DM Complications Flashcards
Retinopathy Treatment
No specific drugs
Photocoagulation procedure may slow progression but doesn’t reverse established damage
Retinopathy Prevention
Fundoscopic Exams
BP Control (<140/80)
Smoking Cessation
Glycemic control
Fundoscopic Exams
T1: within 5 years post-diagnosis then yearly
T2: At diagnosis (once stable) then yearly
Diabetic nephropathy Predictor/RF
Microalbuminuria
Microalbuminuria Screening
T1: 5 years post-diagnosis
T2: At diagnosis
Urine Albumin Excretion
Random spot urine albumin/creatinine ratio
If positive, repeat test ~2-3 times in ~6 months (2/3 abnormal = diagnosis)
Normal 24 hr collection
<30
Normal Time collection
<20
MA 24 hr collection
30-299
MA Time collection
20-199
Clinical albuminuria 24 hr collection
> 300
Clinical albuminuria time collection
> 200
Prevention of Nephropathy
KEY!
Control HTN, lipids, and glucose
Smoking cessation
Annual assessment for microalbuminuria
Treatment of Nephropathy
ACE-I/ARBs can slow progression and slightly reverse
Protein restriction
Protein restriction guidelines
- 8-1.0 g/kg/d (gfr > 60)
0. 8 g/kg/day (gfr < 60)
Peripheral neuropathy
Reduced or loss sensation in LE
Painful neuropathies
Ranges from numbing, tingling, burning to lancinating pain
RF for foot ulcers and lower extremities amputation
Diabetic Neuropathy
Peripheral neuropathy and GI/GU abnormalities
Painful Neuropathies
Symptomatic relief via anticonvulsants/AEDs, antidepressants, capsaicin cream, NSAIDS/pain meds
Anticonvulsants/Antiepileptic
Gabapentin
Pregabalin (Lyrica) (FDA)
Phenytoin
Carbamazepine
Antidepressants
Tricyclic (TCAs): cheap
Duloxetine (Cymbalta): FDA, expensive
Diabetic Foot Ulcers
Peripheral Neuropathy: sensation loss, change in pain threshold, unnoticed trauma, dry/brittle skin
Diabetic Foot Ulcer Prevention
Glycemic and HTN control
Smoking cessation
Foot care and inspections
Treatment of Diabetic Foot Ulcers
Increased duration bc of slow healing Would debridement Pressure relief Oxygen therapy Regranex gel
Dyslipidemia in Diabetes
High TG and Low HDL
Goals for dyslipidemia in Diabetes
HDL 40 (men)/ >50 (women)
Statins
LDL reduction
Pts with CV disease or 40+ with >1 CVD risk factor
Treatments of Elevated TGs
Fibric acid derivative: Gemfibrozil fenofibrate
Niacin!!!
Treatment of Low HDL
Niacin!
Not with sever hyperglycemia
Hypertension in Diabetes
Comorbidity of 20-60% of pts
Increases complications
Goal BP <140/80
Treatment of HTN in DM
ACE-I
Thiazides (but increase glucose)
CCBs
Beta-blockers (reduce complications, mild negative on glycemic control, masks hypogl)
ADA Treatment of HTN
ACE-I or ARB
+ Thiazide/amlodipine (gfr >30)
+ Lood diuretic (gfr <30)
More than one usually necessary
Antiplatelet (aspirin) therapy
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
