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Family Medicine Cases > Diabetes Care Visit > Flashcards

Diabetes Care Visit Flashcards

1
Q

What is a not so obvious historical fact to check on when doing an evaluation for diabetes?

A

Dental caries

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2
Q

Organ systems affected by chronic hyperglycemia

A

Blood vessels

  • Heart
  • Brain
  • Kidney
  • Eyes
  • Nerves
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3
Q

What is the leading cause of death in diabetic?

A

Cardiovascular disease

  • CAD & CVA
  • 2 to 4 times more likely to have a stroke
  • Equivalent risk as having prior MI
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4
Q

What iWhat is the prevalence of retinopathy in poorly controlled diabetic who require insulin within 5 yrs of diagnosis ?

A

40%

- Good control with oral agents: 24%

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5
Q

Prevalence of background retinopathy in patients with 15 yrs of type I or type II diabetes?

A

Type I: Almost all

Type II: 2/3

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6
Q

What is the prevalence of proliferative retinopathy in diabetics with 25 years of disease?

A

25%

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7
Q

Classifications of neuropathy

A 
Focal
Diffuse
Sensory
Motor
Autonomic
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8
Q

Prevalence of neuropathy (via ankle jerk reflexes) at 1 yr? 25 yrs?

A

7%
50%
(Type I & Type II)

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9
Q

What percentage will develop nephropathy?

A

20 to 40%

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10
Q

How does hyperthyroidism play a role in diabetes?

A

It can unmask underlying glucose intolerance

Adversely affect glucose control & lipid management

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11
Q

How can hypothyroidism complicate diabetes?

A

Dyslipidemia
Depression
Fatigue

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12
Q

ADA recommendations for diabetes screening

A

BMI 25+ with 1+ risk factors

  • Numerous risk factors are considered
  • HTN
  • High risk race
  • Dyslipidemia (HDL or TG)
  • Acanthosis nigricans
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13
Q

When to screen if no risk factors are present (ADA)?

A

45 yrs

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14
Q

How often to screen if results are normal (ADA)?

A

q3 years

- More frequent if risk factors are present

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15
Q

USPSTF recommendations for diabetes screening

A

Asymptomatic Adults with sustained BP > 135/80 (B rating)

- If BP

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16
Q

3 Methods of Dx diabetes

A 
Fasting glucose > 126
Random glucose > 200
- Requires symptoms of hyperglycemia 
A1C > 6.5
- Must be confirmed on different day unless symptomatic
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17
Q

High risk ethnic groups

A 
Native Americans
African Americans
Asian Americans
Latin Americans
Pacific Islanders
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18
Q

What is the role of laser photocoagulation in the treatment of retinopathy?

A

Slow progression and reduce vision loss

- Cannot restore vision

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19
Q

Why are eye exams so important in diabetics?

A

Retinopathy begins for the symptoms appear

- Goal of treatment is to preserve vision

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20
Q

You less remembered finding on fundoscopic exam that is significant for diabetic retinopathy.

A

Microaneurysms

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21
Q

What is the hallmark of proliferative retinopathy?

A

Neovascularization

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22
Q

What is the optimal range for blood glucose in a diabetic?

A

Fasting: 80 to 120

Non-fasting:

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23
Q

No so obvious causes of hyperglycemia

A

Dehydration
Infection/Illness
Stress

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24
Q

LEARN

A 
Listen: Empathy
Explain: Perceptions and treatment plan
Acknowledge: Differences & Similarities
Recommend: Based on patients wishes
Negotiate
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25
Q

Two main contributors to diabetic foot ulcers?

A

Impaired sensation: distal symmetric polyneuropathy

Impaired perfusion: vasculopathy and PVD

26
Q

What is the benefit of improve glycemic control in diabetes?

A

Slow progression of neuropathy

- Cannot reverse damage

27
Q

Components of foot exam

A 
Test protective sensation
- 10 gm monofilament
- 128 hz tuning fork or Pinprick or Ankle reflexes
Pedal pulses
Inspection
28
Q

Familismo

A

Family is primary support

- Patients may wish to include them in making decisions about health care

29
Q

Respeto/Simpatia

A

Respect for elders and authority figures

- Patient may be reluctant to contradict or ask questions

30
Q

Personalismo

A

Value warm, friendly relationships over impersonal/institutional formality

31
Q

Fatalismo

A

Control is external to self

- Nothing can be done

32
Q

Faith/Religion

A

Variable affect on diabetes

33
Q

Body image

A

Clean and not too thin

34
Q

Complementary/Alt Health Practices

A

Hot or Cold properties of illness or treatments

- Need to balance the hot or cold out

35
Q

HHS vs DKS: Mortality

A

Both increase with age

HHS increases with serum osmolarity

36
Q

HHS vs DKS: Serum pH

A

HHS: No acidosis
DKA: Metabolic gap acidosis

37
Q

HHS vs DKS: Plasma glucose

A

HHS: > 600
DKA: 250

38
Q

HHS vs DKS: Ketones

A

HHS: Absent or mild elevation
DKA: Ketosis

39
Q

HHS: Physical findings

A

Severe dehydration (excess of 9 L)
Sr osmo > 320
Requires fluid replacement

40
Q

HHS: Precipitating factors

A 
Infections 
- Often compounded by poor fluid intake
Stroke
MI
PE
41
Q

How often should A1C be checked in an already diabetic?

A

At least 2 times per year if patient is stable and meeting their goal

42
Q

How often should a spot urine albumin-to-creatinine ratio be done in a diabetic?

A

Annually

43
Q

When to check FSBS?

A

If symptomatic at acute visits

44
Q

What is another common side effect of metformin that can also be checked via labs?

A

B12 deficiency

45
Q

When should TSH be checked in relation to diabetes?

A

New dx of type I
New dyslipidemia
Women over 50 yrs
- Part of a complete diabetes evaluation

46
Q

Management of ASCVD risk factors

  • Smoking
  • HTN
  • CAD
  • Dyslipidemia
  • TLC
A

Quit smoking

BP

47
Q

Do african americans, or any patient with diabetes need to be on an ACEI?

A

Not unless there are signs of kidney damage

48
Q

What is the recommended statin intensity for diabetics with LDL > 70

A

If only diabetic moderate intensity is fine

If ASCVD risk is >/ 7.5% go with high intensity

49
Q

ASA therapy recommendations in diabetics (ADA)

A

Secondary prevention if hx of CVD
Primary prevention if 10 year ACSVD risk is > 10%
- Most men > 50 & women > 60 with at least 1 risk factor
Multiple risk factors, but risk of only 5 to 10%

50
Q

ASA therapy (USPSTF)

A

Use in men 45 to 79
- Reduce risk of MI
Women 55 to 79
- Reduce risk of stroke

51
Q

What can be used for CVD if the patient is allegic to ASA

A

Clopidogrel 75 mg/day

52
Q

Affect of lowering A1C below 7%

A

Prevent microvascular damage

- Affect on macrovascular level is unknown

53
Q

Step 1 in management of diabetes

A

TLC & Metformin

54
Q

Step 2 in management of diabetes

- If A1C > 8%

A

TLC + Metformin + Sulfonylurea or Glimepiride or Basal insulin or intermediate-acting insulin

55
Q

Step 3 in management of diabetes

- If A1C > 8%

A

TLC + Metformin + Basal insulin or intensify insulin therapy

- Discontinue sulfonylurea

56
Q

Step 4 in management of diabetes

- If A1C > 8%

A

Go to 2nd Tier therapies

  • rapid acting insulin
  • Thiazolidinediones
  • Meglitinides
  • GLP-1 Analogs
  • DPP-4
  • Amylin analog
  • Alpha-glucosidase inhibitors
57
Q

Down side of using thiazolidinediones

A

Increase risk of heart failure, edema, and bone fractures

58
Q

When should patients get pneumococcal vaccine?

A 
Patient with diabetes over 2 years old
One time revaccination when over 64 if
- First vaccine was given > 5 years ago
- Nephrotic syndrome
- CKD
- Immunocompromised
59
Q

When should type 1 diabetics have their first eye exam

A

5 years after diagnosis

- Type IIs needs it at time of diagnosis

60
Q

What areas of their feet should diabetics not apply lotion to?

A

Between the toes

Family Medicine Cases (13 decks)

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