USMLE Forum Archives - USMLE Step 3 - CCS - New onset DM
CCS - New onset DM
meduploader - 01-02-09 13:21
A 45 yrs old male comes to your office for routine health maintenance visit. He has history of HTN for last 10 yrs maintained with lisinopril and hypercholesterolemia for 2 yrs for which he takes atorvastatin. Recently he feels tired and lost 6 lbs weight. His BMI = 27kg/m2.
How to approach this case?
Location : Office
Complete PE
Orders:
CBC
BMP
RBS
CXR
EKG
UA
RBS result : >11.1 mmol/L ( 212mg/dl)
Follow-up visit: 3 days
Orders:
FPG
Result shows : >7.0 mmol/L ( >126mg/dl)
S, The DM is confirmed…now do..
Serum Antibody to Insulin
HbA1C
24 Hr Urinary Protein
BUN
Serum Creatinine
Lipid Profile
Serum TSH
Stress Test ( if CAD )
Now specific treatment for DM:
It depends on initial FPG level and HA1c:
Glycemic Control:
Diet
Life Style
Exercise
Medication : For this pt we can start with Metformin, po
Treat Associated conditions:
Dyslipidemia - Atorvastatin
HTN - Lisinopril
CAD
Screen for/ or Manage Complications:
Retinopathy
Nephropathy
Neuropathy
Self-monitoring of blood glucose (individualized frequency)
A1C testing (2–4 times/year)
Patient education in diabetes management (annual)
Medical nutrition therapy and education (annual)
Eye examination (annual)
Foot examination (1–2 times/year by physician; daily by patient)
Screening for diabetic nephropathy (annual)
Blood pressure measurement (quarterly)
Lipid profile and serum Creatinine (estimate GFR) (annual)
Influenza/pneumococcal immunizations
RATED SEX
meduploader - 01-02-09 13:21
A 45 yrs old male comes to your office for routine health maintenance visit. He has history of HTN for last 10 yrs maintained with lisinopril and hypercholesterolemia for 2 yrs for which he takes atorvastatin. Recently he feels tired and lost 6 lbs weight. His BMI = 27kg/m2.
How to approach this case?
Location : Office
Complete PE
Orders:
CBC
BMP
RBS
CXR
EKG
UA
RBS result : >11.1 mmol/L ( 212mg/dl)
Follow-up visit: 3 days
Orders:
FPG
Result shows : >7.0 mmol/L ( >126mg/dl)
S, The DM is confirmed…now do..
Serum Antibody to Insulin
HbA1C
24 Hr Urinary Protein
BUN
Serum Creatinine
Lipid Profile
Serum TSH
Stress Test ( if CAD )
Now specific treatment for DM:
It depends on initial FPG level and HA1c:
Glycemic Control:
Diet
Life Style
Exercise
Medication : For this pt we can start with Metformin, po
Treat Associated conditions:
Dyslipidemia - Atorvastatin
HTN - Lisinopril
CAD
Screen for/ or Manage Complications:
Retinopathy
Nephropathy
Neuropathy
Self-monitoring of blood glucose (individualized frequency)
A1C testing (2–4 times/year)
Patient education in diabetes management (annual)
Medical nutrition therapy and education (annual)
Eye examination (annual)
Foot examination (1–2 times/year by physician; daily by patient)
Screening for diabetic nephropathy (annual)
Blood pressure measurement (quarterly)
Lipid profile and serum Creatinine (estimate GFR) (annual)
Influenza/pneumococcal immunizations
RATED SEX
Page 1
#1
Re: CCS - New onset DM bingousmle - 06-18-10 08:17 a nice summary.. to this we can add if the patient is above 40 yrs he can be started on aspirin if there are no contraindications. and the flu shot every one year and the pneumococcal vaccine only once
#2
Re: CCS - New onset DM babbu5508 - 06-18-10 15:01 Screening for diabetic retinopathy (DR) is important because the majority of patients who develop DR have no symptoms until macular edema (ME) and/or proliferative diabetic retinopathy (PDR) are already present.
#3
Re: CCS - New onset DM bingousmle - 06-18-10 15:26 yes, for the purpose of CCS however it would suffice if these are just mentioned in the five minute screen and not essential as a work up as this is a newly diagnosed case of DM
Page 1