Diabetes Mellitus

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Diabetic Foot
Diabetic Ketoacidosis
Non Ketotic Hyperosmolar Coma
Drugs Used In Diabetes Mellitus

Diabetes Mellitus


  • Lack of Insulin or resistance to insulin
  • Type I = insulin dependent / autoimmune
  • Type II = non-insulin dependent / insulin resistance

Emergencies

Types

Type I

  • young patient
  • thin
  • short history
  • often presents in diabetic ketoacidosis
  • treated with insulin from time of diagnosis
  • association with HLA-DR3 / HLA-DR4

Type II

  • middle-aged / overweight
  • often present sub-clinically
  • may be treated with diet alone / oral hypoglycaemics

Secondary diabetes

Presentation

  • Polyuria
  • Thirst
  • Weight loss
  • Complications

Complications

History

PMH

  • Hypertensive
  • Other complications / admissions

FHx

  • increased incidence in relatives

DHx

  • Diet
  • Oral Hypoglycaemics
  • Insulin

ROS

  • complications

Driving

  • Diabetic drivers must report their condition and treatment to the DVLA and check their blood glucose before driving or every 2 hours on long journeys

Examination

General

  • Well / Unwell
  • Thin / Obese

CVS

  • hypertension
  • foot pulses

Abdo

  • Injection sites

CNS

  • visual acuity
  • fundoscopy
  • peripheral neuropathy
  • absent ankle jerks
  • distal sensory loss
  • neuropathic ulcers

Investigations

Diagnosis

  • fasting blood glucose >7.0 mmol/l
  • random blood glucose >11.0 mmol/l

Others

  • U&Es
  • Cholesterol

Cut off values in diabetes

Treatment

Blood Glucose monitoring

  • Many patients monitor their own BG using BG strips and an electronic meter.
  • BG fluctuates over 24 hours.
  • Ideal BG is in the range 4-10 mmol/litre for most of the time (it may rise above that for short periods)

Diet

Drugs Used In Diabetes Mellitus

Control other complications

 

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