10 Questions
What is the characteristic breath odor of someone with Kussmaul breathing?
Fruity (Acetone)
What is the name of the condition characterized by hyperglycemia, hyperosmolarity, and dehydration without significant ketoacidosis?
HHS
What is the name of the complication that can lead to chronic renal failure?
Diabetic Nephropathy
What is the name of the complication that can lead to severe vision loss or blindness?
Diabetic Retinopathy
What is the ideal A1C goal for diabetes management?
Less than 7.5
What is the main goal of diabetes treatment?
To maintain daily ranges of blood glucose concentrations
What is the name of the complication that can lead to abnormal and decreased sensation in the feet and hands?
Diabetic Neuropathy
What is the name of the complication that can lead to macular edema and severe vision loss or blindness?
Diabetic Retinopathy
What is the name of the condition that can result from inadequate or delayed treatment, or from complications?
Death
What is the name of the condition characterized by severe hypoglycemia?
Severe Hypoglycemia
Study Notes
Preventing Acute Complications
- Monitor for hyperglycemia and hypoglycemia
- Minimize adverse drug reactions
- Screen for and control comorbidities (hyperlipidemia, hypertension, nephropathy, hypothyroidism, celiac disease)
- Foster self-management with age- and ability-appropriate goals that meet patient expectations
Lifestyle Modification
- Diabetes self-management education (DSME) and support (DSMS) programs
- Weight management to delay progression from prediabetes to type 2 diabetes
- Limit alcohol consumption to avoid hypoglycemia, weight gain, and hyperglycemia
Nutrition Therapy
- Carbohydrate counting:
- Educate patients on carbohydrate counting
- Help plan meals and count carbohydrates in each meal and snack
- Adjust insulin dose according to carbohydrate intake
- Protein: does not increase plasma glucose concentrations
- Dietary fat: recommend foods rich in long-chain omega-3 fatty acids to prevent CVD
- Sodium: limit intake to 2,300 mg/day
- Nonnutritive sweeteners: reduce calorie and carbohydrate intake
Physical Activity and Smoking Cessation
- Improve blood glucose control, reduce cardiovascular risk factors, and contribute to weight loss
- Quit smoking to reduce diabetic complications
Medication
- Insulin: for type 1 and type 2 diabetes
- Antidiabetic drugs: for type 2 diabetes
Insulin Classes
- Short-acting insulin: regular human insulin (bolus)
- Rapid-acting insulin: insulin lispro, insulin aspart (bolus)
- Intermediate-acting insulin: neutral protamine Hagedorn (bolus/basal)
- Long-acting insulin: insulin glargine, insulin detemir, insulin degludec (basal)
Oral Hypoglycemic Agents
- Insulin secretagogues: sulfonylureas (1st generation: tolbutamide, 2nd generation: glimepiride, glyburide, glipizide)
Chronic Complications
- Microangiopathy:
- Diabetic nephropathy: kidney damage leading to chronic renal failure
- Diabetic neuropathy: abnormal and decreased sensation
- Diabetic retinopathy: damage to small blood vessels and neurons of the retina
- Macrovascular disease:
- Coronary artery disease
- Peripheral vascular disease
- Diabetic foot
- Female infertility
- Immune dysfunction:
- Infections and autoimmune diseases
- Leukocytoclastic vasculitis
Treatment Goals
- Maintain daily blood glucose concentrations to prevent inhibition of daily activities
- Prevent long-term macrovascular and microvascular complications
- Meet A1C goals (<7.5)
This quiz covers the essential strategies for managing diabetes, including preventing acute complications, controlling comorbidities, and incorporating lifestyle modifications. It highlights the importance of self-management and meeting patient expectations.
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