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Diabetes

Complex Problems

QuestionAnswer
Diagnostic Criteria FPG > 126 mg/dl. Fasting is defined as no caloric intake for at least 8 hours.
Diagnostic Criteria Symptoms of hyperglycemia and a random plasma glucose >200mg/dl. Random is defined as any time of the day without regard to time since last meal. The classic symptoms of hyperglycemia include polyuria, polydipsia, and unexplained weight loss.
Diagnostic Criteria 2 hour plasma glucose > 200 mg/dl during an OGTT. The test should be performed as described by the WHO using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water.
Screening for asymptomatic Patients WHO: Adults with BMI > 25 AND those who are Age 45 or older adults without risk factors. HOW: FPG, or 2 hr OGTT or both. FREQUENCY: If tests are WNL, repeat at least every 3 years.
Consider Metformin for Prevention in some patients Very high risk pts, such as metabolic syndrome and a first degree relative.
Labs A1C: 6% = 135 Keep it <7%
Immunizations INfluenza anually. Pneumococcal all diabetics, repeat at 65.
BP GOals <130/80. Treat with ACE or ARB. 2nd line thiazide diuretic.
Cholesterol goals HDL >50 in women, >40 in men. LDL< 70 for very high risk, or <100 in high risk. Triglycerides <150.
Cholesterol treatments Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients: with overt CVD or without CVD who are over the age of 40 years and have one or more other CVD risk factors. Definitely start if LDL >100
Antiplatelet Therapy Use aspirin therapy (75–162 mg/day) in those with type 1 or type 2 diabetes at increased cardiovascular risk, including those who are 40 years of age or who have additional risk factors
Antiplatelet therapy Use aspirin therapy (75–162 mg/day those with diabetes with a history of CVD. For patients with CVD and documented aspirin allergy, clopidogrel (75 mg/day) should be used. Combination therapy with ASA (75– 162 mg/day) and clopidogrel (75 mg/ day) is
Created by: DianaB
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