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Students will be referring to a “Diabetes” section on my class web page to guide them through the majority of the unit. On the following pages, I have provided you with the links they will be using to find the information required to complete the Clinical Diagnosis Packet. PART I: DIAGNOSING & MANAGING DIABETES DIAGNOSING DIABETES Lab Tests Online: Glucose Tests http://www.labtestsonline.org/understanding/analytes/glucose/test.html SELF-MONITORING BLOOD GLUCOSE Diabetes Handbook: Ch. 5- Monitoring http://www.umassmed.edu/diabeteshandbook/chap05.htm Diabetes Handbook: Ch. 8- Insulin http://www.umassmed.edu/diabeteshandbook/chap08.htm URINE GLUCOSE TESTING Diabetes Handbook: Ch. 5- Monitoring http://www.umassmed.edu/diabeteshandbook/chap05.htm INSULIN Lab Tests Online: Glucose Tests http://www.labtestsonline.org/understanding/analytes/glucose/test.html Diabetes Handbook: Ch. 8- Insulin http://www.umassmed.edu/diabeteshandbook/chap08.htm TESTING THE URINE FOR KETONES Diabetes Handbook: Ch. 5- Monitoring http://www.umassmed.edu/diabeteshandbook/chap05.htm HEMOGLOBIN (A1C) TEST: Lab Tests Online: A1C http://www.labtestsonline.org/understanding/analytes/a1c/test.html Clinical Diabetes: The Expanded ABC’s of Diabetes Care http://clinical.diabetesjournals.org/cgi/content/full/21/3/128 DIAGNOSING & TREATING DISEASES ASSOCIATED WITH DIABETES CARDIOVASCULAR DISEASES Diabetes Handbook: Ch.12- Complications http://www.umassmed.edu/diabeteshandbook/chap12.htm ABC’s of Diabetes Care http://clinical.diabetesjournals.org/cgi/content/full/21/3/128 KIDNEY DISEASE DiabetoValens.com- The Diabetes Guide http://my.diabetovalens.com/infocus/feafeb0404.asp ABC’s of Diabetes Care http://clinical.diabetesjournals.org/cgi/content/full/21/3/128 Physicians Reference Laboratory: Kidney Function Panel http://www.prlnet.com/Kidney.htm Diabetes Handbook: Ch.12- Complications 57, 58 http://www.umassmed.edu/diabeteshandbook/chap12.htm NEUROPATHY Diabetics Foot Disease: An Interactive Guide http://www.diabetes.usyd.edu.au/foot/Neurop1.html Diabetes Handbook: Ch. 12- Complications http://www.umassmed.edu/diabeteshandbook/chap12.htm ABC’s of Diabetes Care http://clinical.diabetesjournals.org/cgi/content/full/21/3/128 RETINOPATHY: New England Eye Center: Diabetic Retinopathy http://www.neec.com/Vitreoretinal_Disease_Diabetic_Retinopathy.html PERIODONTITIS Diabetics Handbook to Complications with Teeth http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/index.htm Periodontal Disease: Diagnosis and Treatment http://www.stevedds.com/periodon.htm INFECTION ABC’s of Diabetes Care http://clinical.diabetesjournals.org/cgi/content/full/21/3/128 Clinical Diagnosis Packet Name_____________________________ PART I: DIAGNOSING & MANAGING DIABETES DIAGNOSING DIABETES 1. Name five symptoms of diabetes/hyperglycemia. 2. In order to diagnosis diabetes, when is the blood drawn to determine the fasting blood glucose level? 3. If the symptoms of diabetes are present, but the blood glucose level from the above test is not very high, the oral glucose tolerance test may be required. What is involved in this test? 4. Complete the charts below. FASTING BLOOD GLUCOSE: Lab Result Meaning From _____ to _____ mg/dL Normal glucose tolerance (_____ to ______ mmol/L) From _____ to _____ mg/ dL Impaired fasting glucose (pre-diabetes) (_____ to ______ mmol/L) _____ mg/dL ( _____ mmol/L and above) Probable diabetes ORAL GLUCOSE TOLERANCE TEST (2 hours after a 75-gram glucose drink) Lab Result Meaning Less than _____ mg/dL (_____mmol/L) Normal glucose tolerance From _____ to _____ mg/ dL Impaired fasting glucose (pre-diabetes) (_____ to ______ mmol/L) Over 200mg/dL (_____ mmol/L) Probable diabetes 5. What is meant by “pre-diabetic” levels? 6. What are some reasons, other than pre-diabetes or diabetes, that a person may have elevated blood glucose levels? SELF-MONITORING BLOOD GLUCOSE 7. How many times a day (range) are diabetics advised to test their own blood glucose levels (Self Monitoring Blood Glucose- SMBG), and what are typical times of day recommended for testing? 8. Complete the following chart regarding blood glucose level guidelines for SMBG: TIME: EXCELLENT GOOD FAIR POOR Before a meal (or fasting) After a meal 9. What are the 3 causes of fluctuations in blood sugar level? 10. What are some common reasons for blood sugar fluctuations? URINE GLUCOSE TESTING 11. Why isn’t simple urine testing used to determine glucose levels? (Give 3 reasons) 12. Considering the drawbacks of urine testing, why would a doctor decide that this is the best option for some patients? 13. What percentage range indicates a positive urine test? 14. A negative urine test indicates that the blood glucose level is probably below _______. INSULIN 15. What do the insulin test and the C-Peptide test monitor? 16. What are signs of an allergic reaction to insulin (mild/generalized)? 17. Insulin edema may develop when insulin therapy is started, subsiding in a few weeks. What are the signs? 18. What is lipohypertrophy? 19. What is lipoatrophy, and why is the condition now rare? 20. What happens to the blood glucose level when one has an insulin reaction? 21. What are common triggers of an insulin reaction (hypoglycemia)? 22. What are the symptoms of a mild hypoglycemia, and what should be done? 23. What are the symptoms of moderate hypoglycemia, and what should be done? 24. What are the symptoms of severe hypoglycemia, and what can family member do to help? TESTING THE URINE FOR KETONES 25. At what blood glucose level would a doctor recommend the patient to test the urine for ketones, and in general, what do ketones in the urine signify? HEMOGLOBIN (A1C) TEST 26. What is the glycosylated hemoglobin/ hemoglobin A1C test and why is it tested? 27. A normal level on the glycosylated hemoglobin (A1C) test can result from what two situations? 28. What is a good test result for the A1C test if you are a diabetic? 29. Each 1% decrease in A1C translates into a __________% decrease in the frequency of microvascular complaints. DIAGNOSING & TREATING DISEASES ASSOCIATED WITH DIABETES CARDIOVASCULAR DISEASES 30. To what does macrovascular disease refer? Briefly describe arterio/atherosclerosis. 31. What blood pressure level is indicative of hypertension? 32. Hypertension increases the risk of what related health problems for diabetics? 33. Epidemiological analyses show that blood pressures > _______ mmHg are associated with increased cardiovascular event rates and mortality in people with diabetes. 34. What are the target lipid levels for diabetics? 35. Why is lipid management so important? 36. Explain, in your own words, why aspirin is used for the prevention of cardiovascular events. 37. What dosage does the ADA recommend for aspirin therapy for all adult patients with diabetes and macrovascular disease? 38. What is the name of the medication that can be used as adjunctive therapy for very-high-risk patients or as alternative therapy in aspirin-intolerant patients? 39. What is peripheral vascular disease, and what symptoms result if blood flow is only partially interrupted versus completely interrupted? 40. How is peripheral vascular disease treated? 41. What is coronary artery disease, and what medical conditions result if blood flow is decreased versus completely blocked? 42. What are the symptoms of partial/complete blockage of coronary arteries? 43. What are treatments of coronary artery disease? 44. What is cerebral vascular disease? 45. What is the medical phrase given to describe a reduction in blood flow due to a partial blockage in an artery of the brain? 46. What causes complete loss of blood supply to an area of the brain, and what is the result? 47. What are symptoms of a partial/complete blockage of cerebral arteries? KIDNEY DISEASE 48. What is microalbuminuria, and why is it a sign of diabetic nephropathy? 49. Of what, other than nephropathy, is microalbuminuria a well-established marker? 50. What are normal levels of urine microalbumin? 51. What level is indicative of macroalbuminuria? 52. What is creatinine and blood urea nitrogen (BUN), and why are blood tests for these administered to measure kidney function? 53. What is the reference range for BUN? 54. What is the reference range for creatinine? 55. What are the signs and symptoms of kidney disease? 56. Name 3 treatments for kidney failure. 57. What causes diabetic bladder dysfunction, and what further organ complications can result from this dysfunction? NEUROPATHY 58. Describe the various stages of treatment required for neuropathic ulcer. 59. What body parts are involved in peripheral neuropathy? 60. What body parts are involved in autonomic neuropathy? 61. With what is autonomic neuropathy most often associated? 62. What are the symptoms of autonomic neuropathy? 63. What are some treatment options for the above symptoms? 64. What should be included in the annual comprehensive foot examination for diabetics? 65. What are the foot-related risk conditions that are associated with an increased risk of amputation? RETINOPATHY 66. Comprehensive eye examinations are important for diabetics. What is the name of the therapy that can prevent the loss of vision for those with diabetic retinopathy and why is it effective? 67. What surgery is used to treat hemorrhage (into the vitreous chamber)/retinal detachment? 68. What surgery is used for the treatment of cataracts? PERIODONTITIS 69. Why do individuals with diabetes have an increased risk for gum disease (periodontitis)? 70. What are the signs/symptoms of gum disease? 71. What is the difference between gingivitis and periodontitis? 72. The clinician checks for the amount of tartar (calculus), checks the mobility of all teeth, and evaluates the bite. Why are x-rays needed? 73. Treatment of periodontitis involves “scaling and root planning.” What is this? 74. What is the goal of treatment? 75. Why are laser treatments sometimes used? INFECTION 76. Why are immunizations so important for diabetics? 77. What immunizations are recommended, and what are the indications for repeat vaccination?
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