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By
Jeff M. Robbins, DPM
Director, Podiatry Services
VA Central Office
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"The podiatric practitioner must have a strong
working knowledge of not only the pedal complications of Diabetes Mellitus, but
also other systemic morbidity associated with this disease. It is no
secret that Americans are getting more and more obese, and with this increase in
obesity, the concomitant rise in the prevalence of diabetes, especially Type 2,
is no coincidence. The purpose of this talk is to gain an overall
perspective of this disease, from diagnosis through complications and management
principles.
If there is one essential take home message, it would be that
medicine today is NOT an individual pursuit. It is interdisciplinary and requires
close communication and cooperation of patients, their families and many health
care providers that seek to control this disease and limit its
complications"
Jeff M. Robbins, DPM
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Each year, the American Diabetes Association publishes its
Clinical Practice Recommendations. The most recent document was released
in January of 2004. The document is a compilation of hundreds of
individual references that represent the most recent evidence and expert
opinion. Dr. Robbins strongly encourages us to read over the changes
made to the previous document, as new ADA Clinical Practice
Recommendations are released.
The chronic hyperglycemia of diabetes is associated with
long term damage, dysfunction and failure of various organs; especially the
eyes, kidneys, nerves, heart and blood vessels. The risk of heart disease
and stroke is 2-4 times greater in patients with diabetes. Diabetes is the
leading cause of blindness, accounting for 12,000-24,000 new cases yearly.
Sixty percent of non-traumatic amputations are seen in patients with diabetes
mellitus. Forty three percent of kidney disease is related to diabetes
mellitus. Prolonged periods of hyperglycemia may cause a decrease in chemotaxis, the ability to phagocytize, which results in decreased
intracellular destruction of bacteria.
Dr. Robbins reviews the Types of diabetes. Type 1
(pancreas produces little or no insulin), Type 2 (ineffective insulin
production), Gestational diabetes and a new classification,
"prediabetes". Management principles and goals of therapy
are discussed with careful adherence to ADA guidelines.
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ADA GUIDELINES |
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A1C
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<7.0%
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Preprandial plasma glucose
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90-130 mg/dl
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Peak Postprandial plasma glucose
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<180 mg/dl
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Signs |
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Blood Pressure
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<130/80 mm/Hg
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LDL
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<100 mg/dl
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Trigylcerides
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<150 mg/dl
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HDL
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>40 mg/dl
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Dr.
Robbins also cites changes in the new ADA guidelines.
Oral medications for diabetes help control blood glucose
levels in people whose bodies still produce insulin. Dr. Robbins discusses
the oral medications that are available and their mechanisms of action.
Type 1 diabetes patients always need insulin. The various types of insulin
are reviewed, with particular attention to their speed of action and length of
their activity.
PRESENT Courseware recommends that practitioners not only
play an active role in the well being of their patients, but also support the
activities of the American Diabetes Association. Listed below are some activities
which will help raise awareness of diabetes and provide much needed financial
support of this organization.
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