Endocrine: DM Complications

> 140/80 x 2 Readings

< 140/80

• <130/80 supported by JNC-7 & AHA
• consider in younger pts

• Na < 1500 mg/day
• 8-10 servings/day fruits and veg
• 2-3 servings/day low-fat dairy
• Minimal EtOH (2/day for men, 1 for women)
• Increase exercise

• TC < 200
• TG < 150
• HDL > 40 (50 w/women)
• LDL <100 (<70 DM + CHD)

• Sat fat < 7% of calories
• < 200 mg cholesterol/day
• Inc. Omega-3
• Inc. viscous fiber (10-25 g/day)
• Plant stanols/sterols (2 g/day)
• Weight loss
• Increased exercise

All pts w/DM + CHD

All Pts w/DM - CHD & > 40 yo w/1+ CHD RF

Lower risk pts w/LDL >100 or multiple CHD RFs

DM w/10 yr risk >10%:

Men > 50yo (Women > 60 yo)

AND 1+

HTN, Smoking, Dyslip, Albuminuria, FH of CHD

DM + Hx of CHD

• DM w/10yr risk <5%
• Men < 50
• Women<60
• ASA allergy

Performed annually

• Dyslipidemia
• HTN
• Smoking
• FH of premature coronary disease
• Micro/Macroalbuminuria

• ACEi / ARB
• ASA
• Statin

ADD Beta-Blocker

• Avoid TZDs
• Metformin (if renal fxn stable)

• Test microalbuminuria (2-3 x in 3-6 months to Dx)
• Test SCr annually

• 30-299 -> micro
• 300+ -> macro

0.8-1 g/kg/day protein

• ACEi (or ARb unless T1DM)
•  
• Use ARB if SCr > 1.5 w/macroalbumin in T2DM

Annual dialated comprehensive eye exam

Non-proliferative -> proliferative (vitreous hemorrhage, fibrosis, retinal detacment)

Conversion of glucose to sorbitol and fructose -> increased oxidative stress -> ishemia

• Pin prick
• Vibration
• 10-g monofilament
• Ankle reflexes

• TCAs
• Anticonvulsants (gabapentin, pregabalin*, carbamazepine)
• Duloxetine (FDA approved)
• Venlafaxine
• Topical capsaicin
• Tramadol
• NSAIDs

• Resting tachycardia
• Orthostatic hypotension
• Gastroparesis
• Constipation
• Diarrhea
• Fecal incontinence
• ED
• Retrograde ejaculation
• Bladder dysfunction

• Previous amputation
• Past foot ulcer history
• Peripheral neuropathy
• Foot deformity
• Peripheral vascular disease
• Visual impairment
• Diabetic nephropathy
• Poor glycemic control
• Cigarette smoking

• Flu annually
• Pneumococcal (once pre & once post 65 yo)
• Hep B (between 19-59 yo; consider in 60+)