Clinical Aspects of DM II

Question 1

What are 8 signs/symptoms of T2DM?

Answer 1

polydipsia/polyuria/ Nocturia

Blurry vision

Dehydration, obrundation

acanthosis nigrans

overweight/obese

abdominal obesity

Question 2

You should be screened

1. If you have a BMI >25 and ….
2. or you are over _____ regardless of BMI

Answer 2

You should be screened

1. If you have a BMI >25 and ….
   
   1. sedentary lifestyle
   2. first-degree relative with diabetes
   3. ethnicity (african american, hispanic, native american, asian american, pacific islander)
   4. hx of CV disease
   5. HTN
   6. PCOS
   7. Dyslipidemia
2. or you are over 45 regardless of BMI

Question 3

If you are screened and the test is normal, when should you be screened again?

what if the test comes back as prediabetes?

Answer 3

If your tests are normal you should screen every 3 years (unless you come in with s/s or there is a resonable suspicion)

if you are prediabetic you should be tested every year

Question 4

Lab Values: Normal

1. A1c
2. Fasting Glucose:
3. Random Glucose:
4. Glucose after 2-hr oral glucose tolerance test:

Answer 4

Lab Values: Normal

1. A1c: <5.7
2. Fasting Glucose: <100
3. Random Glucose: <140
4. Glucose after 2-hr oral glucose tolerance test: <140

Question 5

Lab Values: Pre-diabetes

1. A1c
2. Fasting Glucose
3. random glucose
4. glucose after tolerance test:

Answer 5

Lab Values: Pre-diabetes

1. A1c: 5.7-6.4
2. Fasting Glucose: 100-125
3. random glucose: 140-199
4. glucose after tolerance test: 140-199

Question 6

Lab Values: Diabetes

1. A1c:
2. Fasting Glucose:
3. Random Glucose:
4. Glucose after tolerance test:

Answer 6

Lab Values: Diabetes

1. A1c: >/=6.5
2. Fasting Glucose: >/= 126
3. Random Glucose: >/= 200 with symptoms of hyperglycemia
4. Glucose after tolerance test: >/= 200

Question 7

A patient comes in with diagnosed diabetes:

what 8 things should we assess at every visit?

Answer 7

1. Glycemic control- A1c done quarterly if it is not <7 or after medication change, or at least 2x/year
2. BP. Goal SBP<140, DBP<90
3. smoking status
4. weight/BMI
5. signs of infection- dental, GU, foot, respiratory
6. Immunization status: annual flu shot, pneumonia, Hep B
7. Medication adherence/side effects
8. Diabetic foot exam should be done yearly

Question 8

Coronary Artery Disease:

1. Symptoms:
2. PE:
3. Screening Tests
4. Treatment:

Answer 8

Coronary Artery Disease:

1. Symptoms: chest pain, palpitations, SOB
2. PE: Auscultate heart and major arteries
3. Screening Tests: baseline EKG done when pt is asymptomatic
4. Treatment: its an FYI Asprin, beta blocker, ACEI

Question 9

Cerebrovascular Disease

1. Symptoms:
2. PE:
3. Screening:
4. Treatment:

Answer 9

Cerebrovascular Disease

1. Symptoms: focal weakness, slurred speech, headache
2. PE:auscultate carotids for bruits, neurologic exam, strength testing
3. Screening: none
4. Treatment: control BP

Question 10

Peripheral Vascular Disease:

1. Symptoms:
2. PE:
3. Screening:
4. Treatment:

Answer 10

Peripheral Vascular Disease:

1. Symptoms: claudication
2. PE: palpate major pulses (esp in feet), skin: decreased hair, thin, brittle, cool skin
3. Screening: ankle-Brachial index or ankle-toe index if symptoms suggestive or if diminished pulses
4. Treatment: Cilostazol or clopidogrel; exercise therapy, revascularization

Question 11

what is claudication?

Answer 11

extremity pain with exertion that improves with rest

typically in the lower extremity

Question 12

when can we give aspirin for primary prevention of atherosclerotic cardiovascular disease?

Answer 12

we can give aspirin for primary prevention in diabetic patients under 50 with 1 of the following:

HTN, smoker, family hx, LDL >100, albuminuria

Question 13

Retinopathy

1. symptoms
2. PE
3. Screening test
4. treatment

Answer 13

Retinopathy

1. symptoms: blurry vision, floaters, dark spots, vision loss
2. PE: opthalmoscope- microaneurysms, dot/blot or flame hemorrhages, cotton-wool spots, neovascularization
3. Screening test: dilated eye exam by opthalmologist yearly if retinopathy is present, otherwise every 2 yrs as a screening
4. treatment: some require surgery. Control BP

Question 14

Nephropathy

1. Symptoms
2. PE
3. Screening
4. Treatment

Answer 14

Nephropathy

1. Symptoms: may be asymptomatic, possible edema
2. PE: edema, xanthomas if patient has developed nephrotic range proteinuria
3. Screening:
   
   1. annual urine albumin: Cr
   2. Annual serum creatinine to estimate GFR
4. Treatment: ACEI/ARB if urine albumin:Cr is >300

Question 15

What are the components of the foot exam:

Answer 15

1. inspection for signs of infection or charcot arthropathy
2. palpate pulses
3. testing for loss of sensation
4. Large fiber function (ankle reflexes or 128 Hz tuning fork for vibratory sensation)
5. Small fiber: pinprick or temp

Question 16

Peripheral Neuropathy

1. Symptoms:
2. PE
3. Screening tests
4. Treatment:

Answer 16

Peripheral Neuropathy

1. Symptoms: numbness, tingling, burning, loss of sensation in extremities often in “stocking-glove” distribution
2. PE: foot exam
3. Screening tests: annual foot exam
4. Treatment: FYI pregabalin for neuropathic pain

Question 17

Diabetic gastroparesis

1. Symptoms:
2. PE
3. Screening:
4. Treatment:

Answer 17

Diabetic gastroparesis

1. Symptoms: early satiety, postprandial nausa and/or vomiting, abdominal fullness
2. PE; gastric fullness
3. Screening: gastric emptying study if high suspicion- this is a diagnostic test, not a screening test
4. Treatment: metoclopramide

** this is a form of autonomic neuropathy**

Question 18

what can reduce the risk and slow the progression of microvascular complications?

Answer 18

Glycemic Control

“Put down those ho hos!”