A diagnosis of diabetic ketoacidosis (DKA) requires the patient’s plasma glucose concentration to be above 250 mg per dL (although it usually is much higher), the pH level to be less than 7.30, and the bicarbonate level to be 18 mEq per L or less. Continue reading
Foot ulcerations are among the most complex and heterogeneous complications in patients with diabetes. Skin ulcers need to be managed in different ways dependent on their etiology and pathogenesis.
The 10 Saint Elian Wound Score System (SEWSS) categories is helpful in guiding treatment decisions based on severity subcategories.
Hypoglycemia is the major limiting factor in the glycemic management of type 1 and type 2 diabetes. Recommendations from the International Hypoglycaemia Study Group regarding the classification of hypoglycemia considers a blood glucose <54 mg/dL (3.0 mmol/L) detected by self-monitoring of blood glucose (SMBG), continuous glucose monitoring (CGM) (for at least 20 min), or laboratory measurement of plasma glucose as sufficiently low to indicate serious, clinically significant hypoglycemia that should be included in reports of clinical trials of glucose-lowering drugs for the treatment of diabetes. However, a glucose alert value of </=70 mg/dL (3.9 mmol/L) can be important for therapeutic dose adjustment of glucose-lowering drugs in clinical care and is often related to symptomatic hypoglycemia. Severe hypoglycemia is defined as severe cognitive impairment requiring assistance from another person for recovery.
Latent autoimmune diabetes in adults (LADA) accounts for 2%-12% of all cases of diabetes. Patients are typically diagnosed after 35 years of age and are often misdiagnosed as type II Diabetes Mellitus (DM). Glycemic control is initially achieved with sulfonylureas but patients eventually become insulin dependent more rapidly than with type II DM patients.
“Prediabetes” is the term used for individuals with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) and indicates an increased risk for the future development of diabetes. IFG and IGT should not be viewed as clinical entities in their own right but rather risk factors for diabetes and cardiovascular disease (CVD). IFG and IGT are associated with obesity (especially abdominal or visceral obesity), dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension.
The American Diabetes Association (ADA) and the Veterans Health Administration (VHA) recommend diabetes screening beginning at 45 years of age; the ADA advises earlier screening in patients with risk factors.
The levels in this new diabetic retinopathy disease severity scale consist of five scales with increasing risks of retinopathy.
ATP III Definition
Any three or more of the following criteria:
Each insulin preparation has a different pharmacokinetic profile, i.e., onset, peak effect, and duration.
Wagner Classification of Diabetic Foot Ulcers
Grade 0: No ulcer in a high risk foot.
Grade 1: Superficial ulcer involving the full skin thickness but not underlying tissues.
Grade 2: Deep ulcer, penetrating down to ligaments and muscle, but no bone involvement or abscess formation.
Grade 3: Deep ulcer with cellulitis or abscess formation, often with osteomyelitis.
Grade 4: Localized gangrene.
Grade 5: Extensive gangrene involving the whole foot.