Flashcards in Exam 2 Deck (38)
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1
Name 3 common features of Type 1 DM at diagnosis
- Polyuria and thirst
- Weight loss and polyphagia
- Weakness/fatigue
- Nocturnal enuresis
2
Name 3 common features of type 2 DM at diagnosis
- Recurrent blurred vision
- Vulvovaginitis
- Peripheral neuropathy
- Mostly asymptomatic
3
Criteria for the diagnosis of DM
1. FPG greater than 126
2. Random glucose greater than 200 with signs of hyperglycemia or hyperglycemic crisis
3. A1C greater than 6.5
4. 2 hour OGTT FPG greater than 200
4
Microvascular complications of DM
- Retinopathy
- Neuropathy (autonomic/peripheral)
- Nephropathy
5
Microvascular complications of DM
Atherosclerosis (CAD, PAD, cerebrovascular dz)
6
What is the leading cause of death in T1DM?
ESRD
7
What is the leading cause of death in T2DM?
Macrovascular diseases leading to AMI, CVA
8
What causes blindness in T1DM? T2DM?
T1DM = Severe proliferative retinopathy
T2DM = Macular edema/ischemia
9
When do you refer a T1DM patient to an ophthalmologist? What percent of diabetic patients will have retinopathy at 30years?
5 years after diagnosis, 100%
10
When do you refer a T2DM to an ophthalmologist? What percent will have retinopathy after 16 years?
At diagnosis, 60%
11
What is the most common complication of DM in both type 1 and type 2?
Diabetic neuropathy
12
How can you prevent/delay the progression of diabetic neuropathy?
Normalization of blood glucose
13
Name 3 disorders caused by autonomic neuropathy in long-standing DM
1. Diabetic gastroparesis
2. Fecal incontinence
3. Orthostatic HTN
4. N/V/C/D
14
How do you examine diabetic patients feet for peripheral neuropathy? What happens when they fail this test?
Microfilament - failure increases risk for unperceived neuropathic injury
15
What does untreated charcot arthropathy lead to?
Rocker bottom deformity and ulceration
16
How do you manage a diabetic foot ulcer?
- Decrease pressure with mechanical unloading
- Debridement and antibiotic
17
How do you manage a diabetic patient who has lost feeling in their feet?
- Check feet daily for reddened areas, blisters, abrasions or lacerations
- Podiatry referral
18
Name 3 features of the diabetic foot exam
1. Inspection for skin cracking, hair growth, ulcers, calluses, etc.
2. Check vascular supply (temperature and distal pulses)
3. Check neurologic function (sensation, ankle reflex, gait)
19
What tests should you do to check neurologic function of a diabetic foot?
Vibratory sense
Proprioception
Microfilament
20
How do you prevent cardiovascular complications in diabetics?
1. Lower BP to less than 140/90
2. Lower LDL to less than 100 (less than 70 if multiple risk factors)
3. ACE-I if CVD or microalbuminuria present
4. Aspirin
21
Leading cause of death in patties with T2DM?
Coronary atherosclerosis
22
Name 3 complications of diabetes
Candidal infections
Eruptive xanthomas
Carpal tunnel syndrome
23
Name 4 cormorbid conditions associated with diabetes
Obstructive sleep apnea
Fractures
Cancer
Periodontal disease
Fatty liver disease
Hearing impairment
24
What are 2 questions you should ask during a diabetic medical history?
- Patients blood glucose log
- History of DKA
- Hypoglycemic episodes (awareness)
- History of macro/micro complicatons
25
Name 3 components of the physical exam
1. Height, weight, BMI
2. Fundoycopic exam
3. Foot examination
4. Skin examination
5. Thyroid examination
26
What should you be looking for on the skin exam of a diabetic patient?
Acanthosis nigricans
Superficial candidal infections
27
When should you get a lab evaluation of A1C?
If results not available within last 3 months
28
Name 3 lab values you should get on a diabetic if not available within the last year?
1. Lipids
2. LFTs
3. TSH
4. GFR and serum creatinine
5. Urine albumin excretion with spot urine albumin:creatinine ratio
29
What is the A1C recommendation for non-pregant adults with diabetes?
less than 7
30
What is the preprandial capillary plasma glucose recommendation for non pregnant patients with diabetes?
80-130
31
What is the peak postprandial capillary plasma glucose recommendation for non pregnant patients with diabetes?
Less than 180
32
Name 3 referrals you should make for your diabetic paitietn
1. Ophthalmologist
2. Dentist
3. Family planning for women of reproductive age
4. Diabetes self-management education and diabetes self-management support
5. Dietitian
33
Name 3 aspects of patient education in diabetics
1. Medical nutrition therapy
2. Weight management
3. Physical activity
4. Tobacco cessation
5. Immunizations
34
How much of the diabetic diet should be carbs? fat? protein?
Carbs = 45-65%
Fat = 25-35%
Protein = 10-35%
35
How often should you do a foot exam on a diabetic patient?
Yearly, if abnormal at every visit
36
How often should you get a urine albumin:creatinine ratio?
Yearly
37
What vaccinations should diabetic patients get?
Pneumococcal
Influenza
Hep B
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