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Family Medicine Cases > Diabetes Care Visit > Flashcards

Diabetes Care Visit Flashcards

(60 cards)

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1
Q

What is a not so obvious historical fact to check on when doing an evaluation for diabetes?

A

Dental caries

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2
Q

Organ systems affected by chronic hyperglycemia

A

Blood vessels

  • Heart
  • Brain
  • Kidney
  • Eyes
  • Nerves
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3
Q

What is the leading cause of death in diabetic?

A

Cardiovascular disease

  • CAD & CVA
  • 2 to 4 times more likely to have a stroke
  • Equivalent risk as having prior MI
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4
Q

What iWhat is the prevalence of retinopathy in poorly controlled diabetic who require insulin within 5 yrs of diagnosis ?

A

40%

- Good control with oral agents: 24%

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5
Q

Prevalence of background retinopathy in patients with 15 yrs of type I or type II diabetes?

A

Type I: Almost all

Type II: 2/3

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6
Q

What is the prevalence of proliferative retinopathy in diabetics with 25 years of disease?

A

25%

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7
Q

Classifications of neuropathy

A 
Focal
Diffuse
Sensory
Motor
Autonomic
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8
Q

Prevalence of neuropathy (via ankle jerk reflexes) at 1 yr? 25 yrs?

A

7%
50%
(Type I & Type II)

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9
Q

What percentage will develop nephropathy?

A

20 to 40%

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10
Q

How does hyperthyroidism play a role in diabetes?

A

It can unmask underlying glucose intolerance

Adversely affect glucose control & lipid management

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11
Q

How can hypothyroidism complicate diabetes?

A

Dyslipidemia
Depression
Fatigue

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12
Q

ADA recommendations for diabetes screening

A

BMI 25+ with 1+ risk factors

  • Numerous risk factors are considered
  • HTN
  • High risk race
  • Dyslipidemia (HDL or TG)
  • Acanthosis nigricans
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13
Q

When to screen if no risk factors are present (ADA)?

A

45 yrs

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14
Q

How often to screen if results are normal (ADA)?

A

q3 years

- More frequent if risk factors are present

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15
Q

USPSTF recommendations for diabetes screening

A

Asymptomatic Adults with sustained BP > 135/80 (B rating)

- If BP

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16
Q

3 Methods of Dx diabetes

A 
Fasting glucose > 126
Random glucose > 200
- Requires symptoms of hyperglycemia 
A1C > 6.5
- Must be confirmed on different day unless symptomatic
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17
Q

High risk ethnic groups

A 
Native Americans
African Americans
Asian Americans
Latin Americans
Pacific Islanders
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18
Q

What is the role of laser photocoagulation in the treatment of retinopathy?

A

Slow progression and reduce vision loss

- Cannot restore vision

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19
Q

Why are eye exams so important in diabetics?

A

Retinopathy begins for the symptoms appear

- Goal of treatment is to preserve vision

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20
Q

You less remembered finding on fundoscopic exam that is significant for diabetic retinopathy.

A

Microaneurysms

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21
Q

What is the hallmark of proliferative retinopathy?

A

Neovascularization

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22
Q

What is the optimal range for blood glucose in a diabetic?

A

Fasting: 80 to 120

Non-fasting:

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23
Q

No so obvious causes of hyperglycemia

A

Dehydration
Infection/Illness
Stress

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24
Q

LEARN

A 
Listen: Empathy
Explain: Perceptions and treatment plan
Acknowledge: Differences & Similarities
Recommend: Based on patients wishes
Negotiate
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25
Two main contributors to diabetic foot ulcers?
Impaired sensation: distal symmetric polyneuropathy | Impaired perfusion: vasculopathy and PVD
26
What is the benefit of improve glycemic control in diabetes?
Slow progression of neuropathy | - Cannot reverse damage
27
Components of foot exam
``` Test protective sensation - 10 gm monofilament - 128 hz tuning fork or Pinprick or Ankle reflexes Pedal pulses Inspection ```
28
Familismo
Family is primary support | - Patients may wish to include them in making decisions about health care
29
Respeto/Simpatia
Respect for elders and authority figures | - Patient may be reluctant to contradict or ask questions
30
Personalismo
Value warm, friendly relationships over impersonal/institutional formality
31
Fatalismo
Control is external to self | - Nothing can be done
32
Faith/Religion
Variable affect on diabetes
33
Body image
Clean and not too thin
34
Complementary/Alt Health Practices
Hot or Cold properties of illness or treatments | - Need to balance the hot or cold out
35
HHS vs DKS: Mortality
Both increase with age | HHS increases with serum osmolarity
36
HHS vs DKS: Serum pH
HHS: No acidosis DKA: Metabolic gap acidosis
37
HHS vs DKS: Plasma glucose
HHS: > 600 DKA: 250
38
HHS vs DKS: Ketones
HHS: Absent or mild elevation DKA: Ketosis
39
HHS: Physical findings
Severe dehydration (excess of 9 L) Sr osmo > 320 Requires fluid replacement
40
HHS: Precipitating factors
``` Infections - Often compounded by poor fluid intake Stroke MI PE ```
41
How often should A1C be checked in an already diabetic?
At least 2 times per year if patient is stable and meeting their goal
42
How often should a spot urine albumin-to-creatinine ratio be done in a diabetic?
Annually
43
When to check FSBS?
If symptomatic at acute visits
44
What is another common side effect of metformin that can also be checked via labs?
B12 deficiency
45
When should TSH be checked in relation to diabetes?
New dx of type I New dyslipidemia Women over 50 yrs - Part of a complete diabetes evaluation
46
Management of ASCVD risk factors - Smoking - HTN - CAD - Dyslipidemia - TLC
Quit smoking | BP
47
Do african americans, or any patient with diabetes need to be on an ACEI?
Not unless there are signs of kidney damage
48
What is the recommended statin intensity for diabetics with LDL > 70
If only diabetic moderate intensity is fine | If ASCVD risk is >/ 7.5% go with high intensity
49
ASA therapy recommendations in diabetics (ADA)
Secondary prevention if hx of CVD Primary prevention if 10 year ACSVD risk is > 10% - Most men > 50 & women > 60 with at least 1 risk factor Multiple risk factors, but risk of only 5 to 10%
50
ASA therapy (USPSTF)
Use in men 45 to 79 - Reduce risk of MI Women 55 to 79 - Reduce risk of stroke
51
What can be used for CVD if the patient is allegic to ASA
Clopidogrel 75 mg/day
52
Affect of lowering A1C below 7%
Prevent microvascular damage | - Affect on macrovascular level is unknown
53
Step 1 in management of diabetes
TLC & Metformin
54
Step 2 in management of diabetes | - If A1C > 8%
TLC + Metformin + Sulfonylurea or Glimepiride or Basal insulin or intermediate-acting insulin
55
Step 3 in management of diabetes | - If A1C > 8%
TLC + Metformin + Basal insulin or intensify insulin therapy | - Discontinue sulfonylurea
56
Step 4 in management of diabetes | - If A1C > 8%
Go to 2nd Tier therapies - rapid acting insulin - Thiazolidinediones - Meglitinides - GLP-1 Analogs - DPP-4 - Amylin analog - Alpha-glucosidase inhibitors
57
Down side of using thiazolidinediones
Increase risk of heart failure, edema, and bone fractures
58
When should patients get pneumococcal vaccine?
``` Patient with diabetes over 2 years old One time revaccination when over 64 if - First vaccine was given > 5 years ago - Nephrotic syndrome - CKD - Immunocompromised ```
59
When should type 1 diabetics have their first eye exam
5 years after diagnosis | - Type IIs needs it at time of diagnosis
60
What areas of their feet should diabetics not apply lotion to?
Between the toes

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