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what are the short term microvascular complications of DM
neuropath
retinopath
nephropathy
what are the long term macrovascular complications of DM
CAD
cerebrovascular disease
PVD
what are the short term complications of DM
DKA
HHNS hypergly hyperosmol nonketot syndrome
Hypoglycemia
infections
what is the ADA goals for individuals with diabetes
<7%
age of pts with DKA vs HHNS
<40 vs >60
onset of DKA vs HHNS
sudden vs hours to days
urince glucose of DKA vs HHNS
none vs positive
duration of sx of DKA vs HHNS
usually <2 days vs >5 days
glucose lvs of DKA vs HHNS
usually < 600 vs >800mg/dL
HCO3 concentration in DKA vs HHNS
low vs normal
pH in DKA vs HHNS
low vs normal
prognosis of DKA vs HHNA
3-10% vs 10-20%
what is the initial tx goal for acute complications
rehydration
BG levels for hypoglycemia
<70mg/dL
what are some causes to hypoglycemia
insulin errors
intensive oral and insulin tx
delayed or skipped meals
exercise
what are some of the s/s of hypoglycemia
blurred vision
sweating
shaky
hunger
confusion
fatigue
anxiety
poor judgment
what is the tx for hypoglycemia
15g of carbohydrate
repeat in 15 min if BG <70
follow with complex carb snack if meal time is not in one hour
what do you give a pt with hypoglycemia who is unconscious
glucagon 1mg (parenterally)
glucose 25 g IV (50 ml of dextrose 50%)
how often does the ADA recommend eye exams and what is the exception
annually, howeverless frequent (2-3 yrs) may be considered following one or more normal eye exams
what percentage of pts develop evidence of diabetic nephropath
20-30%
what is the mean time of duration DM before development of ESRD
20 years
what is the presence of albuninuria predictive of and what does the ADA recommend
increased cardiovascular morbidity and mortality and the ADA recommends that microalbuminuria is an indication for screening for vascular disease and aggressive intervention
what is the normal and abnormal albumin excretion lvs
normal is <30 and increased excretion is >=30
what are the factors that can cause transient elevations of albumin
short term hyperglycemia
exercise
UTI
marked hypertension
HF
acute febrile illness
what is the recommended therapies for nephropathy
ACEI and ARBs
what is the most common form of diabetic neuropathy
peripheral neuropathy
how does peripheral neuropathy manifest
numbness
tingling
pain
what are the commonly used agents to treat neuropathy
analgesics-NSAIDs, acetamino, narcotics
antidepressants
capsaicin
gabapentin
duloxetine
pregabalin
how does autonomic neuropathy present as
gastroparesis
diabetic diarrhea
hypotension
ED
what is the treatment for gastroparesis associated autonomic neuropathy
metoclopramide or erthyromycin
diet
what is the tx for diabetic diarrhea
10-14 day course of antibiotics (doxycycline or flagyl)
how to treat hypotension associated with autonomic neuropathy
mineralocorticoids (fludrocortisone)
adrenergic agonist (midodrine)
what is the leading cause of death in DM type II
CAD
what is the prophylactic treatment for CAD
aspirin therapy (75-162mg/d) in pts with increased CV risk (men>50 and women >60) who have at least one additional risk
who should prophylactic aspirin therapy not be recommended for and why
< 21 yrs of age because increased risk of Reyes syndrome
what are the 4 major statin benefit groups according to the ACC AHA
pts with ASCVD
LDL >= 190
40 - 75 yrs with diabetes with LDL 70 - 189 mg/dL
pts without ASCVD or diabetes who are 40 -75 yrs with LDL 70 - 189 and estimated 10 year risk >=7.5%