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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 #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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Practical Diabetes Care, 3rd Ed., Excerpt #17: Diabetes and the Eye Part 1 of 4

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David Levy, MD, FRCP      Introduction Diabetic retinopathy is the most common clinically significant microvascular complication of diabetes, but cataract is the most common ocular complication, with a prevalence of about 60% in those aged 30–54, five times more frequent than in those without diabetes. Diabetes is also associated with raised intraocular …

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Practical Diabetes Care, 3rd Ed., Excerpt #16: Diabetic Renal Disease Part 5 of 5

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David Levy, MD, FRCP Renal replacement therapy The decision to start dialysis is often difficult. The clinical decision is based on many factors, including the presence of uremic symptoms and weight loss, and biochemical measurements including serum creatinine (e.g. serum creatinine 700–800 μmol/L(small mu), eGFR < 12–14 mL/min, falling albumin, hyperkalemia). …

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Practical Diabetes Care, 3rd Ed., Excerpt #13: Diabetic Renal Disease Part 2 of 5

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David Levy, MD, FRCP Quantification of Urinary Albumin Excretion The following methods are in current use: Spot early-morning urine specimen expressed as ACR (mg/mmol or mg/g): albumin excretion corrected for urine output; 24-hour urinary albumin excretion (mg per 24 hours); Timed (usually overnight) AER (µg/min); Urinary albumin concentration uncorrected for creatinine …

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