Monitoring Flashcards
What should a patient on insulin and a SGLT-2 inhibitor regularly monitor for?
DKA (increased risk, possibly w/o high blood glucose)
person on insulin and SGLT2 inhibitor may experience euglycemia–pt’s should regularly monitor for blood ketones
How often should a fasting lipid profile be done for a patient with DM?
Annually; however, pt’s with low risk lipid values may be eligible for screenings every 2 years. More frequent monitoring may be indicated after initiation for intensification of lipid lowering therapies
What is the recommended treatement goal of LDL?
< 100 mg/dL for pt’s without over CVD and <70 mg/dL for those with overt CVD
What antiplatlet strategy is recommended by the ADA as a s prevention strategy in most persons with DM1 or DM2?
low dose aspirin, 75-162 mg/day
- Secondary prevention in those with DM who have h/o CVD
- Primary prevention for those at increased risk of CVD (most men > 50, women >60 who have at least 1 additional major risk factor such as family history, HTN, smoking, HLD or albuminurea)
Dose should be person specific and consider for bleeding risks
What is the most common ophthalmic complication of poorly managed DM?
Diabetic retinopathy (occurs when blood vessels in the retina sell and leak fluid or become completely blocked)
Ocular manifestations of DM affect up to 80% of all people who have had DM for >10 years
What are the risk factors for development of diabetic retionpathy?
Duration of DM, HTN, HLD, pregnancy, use of tobacco products
What is the leading cause of ESRD in the US?
Diabetic nephropathy
How is screening for diabetic nephropathy done?
By measuring the albumin to creatinine ration on a spont urine specimen or total urinary albumin in a 24 hr collection
normal: <30 ug/mg
mciroalbuminuria/moderately increased: 30-299 ug/mg
macroalbuminuria: > 300 ug/mg
What is the most common form of neuropathy in DM?
Diabetic peripheral neuropathy (DPN)
Where does neuropathy usually start?
The first and third toes and progresses to the first and third metatarsal heads
(consider testing for DPN using the Semmes-Weinstein monofilament exam)
What is Diabetic autonomic neuropathy (DAN)
A form of polyneuropathy affecting the non-voluntary non-sensory nerves, leaking to damage mostly to the internal organs such as the bladder, CV system, digestive trace, and genital organs.
Risk factors include duration of DM, increasing age, female sex, and higher BMI
What is peripheral arterial disease (PAD) and what are the risk factors for developing it?
Narrowing of the arteries resulting in reduced blood flow to the extremities
Risk factors include hyperglycemia, HTN, HLD, and tobacco use
What is an ABI (ankle brachial index)?
Provides a simple way to screen and dx PAD. Should be performed for pts > 50 with positive risk factors. It is measured by using the ration of systolic BP in the ankle to systolic BP in the arm using a hand held doppler and a BP cuff. Any value <0.9 indicates PAD
People with DM1 have a higher prevalence of what disorder compared to the general population?
Thyroid; up to 1/3rd of women with DM1 have some form of autoimmune thyroid disease
For persons with DM1, it is recommended to test for anti thyroid peroxidase (anti TBO) at diagnosis
What is the most accurate way to determine Vitamin D status?
Measure a 25 hydroxy vitamin D level, with the optiaml range between 25-80 ng/mL
