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nice discussion..it is likely that we will have DM question.. so common.
My question is for Pindi or whoever can answer it.
If patient is symptomatic as in his case with a BS of more than 325. Why we do not admit it to do our work up because even if DK is remote in his case bacause it is type 2 DM. He can still undergo hyperosmolar coma.. Why we do not keep him for one or two days to settle his BS?
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most definitely if there is increased ANION Gap....he will be sent to ER.....we will not only admit him but also put him in the ICU......
But the case is designed to test the handling of a newly diagnosed DM case...to test how you initiate the treatment...this comes as an OFFICE case
DKA case comes on it's own as an ER case
i hope you understand waht these guys are expecting from the above 2 cases...
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If consulting at the outpatient service:
-complete hx and pe
-differentials: DM,DI,Factitious Disorder
-Admit to inpx service
-labs/imaging
cbc,diff & periph film
esr & crp, cxr, Lft, Pft, Chem 14, hba1c, water deprivation test, ekg,serum ,monofilament skin test,serum/urine ketones,serum/urine osmolarity,urine microalbumin.
-ivf nss,
-sliding scale:bld glucose 100-200-do nothing
bld glucose 200-300-5u insulin
bld glucose 300-400-10u insulin
bld glucose greater than 400- call the doctor
-insulin down to 100-200- change ivf to 5%d/s,downgrade insulin dose to 2.5u
-blood glucose (accucheck or finger stick) q2h,serum ketone q2h,serum osmolarity q2h,
-vitals q4h,Activity prn,foley's catheter for intake and output,1800 ADA (55-60% cho,less tham 30% fat,15-20% protein,vitamins,minerals,H20),bedtime lorazepam prn,tylenol prn
-pulse oximetry,cardiac monitor,oxygen,capnographyor ABG (all continuous)
-lisinopril and other anti HTN (if HTN)
-podiatry or chiropody consult
-endocrinilogy consult
-ophthalmology consult
-If insulin 100-200,dc insulin and institute glipizide,dc ivf
-counsel:weight loss,diet,exercise,annual ophthalmologic exam,foot care and protection,medication compliance,depression couseling,family counseling,medication side effect counseling,annual health maintenance and flu vaccine couseling.
-follow-ups.
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I think that Therapetic Lifestyle Changes (TLC) which includes diet,exercise and weight loss are recommended for 12 weeks,if patient meets cetain lipid profile parameters.
Fasting Bloog Blood of >=126mg/dl on two consecutive occasions is diagnostic of DM.
other:
-Lipid profile
-ua
-fundoscopy
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Medic alert bracelet indicated for chronically ill patients who may acute and sudden complications as the NIDDM as the initial post.The encounter frame may be either initial care or continued care .
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Posts: 3,675,937
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Posts: 3,675,937
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Nice discussion guys
i would also like to join u guys
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