)
- Two hour plasma glucose 200mg/dL+ during oral glucose test (needs confirmation)
What is the most frequent cause of new blindness among adults? How can you prevent it?
diabetic retinopathy
laser photocoagulation can only slow the process
What are signs of proliferative retinopathy?
cotton wool spots
retinal hemorrhages
microaneurysms
What are optimal ranges for blood glucose? (fasting and postprandial)
fasting 180-120mg/dL
Postprandial (1-2 hours after meal) <180 mg/dL
what 3 things should be included in a diabetic foot exam?
- loss of proprioception (tuning fork, pinprick, ankle reflexes)
- pedal pulses
- inspection
What does the ACA say about goal BP for someone with HTN?
<130/80
According to ACC/AHA, when should statins be initiated? (4)
- individuals with ASCVD (ACS, stroke, TIA, PVD)
- 40-75 years of age with diabetes
- 40-75 with 10 year ASCVD risk >7.5%
- >21 age with LDL >190
What does the USPSTF recommend about aspirin? (ages 50-59 and age 60-69)
50-59 = low-dose ASA for the prevention of CVD and colorectal cancer who have a 10%+ ASCVD risk, not at risk for bleeding
60-69= DECISION TO INITIATE low-dose ASA for the prevention of CVD and colorectal cancer who have a 10%+ ASCVD risk, not at risk for bleeding
What is the A1C goal for diabetics?
close to or <7%
what is the algorithm for medication management of DM?
Step 1: lifestyle changes and monotherapy
- if A1C is <9%, start with metformin and exercise/diet
- If A1C is 9-10%, consider duel therapy (step 2) and exercise/diet
- If A1C is >10%, consider metformin and insulin and exercise/diet
Step 2:
- Duel therapy and exercise/diet
What are vaccines recommended for patients with diabetes?
influenza
Pneumovax
Hep B
fill the blanks
What is the 1/2 life of warfarin? How long will it take to reach steady state?
40 hours
5-7 days (this is when to check INR after warfarin initiation)
What are the 5 Wagner gradings?
Grade 1: Diabetic ulcer (superficial)
Grade 2: Ulcer extension (involving ligament, tendon, joint capsule or fascia)
Grade 3: Deep ulcer with abscess or osteomyelitis
Grade 4: Gangrene forefoot (partial)
Grade 5: Extensive gangrene of foot
How are ulcers managed? (think about wagner grading)
Grade 1-2: Outpatient management, extensive debridement, wound care, and relief of pressure
Grade 3: typically a brief hospitalization, evaluation for possible osteomyelitis as well as PAD
Grade 5: surgical amputation consult
What are the advantages of LMWH? (5)
does not require hospitalization for administration
long half-life so it can be administered sub-q 1-2 times daily
lab monitoring is not required
thrombocytopenia is less leikely
bleeding complications are less likely
Do Xa inhibitors require labs and INR monitoring?
yes
Can direct thrombin inhibitors or Factor Xa drugs be used in pregnancy? Heparin?
NO! But heparin can
after a PE or DVT, how long should someone be antiocoagulated? What if it was caused by cancer?
3 months
Cancer = 6 months or more
If someone on Warfarin has an elevated INR, what should you do?
Hold the warfarin and give vitamin K to reduce INR. Check INR in 24 hours
