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Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

Practical Diabetes Care, 3rd Ed., Excerpt #26: Hypertension Part 1 of 5

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David Levy, MD, FRCP      Introduction Despite more clinical trials than any other aspect of diabetes, many questions still remain about hypertension. Treatment targets continued to fall after UKPDS (1998), but even in contemporary trials with the most stringent treat-to-target protocols they are rarely achieved (see Chapter 8). Because antihypertensive agents, like …

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Practical Diabetes Care, 3rd Ed., Excerpt #25: Diabetic Neuropathy Part 5 of 5

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David Levy, MD, FRCP      Erectile dysfunction This is the commonest neuropathic complication: 20% of men have erectile dysfunction (ED) at diagnosis, increasing to 34% at 12 years (UKPDS). The prevalence in a newly diagnosed Kuwaiti population was 30%, and nearly 50% in a large survey of Canadians attending their primary-care physicians …

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Practical Diabetes Care, 3rd Ed., Excerpt #24: Diabetic Neuropathy Part 4 of 5

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David Levy, MD, FRCP      Mononeuropathies and other focal syndromes Peripheral mononeuropathies Upper limb Carpal tunnel syndrome (median nerve) Carpal tunnel syndrome is very common (remember the association with primary hypothyroidism, especially in type 1 diabetes) and may present with atypical symptoms, as it is often superimposed on diabetic polyneuropathy. Consider it …

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Practical Diabetes Care, 3rd Ed., Excerpt #23: Diabetic Neuropathy Part 3 of 5

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David Levy, MD, FRCP      Charcot neuroarthropathy Charcot neuroarthropathy is a serious and poorly understood condition associated with rapid destruction of bones and joints and resulting in bone fragmentation. It occurs only in patients with advanced sensory and autonomic neuropathy, and is characteristic of long-duration type 1 diabetes with other microvascular complications, …

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Practical Diabetes Care, 3rd Ed., Excerpt #22: Diabetic Neuropathy Part 2 of 5

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David Levy, MD, FRCP      Foot ulceration The ulcerated, infected and possibly gangrenous foot is a common reason for hospital admission. Anatomically, diabetic foot ulceration is restricted to the region distal to the ankle; proximal lesions are more likely ischemic, vasculitic, venous, or to have another underlying cause. Most ulcers are predominantly …

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Practical Diabetes Care, 3rd Ed., Excerpt #21: Diabetic Neuropathy Part 1 of 5

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David Levy, MD, FRCP      Introduction The devastating consequences of diabetic neuropathy are seen every day both in hospital – more bed days are taken up with the consequences of diabetic foot ulceration than any other diabetic complication – and in primary care, where sensory symptoms, especially pain, and autonomic neuropathy, especially …

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Practical Diabetes Care, 3rd Ed., Excerpt #19: Diabetes and the Eye Part 3 of 4

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David Levy, MD, FRCP      Pre-proliferative retinopathy An important diagnosis, as there is a very high risk of progression to proliferative retinopathy and significant visual loss. Pre-proliferative changes are characterized by the following. Multiple (> 5) cotton-wool spots. Multiple large blot hemorrhages. Venous abnormalities: irregularities, beading, looping or reduplication. Intraretinal microvascular abnormalities: …

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Practical Diabetes Care, 3rd Ed., Excerpt #18: Diabetes and the Eye Part 2 of 4

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David Levy, MD, FRCP      Non-proliferative diabetic retinopathy Background retinopathy Microaneurysms Small, red, intraretinal lesions usually found at the posterior pole of the eye, around the disc and macula. They occur in areas of capillary non-perfusion and show leakage of fluorescein. It is worthwhile estimating the number of microaneurysms as it has …

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