Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 475

■Weight, BP, foot exam at each visit

■HgbA1cquarterly

■Serum lipid profile yearly or more frequently if abnormal

■Dilated eye exam, serum creatinine, urine microalbumin yearly

complications and prognosis

■Diabetic ketoacidosis: 5–9% mortality

■Hypoxia

■Cerebral edema: usually only occurs in children; treat with mannitol,

dexamethasone, and mechanical ventilation; 50% mortality

■Venous and arterial thrombosis

■Retinopathy: develops in 50–90%; best treated by near-normal glu-

cose control, BP management, and photocoagulation therapy by

ophthalmologist; may lead to blindness in up to 10%

■Neuropathy: develops in 50–90%, best treated by near-normal glu-

cose control; predisposes to foot ulcers and amputations

■Nephropathy: develops in 30–50%, best treated by near-normal glu-

cose control, BP management, ACE inhibitor; end-stage renal dis-

ease in 50–75% with nephropathy

■Atherosclerosis: CAD 11-fold higher; peripheral vascular disease 4-

to 6-fold higher; CVD 2- to 4-fold higher; best prevented by aggressive

BP and lipid management; use aspirin/ACE inhibitor

■35% mortality by age 55 y

Diabetes Mellitus, Type 2...............................

FREDRIC B. KRAEMER, MD

history & physical

History

■Known type 2 diabetes

■Family history of type 2 diabetes

■Obesity

■Metabolic syndrome (hypertension, obesity, elevated triglycerides,

low HDL)

■History of gestational diabetes or delivered baby with birth weight

>9.0 lbs

■Increased risk if Native American, Hispanic, African American,

Indian (Asia)

Signs & Symptoms

■May be asymptomatic