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Diabetes Mellitus

Definition

(Show Disclaimer) Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.

(Show Definition) Diabetes is a group of diseases characterized by high levels of blood glucose with a defect in insulin secretion or action caused by a chronic disorder of carbohydrate, fat, and protein metabolism. There are four categories of diabetes: type 1, type 2, gestational, and other specific types including genetic-defined forms and those related to other diseases or medication use.

Incidence/Prevalence

Likely not important for the NAC OSCE Exam:

(If you're a keener click here)

Pathogenesis

Not as important, but may be useful for patient teaching:

(Extra reading click here)

Predisposing Factors


Screening Protocols for Diabetes:

Canadian Recommendations

American Recommendations



Note: Unclear of the frequency of screening outlined in USPSTF


Common Findings:

  1. Classic triad: polyuria, polydipsia, polyphagia.
  2. Weight loss.
  3. Lack of energy.
  4. Recurrent infections (urinary tract, vaginal, skin breakdown that is slow to heal).
  5. Asymptomatic.

Other Signs and Symptoms:

  1. Weakness.
  2. Fatigue.
  3. Nausea and vomiting.
  4. Abdominal pain.
  5. Anorexia.
  6. Sexual dysfunction, including impotence or dyspareunia.
  7. Pruritus.
  8. Visual disturbances.
  9. Signs and symptoms related to nephropathy, neuropathy, and/or retinopathy.

History

  1. HPI:
  2. ROS:
  3. ALL/MEDS/HIITS: (What are HIITS? - Click to expand)
  4. PMH/FAMHx/OBGYN: Review family history of diabetes, and other endocrine disorders.
  5. SOCHx: Determine client’s nutritional status, 24-hour recall, weight history, and eating patterns. SocHx also includes smoking/EtOH, exercise.

Physical Exam

Will add soon.

Diagnostic Tests

  1. A1C ≥ 6.5%.


  2. OR

  3. FPG ≥126 mg/dL (7.0 mmol/L). *Fasting is defined as no caloric intake for at least 8 hours.


  4. OR

  5. 2-hour plasma glucose ≥200 mg/dL (11.1 mmol/L) during an OGTT (75 g).


  6. OR

  7. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

Differential Diagnosis

Plan

General

Follow-up

Diabetes management goals:

  1. Fasting plasma glucose (FPG) or preprandial glucose 4 to 7 mmol/L (72 mg/dL to 126 mg/dL).

  2. A glucose level of 5.0 to 10.0 mmol/L two hours after meals (90 mg/dL to 180 mg/dL).

  3. A1c < 7.0 % for most adults. May be lower for those with comorbidity. If low risk of hypoglycemia, < 6.5% to prevent CKD.

  4. Diabetes Canada recommends SBP/DBP <130/80 mmHg.

  5. Lipid targets (not shown). If not at target TGL, start fibrate to avoid pancreatitis. If no treatment is initiated, repeat lipid profile q.3yrs.

Consultation/Referral

Individual Considerations


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