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DM complications

Clinical Medicine II

Why is the incidence of DM ^ d/t obesity and sedentary life style
What is 80% COD in pt’s w/ DM premature vascular dz
Effects of chronic ^ glucose damages capillaries, “end organ” damage, leading to atherosclerosis > MI, CAD, PVD, CHF
What are acute diabetic complications hypoglycemia, DKA,
Macrovascular DM complcations CHD, Cerevbrovasbular dz, PAD
Microvascular DM complications retinopathy, nephropathy, neuropathy: sensory and Autonomic
What PEs are included w/ DMs Ht, Wt, BMI, BP, (orthos?), fundoscopic, thyroid, foot exam
What does the foot exam entail inspection, palpation, pulses, patellar and Achilles reflexes, propiroception, vibration, monofilament sensation
Labs for DMs A1c, FLP, LFTs, SCr and GFR, UA + albumin to creatinine ratio, TSH-T1DM,
Frequency for Primary care visit, FPG, A1c, Lipids, UA, 2, 4-6, 2-4, 1, every visit
What is the major cause of morbidity and mortality in individual w/ DM Coronary Vascular Dz (CVD)
Coexisting conditions contributing to CVD HTN, dyslipids, smoking, obesity, obstructive sleep apnea
Goal HTN to decrease vascular complications 125-130/80
Which number is more important want DBP <80, systolic CAN be higher…
What measured BP is associated w/ ^ cardiovascular events in diabetes >115/75
What causes in underlying nephropathy in T1DM HTN
What significantly reduces nonfatal and fatal strokes reducing BP
How do we tx HTN by individualizing pt’s and their therapy d/t characteristics and RFs
Non-pharm tx for HTN diet, exercise, wt loss, alcohol consumption
What should lipid levels be LDL <100, HDL >50, TGs < 150
Tx for dyslipidemia lifestyle modifications, dec cholesterol and sat fats, ^ n-3FAs, fiber, plant stanol/sterols, wt loss and ^ Physical activity
What is an acceptable lipid goal for DMs 30-40% of baseline
What is LDL goal for DM2 pts w/ CVD < 70mg/dl
What pharm therapy is added in DM pts with lipidemia ASA 75-162mg/day
RFs for CVD risk dyslipdemia, HTN, smoking, FH of premature CVD, micro-macro-albuminuria, ED
Leading casue of blindness in the U.S diabetic retinopathy
Signs for diabetic retinopathy black spots over vision
Cause of DR chronic hyperglycemia: exacerbated by HTN, dyslipid, preggo
Sxs of DR blurry vision, gradual blind spots, vision loss
Difference b/w proliferative and non-proliferative DR proliferative: hasn’t started new blood vessels yet
DM macular edema swelling of retina d/t leaky capillaries, accumulates in retinal layers
Mild Classifications of Diabetic macular edema mild: some retinal thick, hard exudates in post pole, but DISTANT from center of the macula
Moderate classifications retinal thinckening or hard exudates approaching the center of macula
Severe classifications retinal thickening or hard exudates INVOLVING the macula
TX for DR best if caught early, laser photocoagulation, vitrectomy, intraocular injections, Tight BP control, ASA
Is ASA CI in DR no
F/U and evaluation for DR and DME for T1DM and T2DM 1: 3-5 years after dx and yearly once pt is 10 and older 2: at time of dx
How should the eye exam be performed with a dilated pupillary exam by a specialist,
Exacerbating factors of DN HTN, atherosclerosis, poor BG control, pregnancy
How does diabetic nephropathy ↑ d/t hyperfiltration, micro and macroprotenuria causing a ↓ GFR
How long until end stage renal dz with DN 10 years or so
What classifies as macroproteinuria albumin >300mg, total proein >550
Screening for nephrophathy 2: at dx 1: w/I 5 years of dx,puberty, then annually
Which DM is more likely for DN type 1
What is nl proteinuria <30ug/mg? of creatinine
Dx of DN neuro exam: pin prick, temp, ankle DTR, be aware of potential autonaumic problems
How does diabetic peripheral neuropathy (DPN) occur capillary damage d/t high blood glucose, ↓ perfusion of distal tissues, death to peripheral nerves
MC cause of hospital admissions for diabetics foot ulcerations
Screening for diabetic neuropathy 2: at dx 1: 5 yrs later same w/ autonaumic signs
What indicates large fiber loss loss of light touch and proprioception
What indicates small fiber loss loss of pain and temperature
What is the MC type a combinations of both alrge and small fibers
Sxs of DPN numbness, tingling, prickling, aching, burning, lanciting, unusual sensitivity
Signs of DPN ↓ vibratory perception and proprioception, ↓ DTR, ↓ hot, cold,
Motor syndromes of Diabetic neuropathy wrist, foot drop, lateral rectus paralysis, proximal motor weakness, thigh pain, ↓ DTR
MC motor neuropathy distal muscle wasting of the forefoot
Two types of ulcerations with motor neuropathy claw toes, equinus contracture
What is autonomic Diabetic neurpathy gastroparesis, D/C, Urinary retiention: UTI and pyelo, incontinence, impotence
AC autonomic DN orthostatic HOTN, dysrhythmias, tachy, exercise intolerance, MI, painless MI
Cranial mononeuropathy acute onset, usually unilateral occulomotor n. palsys, often do MRI MRA to r/o other causes
When do we see peripheral neuropathy frequently once they are severe and past the dx of it
Clinical guidelines for DPN 0-1: No S/S, 2a: + for sxs, ↑ pains burning, shoot, pins’& needles, abscent sensation to several modalities and ↓ DTR, 2b: no sxs of numbness or pain, but reduced thermal sensitivity, 3: foot lesions and deformaties
Tx of type 2a DPN stable glycemic control and sxs tx, referral: neurologist, diabeticologist?
Tx of type 2b DPN Educate, foot care, glycemic control, can lead to ulcers more quickly d/t no pain/sensation
Tx of type 3 DPN surgery, ambutation if needed, educations
Who do we refer for preventative care and survelliance smokers and charcot foot
Screening for PAD cladification, pedal pulse, ankle/bracial test
Ischemia of the limbs resulting in infx gangrene, d/t neuropathy and elderly
Why don’t diabetic sores heal as fast ↓ blood and neuro supply
Assessment during foot examination skin color changes, swelling, sores, ingrown toenails, cracks and cuts,
How do sores form on the feet ↓ autonomic neuopathy and vascular supply, ↓ sweating so ↑ dryness and skin fissures
4types of contributing factors to foot dz Autonomic neuropathy, Biomechanical alterations, PAD
progressive musculoskeletal condition characterized by joint dislocation, fractures and deformities. It results in progressive destruction of bone and soft tissue of weight-bearing joints, most commonly in the foot and ankle charcot foot
what can initiate charcot foot minor trauma, like twisting the foot
sxs of charcot foot dislocation of joint, swelling in foot and ankle, subluxation
tx of charcot joint stabilization, non wt bearing for 8 weeks and surgery?
Two causes of charcot foot neurotraumatic and neurovascular
↓ sensation + repatetive trauma joint and bone collapse of neurotraumatic charcot foot
Loss of sympathetic vascular tone leads to increased blood flow to the joint, causing an imbalance in bone metabolism. Over time the joint becomes osteopenic neurovascular theory
Classifications of charcot fore, mid (MC), and hind foot
one may see extensive resorption of bone ends, osteoporosis, and no spurs or fragments are present atrophic charcot
xrays show no osteoporosis. Fractures and dislocations of bones and disorganization of joints are noticeable hypertrophic charcot foot
compliccation of charcot rocker-foot, little to no tx, hard to walk
Ulcer classifications 0-5 0: intact skin (impending ulcer) 1: superficial, 2: deep to tendon bone or ligament 3: osteomyelitis 4: gangrene of toes or forefoot 5: gangrene of entire foot
Name for ulcer clasifications wagner’s classifications
How does ED occur w/ DM damaged BVs ↓ BF to penis, damaged nerves,
What does ↓ erection show a sign of early sign of atherosclerosis
Created by: becker15
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