Condition Info - BotMed Application

ConditionName

Diabetes mellitus (DM) type 2

ConditionDescription

Symptoms

Gradual onset; Polyuria; Polydipsia; Polyphagia;
Poor wound healing, immunocompromise;
Obesity; No DKA;

PhysicalFindings

Acanthosis nigricans;

ClinicalTests

2 times fasting glucose >125;
Or one random  >=200 with symptoms;

MOST accurate: oral glucose tolerance test (2 H after sugar intake);

H1C >= 6.5% - one test is enough;

RiskFactors

After 40
Family predisposition
Obesity, metabolic syndrome;
Lack of exercise;
Not-white;
Gestational DM in the past.

IsRedFlag

IsNPLEX

Consequence

Send to eye doctor right after diagnosis;
Nephropathy, neuropathy, retinopathy.

ProgressionFromCondition

Related to obesity;
Insulin resistance

TreatmentOptions

Diet, Exercises, Weight loss- helps to control 25% of cases without medication;

15-20 min exercises every day for 24 hours, 2 h/week;
Check glucose;
Prevention: pneumococcal, flu vaccine, every eye exam;
Statins if LDL < 100 mg/dL;
ACE or ARB for high BP <130/80;
Check microalbuminuria with progression to proteinuria - high creatinine and BUN (use ACE or ARB);
Foot exam for neuropathy and ulcers;
BP control, no smoking, aspirin.

Monitoring Complications

Neuropaty: Assess loss of sensation at great toe. At diagnosis, then annually.

Retinopathy: Exam by experienced professional. At time of diagnosis, then every 1-2 years.

Nephropathy: Random urine ACR & random urine dipstick. At diagnosis, then annually.

Dyslipidemia: Fasting lipid profile. At diagnosis & every 1-3 years. Targets:
Moderate risk: LDL-C < 3.5 mmol/L; TC:HDL-C < 5.0
High risk: LDL-C < 2.5 mmol/L; TC:HDL-C < 4.0

Hypertension: Measured at every visit, target 130/80 mm Hg

PharmOptions

After 3-6 months – metformin (blocks gluconeogenesis);
Pioglitazone – CI: CHF
May need insulin;
Metformin.

WebLink

https://www.merckmanuals.com/en-ca/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm