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8 Cards in this Set
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Patient with neuropathy assess feet quarterly I.e 4 times in a year Check feet daily and cut nails straight and across, wear shoes with soft insoles |
Cellulitis ; cephalexin Animal bite; amoxiclav Non bullous impetigo mupirocin, can be used nasally to clear s aureus Dmfoot infection neither limb nor life threatening; amoxi clav Cellulitis around the ulcer ; crphalexin Purulent debris clindamycin |
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Alcohol masks symptoms of hypoglycaemia, reduce hepatic glucose production and increase ketones <2 or <10 drinks for women and <3 or <15 drinks for men per week. One drink is 10g alcohol. Alcohol can mask hypoglycaemia for like 24 hours especially patients on insulin secretagogues |
Retinopathy Screen annually beginning 5 years after diagnosis for T1DM or after the age of 15 Screen at the time of diagnosis for T2DM. Follow up every 1-2 years Evaluate during pregnancy planning, first trimester and one year post partum Check pre and post intervention during intensive diabetes management as there is a risk of worsening retinopathy due to intensification of therapy Increased risk of retinopathy with Semaglutide |
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Rx for retinopathy Optimal glucose control BP control to <130/80 Fenofibrate added to statin therapy to slow the progression Anti VEGF bevacizumab, ranibizumab, aflibercept Intraocular injections of triamcinolone, dexamethasone, fluocinolone but can increase the rates of glaucoma and cataract formation |
CKD Increased albuminuria, decreased GFR |
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CKD Increased albuminuria, decreased GFR, end stage renal disease Risk factors; Long duration of diabetes, lack of glycemic control, BP and lipid control, obesity and cigarette smoking . Assess cv risk factor and optimize Screening ACR and creatinine every 5 years for T1DM and for type 2 at diagnosis and annually ACR greater or equal 2 eGfR60ml/min Monitor creatinine when ACEi or ARB are initiated, titration and acute illness Monitor eGFR when starting sGLT2 inhibitor |
Rx Optimal body weight smoking cessation ACEI or ARB in HTN or albuminuria SGLT2 inhibitors used when eGFR<30ml to reduce the risk of progression of nephropathy ( their glucose lowering effect is decreased with reduced GFR but they may be added for their renoprotective benefit GLP 1 agonist (glutide) have also shown benefits but mainly in reducing albuminuria |
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In acute illness hold off on some medications Sick days . Sick day medications should be held during diarrhoea and vomiting due to inability to maintain adequate fluid intake Monitor glucose mire frequently and adjust dose as necessary |
Sick days drugs SADMANS S: sulfonylurea renal clearance may be reduced, risk of hypoglycaemia A: ACEI may impair renal function D: diuretics, direct renin inhibitors may impair renal function M: metformin renal clearance may be reduced leading to increased risk of lactic acidosis A: ARB may impair renal function N: NSAIDs may impair renal function S: SGLT2 inhibitors may impair renal function |
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Neuropathy Risk smoking HTN, elevated BMI, elevated BG and triglycerides Rx Anti convulsants gabapentin Pregabalin valproate and anti depressants amitriptyline duloxetine venlafaxine alone or in combination Topical capsaicin and topical nitrate Opioids last option due to abuse |
Cv protection Do not use ASA for primary prevention. Only for secondary prevention 81-162 mg daily or clopidogrel in ASa intolerance Statin if greater than 40 years, cv disease or less than 40 years but with DM greater than 15 years and greater than 30 years Micro vascular complications Risk factor for cv diseases ( males, smoking, ecg changes, family history of premature cv disease, ACR of >2) |
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Add ezetimibe to statin or in clinical cvd ezetimibe or pcsk9 inhibitors alirocumab, evolocumab can be used ACEI or ARB if >55 years, micro vascular complications and clinical cvd Type 2 and ASCVD Adverse cvd events liraglutide, sc Semaglutide dulaglutide enpagliflozin Canagliflozin Hospitalization of HF Cana dapa and empagliflozin Progression of nephropathy Cana dapa and empagliflozin Dapa less effective for glycaemic control in eGFR <45 and not recommended in eGFR <25 |
HF Same therapy as without DM RAAS blockers, sacubitril/Valsartan, ivabradineband bb BB carvedilol bisoprolol metoprolol succinate reduce morbidity and mortality in HF reduced ejection fraction and DM Carvedilol improves glycaemic control Metformin first line in HF DPP4 inhibitors safe but saxagliptin increased risk of hospitalization in HF Thiazolidinediones cause fluid retention and may increase risk of Hf Liraglutide no harm or benefit SGLT2 inhibitors benefit in HF reduced EF<40% and eGFR >30ml reducing risk of hospitalization or sudden death Cana and empagliflozin in people with HF both with or without DM |
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