Complications of DM

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Complications of DM
2014-03-30 18:05:44
Exam II
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  1. what are the short term microvascular complications of DM
    • neuropath
    • retinopath
    • nephropathy
  2. what are the long term macrovascular complications of DM
    • CAD
    • cerebrovascular disease
    • PVD
  3. what are the short term complications of DM
    • DKA
    • HHNS hypergly hyperosmol nonketot syndrome
    • Hypoglycemia
    • infections
  4. what is the ADA goals for individuals with diabetes
  5. age of pts with DKA vs HHNS
    <40 vs >60
  6. onset of DKA vs HHNS
    sudden vs hours to days
  7. urince glucose of DKA vs HHNS
    none vs positive
  8. duration of sx of DKA vs HHNS
    usually <2 days vs >5 days
  9. glucose lvs of DKA vs HHNS
    usually < 600 vs >800mg/dL
  10. HCO3 concentration in DKA vs HHNS
    low vs normal
  11. pH in DKA vs HHNS
    low vs normal
  12. prognosis of DKA vs HHNA
    3-10% vs 10-20%
  13. what is the initial tx goal for acute complications
  14. BG levels for hypoglycemia
  15. what are some causes to hypoglycemia
    • insulin errors
    • intensive oral and insulin tx
    • delayed or skipped meals
    • exercise
  16. what are some of the s/s of hypoglycemia
    • blurred vision
    • sweating
    • shaky 
    • hunger
    • confusion
    • fatigue
    • anxiety
    • poor judgment
  17. 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
  18. what do you give a pt with hypoglycemia who is unconscious
    • glucagon 1mg (parenterally)
    • glucose 25 g IV (50 ml of dextrose 50%)
  19. 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
  20. what percentage of pts develop evidence of diabetic nephropath
  21. what is the mean time of duration DM before development of ESRD
    20 years
  22. 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
  23. what is the normal and abnormal albumin excretion lvs
    normal is <30 and increased excretion is >=30
  24. what are the factors that can cause transient elevations of albumin
    • short term hyperglycemia
    • exercise
    • UTI
    • marked hypertension
    • HF
    • acute febrile illness
  25. what is the recommended therapies for nephropathy
    ACEI and ARBs
  26. what is the most common form of diabetic neuropathy
    peripheral neuropathy
  27. how does peripheral neuropathy manifest
    • numbness
    • tingling 
    • pain
  28. what are the commonly used agents to treat neuropathy
    • analgesics-NSAIDs, acetamino, narcotics
    • antidepressants
    • capsaicin
    • gabapentin
    • duloxetine
    • pregabalin
  29. how does autonomic neuropathy present as
    • gastroparesis
    • diabetic diarrhea
    • hypotension
    • ED
  30. what is the treatment for gastroparesis associated autonomic neuropathy
    • metoclopramide or erthyromycin
    • diet
  31. what is the tx for diabetic diarrhea
    10-14 day course of antibiotics (doxycycline or flagyl)
  32. how to treat hypotension associated with autonomic neuropathy
    • mineralocorticoids (fludrocortisone)
    • adrenergic agonist (midodrine)
  33. what is the leading cause of death in DM type II
  34. 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
  35. who should prophylactic aspirin therapy not be recommended for and why
    < 21 yrs of age because increased risk of Reyes syndrome
  36. 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%
  37. treatments used for HDL raising
    • exercise 
    • niacin 
    • fenofibrate
  38. treatment used for triglycerides
    • fenofibrate
    • niacin
    • gemfibrozil
    • statins
  39. what is the number 1 risk factor for strokes
  40. treatment for PVD
    • pentoxifylline
    • cilostazol