Week 12 Diabetes 750
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Questions and Answers

What differentiates Latent Autoimmune Diabetes in Adulthood (LADA) from Type 2 Diabetes Mellitus (T2DM)?

  • LADA often presents with an acute onset of symptoms.
  • LADA demonstrates severe insulin resistance.
  • LADA is characterized by an autoimmune response. (correct)
  • LADA has a higher incidence of ketosis than T2DM.

Which age group is typically associated with the diagnosis of Latent Autoimmune Diabetes in Adulthood (LADA)?

  • Adults over 30 years (correct)
  • Individuals in their 40s
  • Adolescents aged 13 to 19 years
  • Children under 12 years

What is a common symptom that should be screened for when assessing complications of diabetes?

  • Symptoms of hyperglycemia (correct)
  • Restless leg syndrome
  • Epileptic seizures
  • Peripheral vision loss

Which of the following statements is true regarding the beta cell function in individuals with Latent Autoimmune Diabetes in Adulthood (LADA)?

<p>Beta cell function decreases gradually after diagnosis. (D)</p> Signup and view all the answers

In follow-up visits for diabetes management, which question is essential to determine changes in the patient's condition?

<p>Any adverse reactions to the prescribed treatment? (A)</p> Signup and view all the answers

Which of the following statements accurately describes Type 1 diabetes?

<p>It is associated with the destruction of pancreatic beta cells and absolute insulin deficiency. (B)</p> Signup and view all the answers

What is the primary complication associated with diabetes that accounts for the highest mortality rate?

<p>Cardiovascular disease (C)</p> Signup and view all the answers

Which screening method is considered the most appropriate for diagnosing diabetes in asymptomatic adults?

<p>Hemoglobin A1c (C)</p> Signup and view all the answers

When diagnosing diabetes, how many abnormal test results are typically required for a definitive diagnosis?

<p>Two abnormal test results from the same sample or in two separate samples. (D)</p> Signup and view all the answers

Which of the following is NOT considered a common comorbidity associated with diabetes?

<p>Craniocervical dystonia (B)</p> Signup and view all the answers

What underlying condition can lead to pancreatogenic diabetes?

<p>Cystic fibrosis (D)</p> Signup and view all the answers

At what age should general adults begin screening for diabetes?

<p>Age 45 (B)</p> Signup and view all the answers

Which of the following factors is NOT associated with Type 1 diabetes?

<p>Insulin resistance (A)</p> Signup and view all the answers

Which diabetes screening test requires fasting prior to the test?

<p>Fasting plasma glucose test (D)</p> Signup and view all the answers

What percentage of people with diabetes might experience neuropathy during their lifetime?

<p>50% (C)</p> Signup and view all the answers

Which of the following best describes a common symptom related to complications of diabetes?

<p>Fatigue and weakness (B)</p> Signup and view all the answers

Which screening method is crucial for assessing potential diabetic complications in the eyes?

<p>Dilated retinal exam (D)</p> Signup and view all the answers

What is the target fasting blood sugar (FBS) level for most diabetes patients?

<p>80-120 mg/dL (B)</p> Signup and view all the answers

Which of the following factors does NOT typically lead to complications in diabetes?

<p>Well-controlled blood glucose levels (A)</p> Signup and view all the answers

What is the recommended frequency for glycemic assessment in patients not meeting targets?

<p>Four times a year (A)</p> Signup and view all the answers

Which of the following is NOT a common diagnostic criterion for diabetes?

<p>A1c level of 5.0% or lower (B)</p> Signup and view all the answers

What lifestyle modification is most commonly advised for managing diabetes and preventing complications?

<p>Regular physical activity (A)</p> Signup and view all the answers

What is the primary factor contributing to the development of complications in diabetes, as indicated by A1c levels?

<p>1% reduction in A1c (D)</p> Signup and view all the answers

Which monitoring method provides real-time glucose levels using interstitial fluid?

<p>Continuous glucose monitoring (A)</p> Signup and view all the answers

Which of the following is a common symptom associated with cardiovascular complications in individuals with diabetes?

<p>Chest pain (A)</p> Signup and view all the answers

What is the typical duration before insulin dependence occurs in individuals diagnosed with Latent Autoimmune Diabetes in Adulthood (LADA)?

<p>Over 6 months after diagnosis (A)</p> Signup and view all the answers

Which of the following features distinguishes Type 1 Diabetes Mellitus (T1DM) from Latent Autoimmune Diabetes in Adulthood (LADA)?

<p>Onset age (D)</p> Signup and view all the answers

In which situation would the likelihood of ketosis be highest among diabetes types?

<p>T1DM (A)</p> Signup and view all the answers

What is a potential risk concerning beta cell function in LADA compared to Type 2 Diabetes Mellitus (T2DM)?

<p>Gradual decrease in beta cell function (B)</p> Signup and view all the answers

Which characteristic differentiates LADA from both T1DM and T2DM in terms of its progression?

<p>Slow progressive autoimmune beta cell destruction (D)</p> Signup and view all the answers

What is the component of healthcare maintenance specifically focused on diabetes management?

<p>Dilated retinal exam (D)</p> Signup and view all the answers

Which of the following best describes the monitoring frequency for A1c in patients who are meeting targets?

<p>Every six months (C)</p> Signup and view all the answers

What symptoms are commonly associated with the endocrine complications of diabetes?

<p>Polyuria, polydipsia, and polyphagia (C)</p> Signup and view all the answers

Which factor is considered a significant indicator for assessing the risk of diabetic complications?

<p>A1c levels (A)</p> Signup and view all the answers

What is the primary purpose of self-monitoring blood glucose in diabetes management?

<p>To identify trends and adjust treatment effectively (C)</p> Signup and view all the answers

Which blood pressure goal is generally recommended for most diabetes patients?

<p>140/90 or less (A)</p> Signup and view all the answers

What type of glucose monitoring provides both real-time and intermittently scanned data?

<p>Continuous glucose monitoring (D)</p> Signup and view all the answers

Which symptom is least likely to be associated with gastrointestinal complications in diabetes?

<p>Chest pain (B)</p> Signup and view all the answers

What is the primary focus of monitoring vital signs for diabetes patients?

<p>To evaluate weight and blood pressure changes (C)</p> Signup and view all the answers

What common misconception might patients have about fingerstick glucose monitoring?

<p>It is the only method necessary for diabetes management (D)</p> Signup and view all the answers

Which of the following factors is least likely to trigger Type 1 diabetes?

<p>High body mass index (D)</p> Signup and view all the answers

Which of the following complications is most commonly associated with diabetes-related neuropathy?

<p>Non-traumatic amputations (B)</p> Signup and view all the answers

What is the relationship between diabetes and cardiovascular disease in terms of mortality?

<p>Diabetes accounts for 2/3 of deaths in people with diabetes. (C)</p> Signup and view all the answers

How frequently should adults be screened for diabetes if their initial results are normal?

<p>Every 3 years (C)</p> Signup and view all the answers

Which statement about gestational diabetes is accurate?

<p>Fetal macrosomia is a potential outcome. (B)</p> Signup and view all the answers

What combination of abnormal test results is required for a diabetes diagnosis if hyperglycemia is not present?

<p>Two abnormal results from different samples (D)</p> Signup and view all the answers

Which of these is not considered a common comorbidity associated with diabetes?

<p>Insulinoma (C)</p> Signup and view all the answers

What is the impact of Type 1 diabetes on beta cell function?

<p>It leads to absolute insulin deficiency. (D)</p> Signup and view all the answers

Which condition is associated with pancreatogenic diabetes?

<p>Cystic fibrosis (C)</p> Signup and view all the answers

What is a potential long-term consequence of uncontrolled diabetes related to the kidneys?

<p>Nephropathy (D)</p> Signup and view all the answers

What distinguishes Latent Autoimmune Diabetes in Adulthood (LADA) from Type 2 Diabetes Mellitus (T2DM) in terms of insulin dependence onset?

<p>Insulin dependence in LADA typically occurs more than 6 months after onset. (B)</p> Signup and view all the answers

In terms of beta cell function, how does LADA compare to Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM)?

<p>LADA presents a decrease in beta cell function similar to T1DM. (A)</p> Signup and view all the answers

What is a key characteristic of the autoimmune process in Latent Autoimmune Diabetes in Adulthood (LADA)?

<p>Autoimmunity in LADA occurs gradually but is still present. (C)</p> Signup and view all the answers

Why might LADA be commonly misdiagnosed as Type 2 Diabetes Mellitus (T2DM)?

<p>LADA has a slow progression similar to typical T2DM. (C)</p> Signup and view all the answers

Regarding the risk of ketosis, how does LADA compare to Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM)?

<p>The risk of ketosis is rare in both LADA and T2DM. (A)</p> Signup and view all the answers

Which symptom is most indicative of endocrine complications in diabetes management?

<p>Blurry vision (A)</p> Signup and view all the answers

What is the primary goal for fasting blood sugar in diabetes patients?

<p>80-120 mg/dL (D)</p> Signup and view all the answers

What is the recommended maximum blood pressure goal for most diabetes patients?

<p>140/90 (A)</p> Signup and view all the answers

Which aspect of diabetes care is emphasized by self-monitoring blood glucose?

<p>Understanding real-time effects of lifestyle changes (A)</p> Signup and view all the answers

Which monitoring method is best suited for intermittent glucose assessment in diabetes?

<p>Fingerstick glucose monitoring (D)</p> Signup and view all the answers

What is the leading cause of non-traumatic amputations in individuals with diabetes?

<p>Neuropathy (B)</p> Signup and view all the answers

What is the significance of a 1% reduction in A1c levels in terms of complication risk?

<p>Reduces the risk of complications by approximately 30% (C)</p> Signup and view all the answers

Which of the following is NOT a recommended healthcare maintenance activity for diabetes patients?

<p>Annual respiratory check-up (C)</p> Signup and view all the answers

Which of the following is a common comorbidity found in individuals with diabetes?

<p>Osteoarthritis (A)</p> Signup and view all the answers

What is the primary purpose of performing a monofilament exam in diabetes patients?

<p>Checking for signs of neuropathy (B)</p> Signup and view all the answers

Which of the following is primarily associated with Type 1 diabetes specifically?

<p>Absolute insulin deficiency (A)</p> Signup and view all the answers

Which complication is commonly associated with gastrointestinal symptoms in diabetes?

<p>Absorption disorders (A)</p> Signup and view all the answers

What is the consequence of gestational diabetes for both mother and child?

<p>High risk for fetal macrosomia (C)</p> Signup and view all the answers

What is the primary aim of diabetes-related vaccines in healthcare maintenance?

<p>Mitigate risk of viral infections (C)</p> Signup and view all the answers

What screening test is considered the most definitive for diagnosing diabetes?

<p>Hemoglobin A1c (B)</p> Signup and view all the answers

Which characteristic is majorly present in Type 2 diabetes but not in Type 1 diabetes?

<p>Insulin resistance (B)</p> Signup and view all the answers

When should the first diabetes screening occur in the general adult population?

<p>At age 45 (B)</p> Signup and view all the answers

What is a key factor influencing the screening frequency for diabetes in at-risk individuals?

<p>Body mass index (A)</p> Signup and view all the answers

What percentage of individuals with diabetes are affected by kidney disease?

<p>39% (B)</p> Signup and view all the answers

What distinguishes Maturity Onset Diabetes of the Young (MODY) from other forms of diabetes?

<p>Autosomal dominant mutation (B)</p> Signup and view all the answers

Flashcards

LADA

Adult-onset autoimmune diabetes, often mistaken for T2DM; slowly progressive insulin dependence.

T1DM

Childhood/adolescent onset autoimmune diabetes with severe beta cell destruction and acute onset; high risk of ketoacidosis.

T2DM

Adult-onset diabetes with significant insulin resistance and often a gradual onset; not initially reliant on insulin.

Autoimmune diabetes (LADA, T1DM)

Diabetes types in which the body's immune system attacks and destroys insulin-producing beta cells in the pancreas.

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Insulin Resistance

The body's cells don't respond effectively to insulin, leading to higher blood sugar levels.

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Type 1 Diabetes

Destruction of beta cells in pancreas, leading to absolute insulin deficiency.

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Type 2 Diabetes

Insidious onset of diabetes, often related to lifestyle factors.

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3 Ps of Diabetes

Polyuria (excess urination), polydipsia (excess thirst), polyphagia (excess hunger).

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Diabetes Complications

Leading cause blindness, kidney failure, amputations, and cardiovascular disease.

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Diabetes Cardiovascular Disease

Diabetes is a leading cause of cardiovascular disease, affecting nearly 2/3 of those with the condition.

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Diabetes Screening Age

General adult screening for diabetes begins at age 45, and those at risk may be screened earlier.

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Pre-diabetes

A condition characterized by impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or elevated Hemoglobin A1c (HbA1c).

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Fasting Plasma Glucose

A blood test measuring glucose levels after a period of fasting.

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Hemoglobin A1c (HbA1c)

Blood test measuring average blood sugar levels over several months to reflect long-term glucose control.

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Type 3c Diabetes

Diabetes caused by damage to or removal of the pancreas, such as with cystic fibrosis or a pancreatectomy.

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Hypoglycemia

Low blood sugar

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Blood sugar log review

Checking past blood sugar levels to identify trends and adjust treatment.

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Lifestyle modifications

Changes to diet, exercise, and habits to manage diabetes.

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Adherence

Following a treatment plan consistently.

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Symptoms associated with complications

Physical signs of diabetes-related problems.

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Self-Monitoring Blood Glucose (SMBG)

Regularly checking blood sugar levels at home.

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Goal A1c

Target range for blood sugar control.

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Continuous Glucose Monitoring (CGM)

Device that continuously measures blood glucose levels.

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Glycemic assessment

Evaluating blood sugar control frequency based on treatment status.

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Typical diabetes presentation

A 54-year-old patient presents with no prior physicals, weight gain, fatigue, and no significant past medical history. Vital signs show elevated blood pressure (158/90), normal heart rate (78), and high BMI (38).

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Diabetes and cardiovascular disease

Diabetes is a major risk factor for cardiovascular disease (CVD), accounting for 2/3 of deaths in people with diabetes. Diabetics are twice as likely to have CVD compared to non-diabetics.

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Common diabetes comorbidities

Diabetes is often accompanied by other health conditions like hypertension, dyslipidemia, kidney disease, nonalcoholic fatty liver disease, osteoarthritis, obesity, sleep apnea, and depression.

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Gestational diabetes

Gestational diabetes develops during pregnancy and can put both the mother and baby at risk for developing type 2 diabetes later in life.

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Diabetes diagnostic tests

Diagnostic tests for diabetes include fasting plasma glucose, 2-hour post oral glucose tolerance test, hemoglobin A1c, casual glucose, fasting glucose, and HbA1c. In the absence of clear hyperglycemia, diagnosis requires two abnormal tests from the same sample or two separate samples.

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Diabetes screening recommendations

General adult screening for diabetes should begin at age 45. For individuals at risk, initial screening should begin at the identification of risk factors and repeated every 3 years. Risk factors include BMI >25 (23 for Asian Americans), pre-diabetes, and HIV.

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LADA vs. T2DM

LADA is a form of type 1 diabetes that mimics type 2 diabetes, initially misdiagnosed as slower-onset, but develops into insulin dependence. T2DM is a form of diabetes due to insulin resistance, not immune system attack on beta cells.

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Key Features of LADA

LADA typically starts after age 30, may onset slowly, has autoimmunity, and eventually requires insulin. Unlike T1DM, it's rarely acute and has a lower risk of ketosis.

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Differentiating Diabetes Types

Comparing T1DM, LADA, and T2DM involves assessing factors like age of onset, speed of development, presence of autoimmunity, insulin dependence, and risk of ketosis.

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Importance of Diabetes Assessment

Diagnosing diabetes is crucial to determine the best management strategy, screen for complications, establish a baseline health status, and create an appropriate health maintenance plan.

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Diabetes History Taking

A thorough diabetes history includes assessing hyper/hypoglycemia symptoms, onset of symptoms, treatment history, duration of diabetes, lab results, known complications, impact on daily life, and changes in health since the last visit.

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Symptoms of complications

Physical signs indicating potential diabetes-related problems.

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Elevated A1c

A high A1c level indicates poor long-term blood sugar control and increased risk for diabetes complications.

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Diabetes Screening

General adults should start screening for diabetes at age 45. Those at risk, including overweight individuals, those with pre-diabetes, and people with HIV, should be screened earlier.

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Why is diabetes assessment important?

Diagnosing diabetes is crucial to determine the best management strategy, screen for complications, establish a baseline health status, and create an appropriate health maintenance plan.

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What questions should you ask at follow-up visits?

Inquire about any new concerns, whether recommended changes have been made, and any adverse reactions experienced by the patient.

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What are some key components of a diabetes history?

A comprehensive diabetes history should include assessment of hyper/hypoglycemia symptoms, onset of symptoms, treatment history, duration of diabetes, lab results, known complications, impact on daily life, and changes in health since the last visit.

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Review blood sugar log

Examining past blood sugar readings to identify trends, understand the impact of food, medication, and lifestyle on blood sugar levels, and adjust treatment as needed.

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Self-monitoring blood glucose

Regularly checking blood sugar levels at home using a glucometer, providing information about blood sugar trends and the effectiveness of treatment.

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Study Notes

Diabetes Lecture: Week 12

  • Typical presentation of diabetes:

    • Jim, a 54-year-old patient, presented for routine care.
    • He had not had a physical in several years.
    • His spouse encouraged him to be seen.
    • He felt generally healthy but had gained some weight and experienced fatigue.
    • He was not taking any medications and had no significant past medical history.
    • Vital Signs: BP 158/90, HR 78, BMI 38.

  • Complications:

    • Leading cause of blindness, kidney failure, and non-traumatic amputations.
    • ~12% with some degree of visual problems.
    • ~39% with some degree of nephropathy.
    • Vascular disease accounts for 54% of nontraumatic amputations.
    • 50% of people with diabetes have neuropathy at some point.
    • Cardiovascular disease causes 2/3 of deaths in people with diabetes.
    • People with diabetes are twice as likely as non-diabetic patients to have cardiovascular disease (CVD).

  • Common comorbidities:

    • Hypertension
    • Dyslipidemia
    • Cardiovascular disease
    • Kidney disease
    • Nonalcoholic fatty liver disease
    • Osteoarthritis
    • Obesity
    • Sleep apnea
    • Depression

3 Ps of Diabetes

  • Polyuria, polyphagia, polydipsia

Type 1 Diabetes

  • Rapid Onset
  • Destruction of beta cells in the pancreas leading to absolute insulin deficiency.
  • Genetic predisposition, with specific HLA alleles found in 90% of patients.
  • Some shared genetic predisposition to celiac disease.
  • Increased risk in close relatives (50% in identical twins).
  • Triggers: perinatal factors, viruses, diet.
  • Large geographic variation (e.g., Scandinavia).

Type 2 Diabetes

  • Insidious Onset
  • Decreased insulin secretion.
  • Decreased incretin effect.
  • Increased lipolysis.
  • Increased glucagon secretion.
  • Increased hepatic glucose production (HGP).
  • Increased glucose reabsorption.
  • Decreased glucose uptake.
  • Neurotransmitter dysfunction.
  • Ominous Octet (a summary of the factors involved in the development of type 2 diabetes).

Other Forms of Diabetes

  • Gestational Diabetes:
    • High risk for fetal macrosomia.
    • Mom and baby at risk for development of type 2 diabetes later in life.
    • Pancreatogenic (Type 3c).
    • Cystic fibrosis.
    • Pancreatitis.
    • Drug or chemical induced (e.g., corticosteroids, thiazide-type diuretics, atypical antipsychotics).
    • Maturity-onset diabetes of the young (MODY).
    • Autosomal dominant mutation to beta cell receptors.

Appropriate Diagnostic Tests

  • Screening:
    • Fasting plasma glucose.
    • 2-hour post-oral glucose tolerance test.
    • Hemoglobin A1c (HbA1c).
  • Diagnostic:
    • Casual glucose.
    • Fasting glucose.
    • HbA1c.

Supportive Lab Tests

  • Insulin Levels:
    • Elevated in type 2 diabetes.
    • Absent or very diminished in type 1 diabetes.
  • C-peptide: Measures endogenous insulin secretion.
  • Normal to elevated: in type 2 diabetes.
  • Absent to very low: in type 1 diabetes.
  • Blood glucose must be high for c-peptide testing.
  • Antibodies: Assess for autoimmune form of diabetes (i.e., Islet cell antibody, anti-GAD antibody, insulin antibody).

Differentiating the Types of DM

  • A table comparing the features of Type 1 Diabetes, Latent Autoimmune Diabetes in Adults (LADA), and Type 2 Diabetes.

History

  • Symptoms of hyperglycemia, hypoglycemia
  • Onset of symptoms
  • Previous treatment for diabetes
  • Duration of diabetes
  • Recent lab results and trends.
  • Known complications
  • Impact on ADLs

Questions for Follow-up Visits

  • Any new concerns?
  • Make changes recommended?
  • Any adverse reactions?
  • Review blood sugar log.
  • Revisit lifestyle modifications.
  • Adherence.
  • Symptoms associated with complications.
  • Review of Systems (ROS) concerning general health, cardiovascular, gastrointestinal, endocrine, and extremities.

Physical Examination

  • Skin (acanthosis, dermopathy, tinea/yeasts)
  • HEENT (carotids, thyroid, mouth/dentition)
  • Eyes (visual acuity, fundoscopic examination)
  • Heart (arrhythmias, LVH, signs of heart failure)
  • Lungs (signs of heart failure)
  • GI (hepatomegaly)
  • Peripheral vascular (pulses, skin)
  • Neurological/Feet (monofilament exam, wound/infection evaluation)
  • Neurological Assessment (monofilament testing)
  • Vital signs (weight, BMI, BP, A1c)

Laboratory Assessment

  • Glucose control (A1c, meter interpretation)
  • Chemistry (assessing for complications, medication safety, e.g. electrolytes, creatinine)
  • Lipid profile (assessing risk for CVD)
  • Urinary albumin to creatinine ratio (UACR) for complications assessment.

Ongoing Monitoring of Diabetes

  • Hemoglobin A1c (HbA1c).
  • Elevated Alc best indicator of development of complications.
  • 1% reduction in A1c about 30% reduction in complications.

Self-Monitoring Blood Glucose

  • Scheduling depends on treatment and patient.
  • HbA1c insufficient for trend identification and treatment adjustment.
  • Glycemic Assessment.
  • Twice a year in patients meeting targets, four times a year in patients not meeting targets or with treatment changes.

Other Forms for Diabetes

  • Diabetes Care: updates guidelines annually.
  • American Association of Clinical Endocrinologist.
  • Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2024. (Decision Cycle for Person-Centered Glycemic Management in Type 2 Diabetes; Components of comprehensive diabetes medical evaluation at initial, follow-up and annual visits; Assessment and Treatment Plan)
  • Screening for Type 2 Diabetes/Prediabetes: Recommendations concerning risk groups ( BMI, family history, race, ethnicity).

Complications of Diabetes

  • Acute: Hypoglycemia, Hyperglycemia, Hyperosmolar Hyperglycemic Nonketotic Syndrome, Diabetic Ketoacidosis.
  • Chronic: Macrovascular (Cardiovascular disease, Peripheral arterial disease, Stroke), Microvascular (Diabetic Nephropathy, Diabetic Retinopathy) Disease, Neuropathy.
  • Hypoglycemia: relates to treatment rather than diabetes itself.

Other forms of diabetes

  • Gestational Diabetes:
  • Other forms:
    • Pancreatogenic (Type 3c)
    • Cystic fibrosis
    • Pancreatitis
    • Drug or chemical induced(e.g., corticosteroids, thiazide-type diuretics, atypical antipsychotics)
    • Maturity-onset diabetes of the young (MODY)
    • Autosomal dominant mutation to beta cell receptors.

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Week 12-14 Diabetes + Genetics Final Document PDF

Description

Test your knowledge on the differences between Latent Autoimmune Diabetes in Adulthood (LADA) and Type 2 Diabetes Mellitus (T2DM). This quiz covers symptoms, age group associations, beta cell function, and essential follow-up questions for effective diabetes management. Enhance your understanding of diabetes types and their implications for patient care.

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