Case 6 - 57 yo with diabetes Flashcards
Diagnosing diabetes
- HBA1c>6.5%
- fasting plasma >126
- random glucose >200
Diabetes screening recommendations
- american diabetes recommendatoin: obese or overweight adults with additional risk factor
- in absence of risk factors, start at age 45
- USPTF - screen in asx adults with bp greater than 135/80
End organ manifestations of disease
- cardiovascular disease - risk for MI
- retinopathy and blindness
- glaucoma
- neuropathy
- nephropathy
Familismo
Family viewed as primary source of support
Respeto/simpatia
Special respect should be shown to elders and authority figures
Personalismo
Hispanic patients value warm friendly relationships over impersonal or institutional formality
Fatalismo
Holding belief that control of disease is external to self
Diabetes medical history
age of onset, characterisitics of onset, previous treatment, current treatment, microvascular complications, macrovascular complications
Diabetic physical exam
- eye examination
- thyroid
- heart
- skin - acanthosis nigricans
- comprehensive foot examination
Diabetes studies
- HbA1c - measures glycosylated hemoglobin, shows glucose levels over the last 1-3 months
- EKG
- Spot urine:creatinine to test for microalbuminuria
- B12 (could cause neuropathy)
- TSH
- fasting lipid profile
Management of diabetes
Step 1: lifestyle changes + metformin
Stage 2: add a sulfonylurea or basal insulin
Stage 3: Reassessment, add additional management if needed
Glycemic control
- goal is <7% a1c
Barriers for insulin treatment
- patients afraid of needles
- patients have perception that insulin causes side effects that are in fact caused by co-morbidities of diabetes
- physicians are reluctant due to lack of support staff
Eye care
- Eye exam should be done every year
- Type 1 Diabetics should start 5 years after diagnosis
- Type 2 Diabetics should start as soon as they are diagnose (20% have retinopathy at diagnosis)
