Links

Diabetes at FGH

Aspirin:

• No benefit in asymptomatic cardiovascular disease: html pdf 

Metformin and Vitamin B12 deficiency

• PubmedSearch
• Risk factors of vitamin B(12) deficiency in patients receiving metformin [pubmed | free pdf]; Intro: 30% vitamin B12 malabsorption in patients on long-term metformin Tx; MF dcrs VitB12 levels by 14-30%; Results: each 1g/d MF dose increment conferred OR of 2.9 (2.1-3.9) for developing VitB12 deficiency (p<0.001); taking MF > 3 (vs < 3) yrs conferred OR of 2.4.

"Alphabet Strategy" [pdf:JBS2'05]

• Advice—edu., self Mngmnt, Tx concordance, smoking cess., diet, phys. activity, wt reduction, preconception, DVLA, MedicAlert
• BP<130/80mmHg [diuretic,ACEI/ARB,CCB]
• Chol=min(<4.0|-25%) & LDL-C=min(<2.0|-30%)
• Diabetes: HbA1c% 6.5%: Metformin for T2DM esp if hi wt
• Eyes: yearly digital photography
• Feet: yearlyexamination
• "Guardian" drug: Aspirin75 mg if { establ'datherosclerotic dis. | htn | age50yrs | DM>10yrs }

Links

DUK (http://www.diabetes.org.uk/APCProgrammeAPC8 v g*) | ADA

Diagnosis

• http://www.idf.org/webdata/docs/WHO_IDF_definition_diagnosis_of_diabetes.pdf;
• NB: (only) in postprandial state: capillary glucose>venous plasma glucose: conversion:
  ven 7.8 = cap 8.9;
  ven 11.1 = cap 12.2;

Carbohydrate counting [top]

• http://www.leedsth.nhs.uk/sites/diabetes/food/CarbohydrateCountingRef.php
• DAFNE trial

Inpatient Management [top]

• http://clinical.diabetesjournals.org/cgi/reprint/22/2/81.pdf
• http://content.nejm.org/cgi/reprint/355/18/1903.pdf

Ketones [top]

• nml<0.6mmol/L
• 0.6-1.5mmol/L (& Glu>16.7): may need assistance
• >1.5mmol/L (& Glu>16.7): risk of DKA
• [Src: Optium Xceed leaflet]

"Alphabet Strategy" [pdf:JBS2'05]

• Advice—edu., self Mngmnt, Tx concordance, smoking cess., diet, phys. activity, wt reduction, preconception, DVLA, MedicAlert
• BP<130/80mmHg [diuretic,ACEI/ARB,CCB]
• Chol=min(<4.0|-25%) & LDL-C=min(<2.0|-30%)
• Diabetes: HbA1c% 6.5%: Metformin for T2DM esp if hi wt
• Eyes: yearly digital photography
• Feet: yearlyexamination
• "Guardian" drug: Aspirin75 mg if { establ'datherosclerotic dis. | htn | age50yrs | DM>10yrs }

Driving

• http://www.dvla.gov.uk/media/pdf/medical/aagv1.pdf

GI dysfunction

• for diarrhoea (due to changes in alpha-adrenergic receptors): Clonidine 100mcg od [-300mcg od]
• if impaired sphincter function: refer GI Physiology Dept, Hope Hospital