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Suggest Suitable Therapy For Diabetes
49yrs old female, type2 diabetes for 7 yrs, bilateral great49yrs old female, type2 diabetes for 7 yrs, bilateral great toe ulcers, non healing for last 1 year, HbA1c-9% , VPT and HCP-grossly impaired, ABI:right-1.01, left-0.92 1. what other information do you require from this patient? 2. what is the primary goal of treatment for her? 3. do you think her diabetes control is adequate , and if not what might you suggest? 4. what teaching would you do with this patient? 5. what are the plans regarding treatment of her ulcers?
Mon, 29 Sep 2014
Hello there,
Impression so far: Poorly controlled DM With Diabetic neuropathy + neuropathic ulcers (most probably), No PAD.
Answer:
1) I would want to know Urine albumin/creatinine ratio, S. Creatinine levels, Lipid profile, SMBG, type of footwear used, level of awareness of foot care and hypoglycemia.
2) Primary goals: DM control, Ulcer healing, early detection of nephropathy/retinopathy/CVD
3) No her DM control is not adequate and needs to be less than 7 (A1c) or at least 7. Without knowing her current regimen cannot advise changes. But aggressive control with basal bolus insulin if required.
4) Teach SMBG, Foot care, Change in foot wear, if needed casting.Hypoglycemia awareness (considering plan for insulin)
5)Good antibiotic cover, Good sugar control, Debridement if necessary,Off loading with proper foot wear, meet a podiatrist if required.
Take care.
Impression so far: Poorly controlled DM With Diabetic neuropathy + neuropathic ulcers (most probably), No PAD.
Answer:
1) I would want to know Urine albumin/creatinine ratio, S. Creatinine levels, Lipid profile, SMBG, type of footwear used, level of awareness of foot care and hypoglycemia.
2) Primary goals: DM control, Ulcer healing, early detection of nephropathy/retinopathy/CVD
3) No her DM control is not adequate and needs to be less than 7 (A1c) or at least 7. Without knowing her current regimen cannot advise changes. But aggressive control with basal bolus insulin if required.
4) Teach SMBG, Foot care, Change in foot wear, if needed casting.Hypoglycemia awareness (considering plan for insulin)
5)Good antibiotic cover, Good sugar control, Debridement if necessary,Off loading with proper foot wear, meet a podiatrist if required.
Take care.
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