8: DM Management Flashcards
Name 4 macrovascular complications of DM.
- CAD
- MI
- CVA
- PVD (arterial)
How often should a foot exam with monofilament be performed?
2x/year (minimum)
Other than height, weight, BMI, and BP which are collected at most physical exams, what specific other areas need to be examined?
- Fundoscopic exam
- Thyroid palpation
- Skin exam
- Check for acanthosis nigricans and atrophy at injection sites
- Comprehensive foot exam
- Inspect
- Palpate pulses
- Check for DTRs
- Evaluate monofiliment and proprioception sensation
How often should blood sugar be monitored at home?
- 3-4x/day
- Prior to meals/snacks
- Postprandial (occasionally)
- Bedtime
- Prior to exercise
- Suspected hypoglycemia
- Post hyperglycemia treatment
- Prior to critical tasks
What 6 potential initial diagnostics would you order in DM?
- HgA1C
- Fasting lipids
- LFTs
- UA (glucose, microalbuminuria, ketones)
- TSH (women 50+ or T1 or dyslipidemia)
- Baseline EKG (not recommended–use judgement)
What is the HDL goal for men and women with DM?
- >45 in men
- >55 in women
In preexisting DM in pregnancy, what should the A1C be?
- < 6
What is the preprandial glycemic target for nonpregnant patients?
- 70-130
What drugs should be used for lipid management in DM?
- Statins
- Fibrates
How often should a dental exam be performed?
- 2x/year
Metformin should be used for patients with stable HF so long as _____ is normal.
Metformin should be used for patients with stable HF so long as creatinine is normal.
Normally, insulin sensitizers vs insulin does not make a difference in overall CVD outcomes. However, what small group might benefit from reduced risk of MI d/t using insulin sensitizers?
Patients undergoing prompt revascularization/CABG
How often should a dilated eye exam be performed?
Yearly
How long should BB be used in DM patients with prior MI?
At least 2 years
What is the A1C target for nonpregnant patients?
≤7%
In preexisting DM in pregnancy, what should the premeal, bedtime, and overnight BG be?
60-99
When should continuous glucose monitoring (CGM) be used?
- Type 1
- Type 2 on intensive insulin regimens
- Patients with hypoglycemia unawareness
- Patients with frequent hypoglycemic episodes
In GDM, what should the preprandial BG be?
≤95
In GDM, what should the 1-hour postprandial be?
≤140
How often do you test A1C for DM patients who are not at goal or who are having their treatment changed?
Q 3 months
How often should microalbumin UA be performed?
4x/year
What 6 referrals would you consider when diagnosing DM?
- Opthalmologist (dilated eye exam)
- Medical nutritionist
- Diabetes educator
- Podiatrist
- Dentist
- Family planning counselor (women of reproductive age)
What initial drugs should be considered in HTN for DM?
- ACEs
- ARBs
- BBs
- Diuretics
What HgA1C level indicates to maximize lifestyle modifications with the current treatment?
7-8
