Clinical Gems

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetes and hypertension have been termed the ‘bad companions’ for cardiovascular disease risk. Diabetes alone increases this risk 2 – 4-fold; in the presence of hypertension, the risk for coronary heart disease is further trebled and for stroke, doubled. There is also …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Dyslipidemia in type 2 diabetes Abnormalities of blood lipids are common in patients with type 2 diabetes, even when there is reasonable glycemic control. The characteristic dyslipidemia of type 2 diabetes consists of elevated very low-density lipoprotein (VLDL) triglyceride (TG) levels, reduced …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Symptoms, signs and classification Diabetes is one of the most common causes of peripheral neuropathy, a term that encompasses a heterogeneous group of disorders (Figure 17.1). In population-based surveys, up to one-third of patients with diabetes have evidence of peripheral neuropathy but …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetic nephropathy is a clinical diagnosis based upon the detection of proteinuria in a patient with diabetes in the absence of another obvious cause such as infection. Many of these patients will also be hypertensive, have retinopathy and, in advanced stages, renal …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetic eye disease primarily affects the retinal vasculature, but the iris and lens can also be involved. Most people with diabetes will show signs of retinopathy after 25 years duration, but only a minority progress to the severest form. Photocoagulation has revolutionized …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Much of the impact of chronic diabetes results from the development of tissue complications, mainly microvascular (retinopathy, nephropathy and neuropathy) and macrovascular disease (atherosclerosis). Microangiopathy is characterized by progressive occlusion of the capillary lumen with subsequent impaired tissue perfusion, increased vascular …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Etiology and clinical presentation Hypoglycemia is a common side effect of treatment with insulin and oral antidiabetic drugs, especially sulphonylureas, and is a major factor preventing patients with type 1 and 2 diabetes from achieving near normoglycemia. The brain is dependent …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetic ketoacidosis (DKA) is a state of severe uncontrolled diabetes caused by insulin deficiency. It is characterised by hyperglycaemia, hyperketonaemia and metabolic acidosis, and has been somewhat arbitrarily divided into mild, moderate and severe based upon biochemical and clinical features (Table 12.1)….

This week, we are taking a break from our Clinical Text presentations, to bring you this exclusive interview with Al Mann, the legendary founder of Mannkind Corp, and the person primarily responsible for backing the development of the inhaled insulin product, Afrezza, soon to be on the market. Steve Freed: …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Lifestyle modification The starting points and mainstays of treatment for type 2 diabetes are diet and other modifications of lifestyle, such as increasing exercise and stopping smoking (Figure 11.1). The major aims are to reduce the weight of obese patients and …