DM 2 Txs

Question 1

What are the 2 main medications to Tx Autonomic Neuropathy: GI system?

Answer 1

Gastroparesis is treated with metoclopramide
You can also try erythromycin

Question 2

Autonomic Neuropathy: GU: How do you Tx?

Answer 2

1) Incomplete bladder functioning: bethanechol can sometimes help
2) Erectile dysfunction: PDE5 inhibitors
3) Orthostatic hypotension: fitted stockings, tilting head of bed, rising slowly, sometimes fludrocortisone can be considered (but watch for supine hypertension and potassium derangement)

Question 3

Heart disease Tx?

Answer 3

-Lower LDL
-ASA
-In those with hx of stroke or MI, use for secondary prevention
-In those with no such hx but who are at high risk, and who are low bleeding risk (Not for those over 70)

Question 4

Diabetic neuropathic cachexia Tx?

Answer 4

Treated with insulin and analgesics – prognosis is good

Question 5

Peripheral Neuropathy Tx and F/u?

Answer 5

1) Diabetic foot exam, repeat screening
2) Aggressive treatment of injury and involvement of wound care when necessary
3) Neuropathic pain can be treated with tricyclic antidepressants, or with gabapentin

Question 6

Describe diabetic nephropathy Tx

Answer 6

1) Glycemic control as well can reduce hyperfiltration and elevated microalbuminuria
2) Antihypertensive therapy: ACE inhibitors
An ACE inhibitor in normotensive pts with DM impedes progression to proteinuria and prevents increase in albumin excretion rate
3) Pts progressing to kidney disease are given SGLT2 therapy

Question 7

Peripheral vascular disease Tx?

Answer 7

Prevent foot injury!
Avoid tobacco
Control BP, Lower cholesterol

Question 8

Skin and Mucous Membrane Complications Tx?

Answer 8

Antibiotic vs. antifungal

Question 9

How do you Tx DKA?

Answer 9

1) Fluid resuscitation
2) Potassium monitoring
3) Insulin drip
4) Look for the inciting cause
5) ICU admission

Question 10

How do you Tx HHS?

Answer 10

(Same Tx as DKA)
1) Fluid replacement
2) Potassium monitoring
3) Insulin drip
4) Look for the inciting cause
5) ICU admission

Question 11

True or false: The Tx for DKA and HHS is the same

Answer 11

True

Question 12

Describe the Tx and f/u of ocular complications

Answer 12

1) Optimizing blood glucose, BP, kidney function and serum lipids
2) F/u: Initially, patients should receive ophthalmologic exam every 3-4 months, then annually
+ Avoid tobacco