Page 320 - TNFlipTest

FM22 Family Medicine
Common Presenting Problems
Toronto Notes 2019
DM Related Symptoms
Hyperglycemia: polyphagia, polydipsia, polyuria, weight change, blurry vision, yeast infections
Diabetic Ketoacidosis (DKA): fruity breath, anorexia, N/V, fatigue, abdominal pain, Kussmaul breathing, dehydration
Hypoglycemia: hunger, anxiety, tremors, palpitations, sweating, headache, fatigue,
confusion, seizures, coma
Long-Term Complications of DM
• Microvascular: nephropathy, retinopathy, neuropathy
• Macrovascular: CAD, CVD, PVD
Prognosis
• upto40%resolvespontaneouslywithin6-12mo
• risksofrecurrence:50%after1episode;70%after2episodes;90%after3episodes
Diabetes Mellitus
• seeEndocrinology,E7
• see2013ClinicalPracticeGuidelinesfromCanadianDiabetesAssociation(updatedin2016),
available from: http://guidelines.diabetes.ca/fullguidelines
• see Diabetes Mellitus Patient Care Flow Sheet from Canadian Diabetes associated, available from: http://
guidelines.diabetes.ca/organizingcare/patientcareflowsheet
Definition
• metabolicdisordercharacterizedbythepresenceofhyperglycemiaduetodefectiveinsulinsecretion, defective insulin action or both
Classification and Diagnosis
• seeEndocrinology,E7
Epidemiology
• majorhealthconcern,affectingupto10%ofCanadians
• incidenceoftype2DMisrisingduetoincreasingobesity,sedentarylifestyle,andageofthepopulation • leadingcauseofnew-onsetblindnessandrenaldysfunction
• CanadianadultswithDMaretwiceaslikelytodieprematurely,comparedtopersonswithoutDM
Risk Factors
• type1DM
■ personal or family history of autoimmune disease
• type2DM
■ first degree relative with DM
■ age≥40yr
■ obesity (especially abdominal), HTN, hyperlipidemia, CAD, vascular disease
■ prior GDM, macrosomic baby (>4 kg)
■ PCOS
■ history of IGT or IFG
■ presence of complications associated with DM
■ presence of associated diseases: PCOS, acanthosis nigricans, psychiatric disorders, HIV ■ medications: glucocorticoids, atypical antipsychotics, HAART
• both
■ member of a high risk population (e.g. Aboriginal, Hispanic, Asian, or African descent)
Screening
• type2DM
■ FBG or HbA1c in everyone ≥40 q3yr, or at high risk using the CANRISK calculator ■ more frequent and/or earlier testing if presence of ≥1 risk factor (see above)
• gestationaldiabetesmellitus(seeObstetrics,OB26) ■ all pregnant women between 24-28 wk gestation
Goals of Therapy
• seeEndocrinologyandsidebar(SMARTGoals)
Smart Goals
Diabetes Quick Reference Guide
A A1C: Optimal Glycemic Control (Usually <7%)
B BP: Optimal Blood Pressure Control (130/80)
C Cholesterol: LDL-C <2 if treating
D Drugs: Consider ACEI/ARB, Statin, and
ASA
E Exercise/Eating
S Smoking Cessation