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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 #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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Practical Diabetes Care, 3rd Ed., Excerpt #11: Infections in Diabetes Part 3 of 3

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David Levy, MD, FRCP Diabetic foot infections (see also Chapter 10) Multidisciplinary teamwork with specialist podiatrists is crucial. Patients in primary care must be referred for specialist wound débridement and dressing, which are as important as antibiotic treatment. Worsening clinical features of infection are associated with increasing rates of hospitalization and …

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Practical Diabetes Care, 3rd Ed., Excerpt #9: Infections in Diabetes Part 1 of 3

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David Levy, MD, FRCP Introduction Infections in patients with diabetes are a persistent trap for both the inexperienced and world-wise physician. Whenever someone with diabetes presents unwell, always consider the possibility of infection. High blood glucose levels predispose to some acute infections, especially postoperatively, but other mechanisms are involved, for example …

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Practical Diabetes Care, 3rd Ed., Excerpt #9: Pharmacological Treatment of Hyperglycemia Part 2 of 2

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David Levy, MD, FRCP Drugs acting on the incretin system (entero-insular axis) (Fig. 6.2) The incretin effect Bayliss and Starling inferred the existence of gut-derived substances affecting carbohydrate metabolism more than a century ago, but the incretin effect was not described until 1969: the observation that for a given achieved level …

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