Clinical Gems

Diabetic Neuropathic Disorders John R. White, Jr., PharmD, PA R. Keith Campbell, PharmB, MBA, CDE Travis E. Sonnett, PharmD Adaptation by Matthew Szabo, PharmD (candidate) Overview The two most common forms of neuropathy that affect diabetes patients are diabetic peripheral neuropathy (DPN) and diabetic autonomic neuropathy (DAN). 

Long-Term Complications and Treatments Steve V. Edelman, MD Robert R. Henry, MD Microvascular Complications (cont’d) Gastroparesis This neuropathy should be suspected in patients with nausea, vomiting, early satiety, abdominal distention, and bloating following a meal, and is secondary to delayed emptying and retention of gastric contents. The delay in gastric emptying …

Long-Term Complications and Treatments Steve V. Edelman, MD Robert R. Henry, MD Microvascular Complications (cont’d) Treatment for Diabetic Nephropathy Treatment is aimed at early detection and prevention, focusing specifically on improving glycemic control, aggressively treating hypertension (e.g., with ACE inhibitor or ARB therapy and other agents as necessary), and restricting …

Long-Term Complications and Treatments Steve V. Edelman, MD Robert R. Henry, MD Microvascular Complications Retinopathy, nephropathy, and neuropathy are the major microvascular complications of Type 2 diabetes. Prevention, early detection, and aggressive treatment are essential to reduce associated morbidity and mortality. Good metabolic control has been clearly shown to prevent the …

Long-Term Complications and Treatments: Dyslipidemia Steve V. Edelman, MD Robert R. Henry, MD Dyslipidemia Lipid abnormalities that accelerate atherosclerosis and increase the risk of CV disease are significantly more common in patients with type 2 diabetes than in nondiabetic individuals. In addition, central obesity associated with type 2 diabetes is …

Long-Term Complications: Macrovascular Steve V. Edelman, MD Robert R. Henry, MD The long-term, chronic complications of diabetes have the greatest impact on the health of individuals with diabetes as well as on the health care system. Diabetes and its associated vascular complications are the fourth leading cause of death in …

Metabolic: Hyperosmolar Hyperglycemic Nonketotic Syndrome Steve V. Edelman, MD Robert R. Henry, MD This acute metabolic complication is a life-threatening crisis with a high mortality rate that usually is seen in: Elderly patients with Type 2 diabetes (particularly those in nursing homes without access to free water) People with undiagnosed …

Assessment of the Treatment Regimen, Part 2 Steve V. Edelman, MD Robert R. Henry, MD Measuring Other Glycated Proteins Enhanced glycation of other proteins occurs in diabetes and has been proposed as another method of assessing average glucose control. Because of….  

Assessment of the Treatment Regimen, Part 3 Steve V. Edelman, MD Robert R. Henry, MD Self-Monitoring of Blood Glucose (SMBG) Systems A combination of factors affect the overall performance of SMBG systems…

Assessment of the Treatment Regimen, Part 4 Steve V. Edelman, MD Robert R. Henry, MD Applying SMBG Results to Adjust Insulin Doses Patients can be taught how to analyze and use SMBG data to effectively make adjustments in their insulin doses so that they can maintain and improve glycemic control…. …