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The podcast for this weeks topic is covering diabetes. Obviously this is a huge topic. I continue to struggle with how much information to put into these review topics. How much is too much detail for a physician assistant exam review. How much is not enough? I guess I’ll find out when I take my PANRE. In an effort to keep things organized I have decided to split up DM1 and DM2 and cover them separately. Some of the symptoms and information will overlap, but I think it makes the most sense to cover this topic in two parts.
General information
- Greater than 95% diabetes type 1 is secondary to autoimmune disease affecting the islet beta cells of the pancreas.
- Genes related to HLA are contributing risk factors.
- It is believed that environmental factors also play a role in triggering this autoimmune response, but no specific link has been found yet.
- Very little or possibly no insulin secretion from the pancreas
- Avg age of diagnosis is 14
- Normal or low body weight
- DM is the leading cause of blindness in the United States
- DM accounts for approximately 30% of end stage renal disease om U.S.
- DM patients are at increased risk for atherosclerosis
Clinical Findings
- Patients may present in ketoacidosis
- very ill appearance
- nausea/vomiting
- polyuria & polydipsia secondary to hyperosmolar state
- abdominal pain
- change in mental state including stupor.
- fruity breath
- blurred vision
- glaucoma
- cataracts
- loss of sensation in limbs in a stocking glove distribution.
- 50-80% of non traumatic lower extremity amputations are secondary to DM. Video of 2nd toe debridement in a patient with a diabetic necrotic wound.
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