Endocrine: DM Complications

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Author:
jcbarbery
ID:
214855
Filename:
Endocrine: DM Complications
Updated:
2013-04-21 15:08:15
Tags:
diabetes complications endocrine
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Description:
An overview of complications associated with diabetes mellitus
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  1. HTN Dx
    > 140/80 x 2 Readings
  2. HTN Goals
    < 140/80

    • <130/80 supported by JNC-7 & AHA
    • consider in younger pts
  3. HTN Dietary Mods
    • Na < 1500 mg/day
    • 8-10 servings/day fruits and veg
    • 2-3 servings/day low-fat dairy
    • Minimal EtOH (2/day for men, 1 for women)
    • Increase exercise
  4. Lipid Goals
    • TC < 200
    • TG < 150
    • HDL > 40 (50 w/women)
    • LDL <100 (<70 DM + CHD)
  5. Lipid TLC
    • Sat fat < 7% of calories
    • < 200 mg cholesterol/day
    • Inc. Omega-3
    • Inc. viscous fiber (10-25 g/day)
    • Plant stanols/sterols (2 g/day)
    • Weight loss
    • Increased exercise
  6. Statin + TLC
    All pts w/DM + CHD

    All Pts w/DM - CHD & > 40 yo w/1+ CHD RF

    Lower risk pts w/LDL >100 or multiple CHD RFs
  7. Primary Antiplatelet Prophylaxis
    DM w/10 yr risk >10%:

    Men > 50yo (Women > 60 yo)

    AND 1+

    HTN, Smoking, Dyslip, Albuminuria, FH of CHD
  8. Secondary Antiplatelet Prophylaxis
    DM + Hx of CHD
  9. ASA not recommended when...
    • DM w/10yr risk <5%
    • Men < 50
    • Women<60
    • ASA allergy
  10. CV risk factor assessment in DM pt
    Performed annually

    • Dyslipidemia
    • HTN
    • Smoking
    • FH of premature coronary disease
    • Micro/Macroalbuminuria
  11. DM + CHD
    • ACEi / ARB
    • ASA
    • Statin
  12. DM + prior MI
    ADD Beta-Blocker
  13. DM + CHF
    • Avoid TZDs
    • Metformin (if renal fxn stable)
  14. Nephropathy
    • Test microalbuminuria (2-3 x in 3-6 months to Dx)
    • Test SCr annually

    • 30-299 -> micro
    • 300+ -> macro
  15. Nephropathy Tx
    0.8-1 g/kg/day protein

    • ACEi (or ARb unless T1DM)
    •  
    • Use ARB if SCr > 1.5 w/macroalbumin in T2DM
  16. Retinopathy
    Annual dialated comprehensive eye exam

    Non-proliferative -> proliferative (vitreous hemorrhage, fibrosis, retinal detacment)
  17. Neuropathy Pathophys
    Conversion of glucose to sorbitol and fructose -> increased oxidative stress -> ishemia
  18. Neuropathy Testing
    • Pin prick
    • Vibration
    • 10-g monofilament
    • Ankle reflexes
  19. Neuropathy Tx
    • TCAs
    • Anticonvulsants (gabapentin, pregabalin*, carbamazepine)
    • Duloxetine (FDA approved)
    • Venlafaxine
    • Topical capsaicin
    • Tramadol
    • NSAIDs
  20. Autonomic Neuropathy
    • Resting tachycardia
    • Orthostatic hypotension
    • Gastroparesis
    • Constipation
    • Diarrhea
    • Fecal incontinence
    • ED
    • Retrograde ejaculation
    • Bladder dysfunction
  21. Foot Car RFs
    • Previous amputation
    • Past foot ulcer history
    • Peripheral neuropathy
    • Foot deformity
    • Peripheral vascular disease
    • Visual impairment
    • Diabetic nephropathy
    • Poor glycemic control
    • Cigarette smoking
  22. Immunizations
    • Flu annually
    • Pneumococcal (once pre & once post 65 yo)
    • Hep B (between 19-59 yo; consider in 60+)

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