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Diabetes Mellitus Type II, Patho and HPI, Labs, Assessment, Medications,…
Diabetes Mellitus Type II
Cellular insulin insensitivity and defective insulin secretion
Inability to let glucose into cells for energy.
weight loss
Thinning of skin
Cells begin to starve and cannot perform properly.
Inflammation of cells
Endothelial damage will be seen especially if inflammation is chronic
Arteriosclerosis !!
Coronary artery disease
Peripheral artery disease
Decreased blood flow to feet
Impaired wound healing
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Pulses 1+ BLE
Toes pale and cool to touch
Plaque in arteries
Endothelial damage
Polyphagia
Poor Blood Glucose Control
↑ Blood Glucose: 148
Narrowing and occlusion of small vessels that supply nerves
Peripheral neuropathy
Diabetic foot
Foot wounds
Infection and smell
4cm x 4cm wound on BLE
Pale and cool to touch
wound bed with pink and small areas of slough
Wound edge 2mmx4mm
Thready pulse
Slight limp
Fall risk
Pt has a steady, protective gait
Slight limp with left foot due to wound
Bilateral Charcot foot
Aspercreme with Lidocain Max PRN
Patient complains of numbness and tingling in toes
Pulse +1 thready
Toes pale and cool to touch
Non-edematous extremities
Suspected slow capillary refill in toes (not specified)
GI muscles slowed or don't work at all
Gastroparesis: Heartburn and stomach pain
c/o getting full easy, food taking forever to move, and heartburn
Famotidine 20mg PO Qbedtime
Caution: monitor kidney function
Acidophilus: PO 100mg Qam
Protonix 40mg PO q am and bedtime
Beer's List: avoid use over 8 weeks (c.diff and bone loss/fracture risk)
Blood vessel damage in brain
Forgetfulness
Irritation
Emotional lability
Increased osmotic pressure
Increased IOP
Blood vessels damaged in retina
Dizziness
Retinopathy
Glaucoma Risk
Latanoprost/Xalatan: 1 drop each eye Qday
Blurred vision reported (possible side effect)
CoQ10 100 capsule qDaily
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Worsening hypertension
Increased renin-angiotensin aldosterone system(RAAS)
Increased retention of water and sodium
Further hypertension
BP 165/95
Lasix 20mg PO Qday
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Hydorchlorothiazide 12.5mg PO Qday
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Pulses 2+ BUE and 1+ BLE
Secretion of potassium through the urine
↓ K: 3.3
proteins in the blood become cross-linked and deposit in the glomeruli
Scarring of the glomeruli
Glomerularsclerosis and diabetic nephropathy
Decrease in GFR
Increased permeability of large proteins
Increased glucose being excreted in urine (Glycosuria)
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Increased albumin in urine (albuminuria)
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Inadequate waste excretion
↑ BUN: 29
Creatinine: 1.3
See a decreased Creatinine Clearance (45.2)
Decreased EPO secretion
Decreased RBC production
↓ RBC: 3.9
Excess glucose in saliva creating environment for bacteria to grow
Potential dental caries on back molars
Liver is central for glucose metabolism, too much can cause damage to this organ
Increased LDL, decreased HDL
Atorvastatin 40mg PO Qday
C/o joint pain and heartburn (possible side effects)
High sugar can lead to obesity
Obesity can cause liver damage
Decreased thrombopoietin secretion in liver.
↓ Platelets: 120
Increased glucose insensitivity
Increased cardiac afterload
Decreased cardiac output
Increased RAAS
Further HTN
Metformin 500mg PO BID
May cause weight loss
Risk of metabolic acidosis: No ABG to interpret CO2
Barley Green 1 TBSP qAM
Monitor GFR for kidney function
↑ HgA1C: 8%
Risk Factors: age over 45, dyslipidemia, mother died of MI second to diabetes, HTN, early onset dementia (medication/lifestyle/diet adherence)
Patho and HPI
Labs
Assessment
Medications
By: Taylor Van Steenis, Mikayla Pham, Rae Nia Graves, Faith Cooney, Madi Steinhoff, Peyton Ray
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