Diabetes Mellitus

DM 1

DM 2DM 3

 


Screening for T2DM:

  • All adults w\ risk factors
  • All > 45 yr
  • If normal -> repeat after every 3 yr

 


Treatment: 

 

DM 5DM 6

DM 8

DM 9

DM 10

 


Macrovascular complications:

2° to accelerated atherosclerosis

  • CAD (MCC of death in T2DM)
  • Ischemic stroke
  • PAD -> intermittent claudication in LL, intestinal angina, foot ulcers
TG < 150 mg\dL
LDL w\ out CVD < 100 mg\dL
w\ CVD < 70 mg\dL
HDL Male > 40 mg\dL
Female > 50 mg\dL

 Treatment:

  • BP control: all DM pts BP should be < 140\90
  • Lipid control:
  • Consider aspirin to prevent CVD (unless there’s risk of bleeding)

 


Microvascular complications:

  Type 1 Type 2 Frequency
Nephropathy ≥5-year duration At diagnosis Annual
Retinopathy within 5 years of diabetes onset At diagnosis – No evidence -> every 2 years

– Evidence -> annually (at least)

Neuropathy 5 yrs after diagnosis At diagnosis Annual (at least)
Foot care     Annual \ each visit
DM 11
Diabetic retinopathy

 


Dermatological complications:

  • Acanthosis nigricans
  • Necrobiosis lipoidica diabeticorum
  • Scleredema diabeticorum
  • Eruptive xanthomatosis
  • Bullosis diabeticorum

 


Acute complications:

DM 17

dm-20.jpg
DM 21

 

 

 

 

 

 

 

 

 

 

 


Hypoglycemia:

Definition:

  • (BG < 4 mmol\L)

 

Whipple’s triad:

  • BG < 2.5 in males, < 2.2 in females
  • Neuroglycopenic Sx
  • Relief after giving glucose

 

Signs and symptoms: 

Neurogenic (autonomic) Neuroglycopenic
Trembling Difficulty Concentrating
Palpitations Confusion
Sweating Weakness
Anxiety Drowsiness
Hunger Vision Changes
Nausea Difficulty Speaking
Dizziness

 

Risk factors:

Risk factors in Type 1 DM patients Risk factors in Type 2 DM patients
Adolescence Elderly
Children unable to detect and/or treat mild hypoglycemia Poor health literacy, Food insecurity
A1C <6.0% Increased A1C
Long duration of diabetes Duration of insulin therapy
Prior episode of severe hypoglycemia Severe cognitive impairment
Hypoglycemia unawareness Renal impairment
Autonomic neuropathy Neuropathy

 

Treatment:

  • Give simple carbs (15 g) -> retest in 15 mins (BG > 4.0 mmol\L) -> retreat if needed -> snack\meal
  • If unconscious
    • No IV access: 1 mg of glucagon sub-Q or IM
    • IV access: IV glucose 10-15 g (20-50 cc of D5W) over 1-3 mins -> retest in 15 mins (BG > 4.0 mmol\L) -> retreat if needed -> snack\meal if conscious

 


Download the PDF version: here


References:

  • American Diabetes Association (ADA)
  • The Johns Hopkins Internal Medicine Board Review
  • Step up to medicine
  • Pocket medicine
  • Toronto notes
  • Dr Alrasheed’s lecture

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