DM Complications

Question 1

Retinopathy Treatment

Answer 1

No specific drugs

Photocoagulation procedure may slow progression but doesn’t reverse established damage

Question 2

Retinopathy Prevention

Answer 2

Fundoscopic Exams
BP Control (<140/80)
Smoking Cessation
Glycemic control

Question 3

Fundoscopic Exams

Answer 3

T1: within 5 years post-diagnosis then yearly
T2: At diagnosis (once stable) then yearly

Question 4

Diabetic nephropathy Predictor/RF

Answer 4

Microalbuminuria

Question 5

Microalbuminuria Screening

Answer 5

T1: 5 years post-diagnosis
T2: At diagnosis

Question 6

Urine Albumin Excretion

Answer 6

Random spot urine albumin/creatinine ratio

If positive, repeat test ~2-3 times in ~6 months (2/3 abnormal = diagnosis)

Question 7

Normal 24 hr collection

Answer 7

<30

Question 8

Normal Time collection

Answer 8

<20

Question 9

MA 24 hr collection

Answer 9

30-299

Question 10

MA Time collection

Answer 10

20-199

Question 11

Clinical albuminuria 24 hr collection

Answer 11

> 300

Question 12

Clinical albuminuria time collection

Answer 12

> 200

Question 13

Prevention of Nephropathy

Answer 13

KEY!
Control HTN, lipids, and glucose
Smoking cessation
Annual assessment for microalbuminuria

Question 14

Treatment of Nephropathy

Answer 14

ACE-I/ARBs can slow progression and slightly reverse

Protein restriction

Question 15

Protein restriction guidelines

Answer 15

0. 8-1.0 g/kg/d (gfr > 60)

0. 8 g/kg/day (gfr < 60)

Question 16

Peripheral neuropathy

Answer 16

Reduced or loss sensation in LE
Painful neuropathies
Ranges from numbing, tingling, burning to lancinating pain
RF for foot ulcers and lower extremities amputation

Question 17

Diabetic Neuropathy

Answer 17

Peripheral neuropathy and GI/GU abnormalities

Question 18

Painful Neuropathies

Answer 18

Symptomatic relief via anticonvulsants/AEDs, antidepressants, capsaicin cream, NSAIDS/pain meds

Question 19

Anticonvulsants/Antiepileptic

Answer 19

Gabapentin
Pregabalin (Lyrica) (FDA)
Phenytoin
Carbamazepine

Question 20

Antidepressants

Answer 20

Tricyclic (TCAs): cheap

Duloxetine (Cymbalta): FDA, expensive

Question 21

Diabetic Foot Ulcers

Answer 21

Peripheral Neuropathy: sensation loss, change in pain threshold, unnoticed trauma, dry/brittle skin

Question 22

Diabetic Foot Ulcer Prevention

Answer 22

Glycemic and HTN control
Smoking cessation
Foot care and inspections

Question 23

Treatment of Diabetic Foot Ulcers

Answer 23

Increased duration bc of slow healing
Would debridement
Pressure relief
Oxygen therapy
Regranex gel

Question 24

Dyslipidemia in Diabetes

Answer 24

High TG and Low HDL

Question 25

Goals for dyslipidemia in Diabetes

Answer 25

HDL 40 (men)/ >50 (women)

Question 26

Statins

Answer 26

LDL reduction

Pts with CV disease or 40+ with >1 CVD risk factor

Question 27

Treatments of Elevated TGs

Answer 27

Fibric acid derivative: Gemfibrozil fenofibrate

Niacin!!!

Question 28

Treatment of Low HDL

Answer 28

Niacin!

Not with sever hyperglycemia

Question 29

Hypertension in Diabetes

Answer 29

Comorbidity of 20-60% of pts
Increases complications
Goal BP <140/80

Question 30

Treatment of HTN in DM

Answer 30

ACE-I
Thiazides (but increase glucose)
CCBs
Beta-blockers (reduce complications, mild negative on glycemic control, masks hypogl)

Question 31

ADA Treatment of HTN

Answer 31

ACE-I or ARB
+ Thiazide/amlodipine (gfr >30)
+ Lood diuretic (gfr <30)

More than one usually necessary

Question 32

Antiplatelet (aspirin) therapy

Answer 32

Secondary CHD prevention: everyone
Primary CHD Prevention: 50+ men, 60 + women & 1 or more CHD RF (family CHD, smoke, protein in urine, dyslipidemia, HTN)

75-160 mg daily