|
 | Presentation
 | Polydipsia, polyuria |
|
| History
| Ask about blood sugar diary, exercise, vision changes |
| Changes in bowel habit, foot/joint problems, neuropathy |
| Diet: 30?% fat, 20% protein, 50% carbs |
|
| PE
| Vitals, weight changes |
| HEENT: fundoscopic exam w/
green light, visual acuity/fields, EOM |
| CV: cardiac exam, peripheral pulses |
| Lungs: auscultate |
| Ext: Check feet for injury, hair loss, Charcot's
joints |
| Neuro: vibratory sense, position sense, DTRs in LE |
|
| Laboratory
| Fasting BG, HBA1c, fasting lipids, BMP |
| 24-hour urine protein once a year |
| Ophtholmology exam once a year |
|
| Treatment
| Type II
 | Weight loss, diet, exercise |
| Metformin, sulfonylureas, glitazones |
| Insulin as last resort |
| ACE-i (renoprotective), statins, ASA, control HTN |
| Goal fasting BS = 70-120. |
|
| Type I
| Insulin |
|
|
| Miscellaneous
| Somogyi effect
| High BS at breakfast |
| Hypoglycemia at 3 am |
| Decrease pm insulin |
|
| Dawn phenomenon
| High BS at breakfast |
| Hyperglycemia at 3 am |
| Increase pm insulin |
|
| Remember health care maintenance on these folks! |
|
|
