28/3/2020 Diabetes Course

Module 1.

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Ask Qualification
1. According to current figures, how many deaths per year are caused by diabetes?

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Diabetes is responsible for the largest number of cases of permanent blindness, chronic kidney failure
and non-traumatic amputations of the lower extremities, data that explain why it represents the leading
cause of mortality.
2. The initial evaluation of a patient with diabetes includes an interview that allows investigation of the
following data, except:

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Once it has been confirmed that the patient has diabetes, an initial evaluation must be carried out, in
which the doctor must do an interview that allows him to investigate, in addition to the basic
identification sheet, the following data:

1. The time of exposure to the disease

2. The age of onset
3. The treatments received
4. The cause of previous therapeutic failures
5. The history of hypoglycemia, especially if these were inadvertent or severe, defined by the need for
the intervention of a third party to prevent it.
6. Foot injuries
7. Frequent falls
8. Recent infections and hospitalizations (recording their causes)

Minimum, maximum and current weight; as well as the frequency with which the patient measures their
weight, capillary blood glucose and blood pressure at home.

3. It refers to the most common eating behavior alteration in people with diabetes.

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The term ED (Eating Disorder) includes pathologies such as bulimia, anorexia nervosa, binge eating
disorder and night eating syndrome. The most common is binge eating disorder defined by the
consumption of foods unrelated to appetite, associated with an affective response, more than twice a
week for more than six months.
4. There are some data that must be investigated during the interrogation, in addition to the patient's
basic identification sheet:

1. The time of exposure to the disease

2. Muscular atrophy
3. The age of onset
4. Onychomycosis
5. The treatments received
6. The history of hypoglycemia
7. Periodontitis
8. The cause of previous therapeutic failures
9. Changes in the shape of the feet
10. Frequent falls
11. Minimum, maximum and current weight

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28/3/2020 Diabetes Course
Once it has been confirmed that the patient has diabetes, an initial evaluation must be carried out, in which the doctor
must do an interview that allows him to investigate, in addition to the basic identification sheet, the following data:

1. The time of exposure to the disease

2. The age of onset
3. The treatments received
4. The cause of previous therapeutic failures
5. The history of hypoglycemia,
6. Foot injuries
7. Frequent falls
8. Recent infections and hospitalizations
9. Minimum, maximum and current weight

5. When the diameter of the neck is greater than 44 cm, it is suspected that the patient may present one of the
following syndromes.

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When the neck circumference is > 40 cm, it is highly suspicious and likely that the patient has sleep apnea.
6. The following studies are part of the initial evaluation of the patient with type 2 diabetes mellitus, except:

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The initial evaluation is completed with the following laboratory tests:

• A lipid profile (after fasting for 9 to 12 hours)

• Blood chemistry, transaminases, a general urine test, the albumin/creatinine ratio and the HbA1c value.
• Electrocardiogram.

7. What is the minimum goal applicable to all patients with diabetes and high blood pressure?

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The minimum applicable goal for all patients with diabetes and high blood pressure is to achieve a value less than 140/90
mmHg. More stringent goals (< 130 systolic pressure or < 80 mmHg diastolic pressure) are acceptable in younger people
or in those cases in which this goal is achieved without causing side effects).

8. These are some of the therapeutic objectives to be reviewed in each consultation:

1. Administration of acetylsalicylic acid

2. Smoking cessation
3. Triglycerides
4. Body weight
5. Review of the feet to prevent ulcers and amputations.
6. fasting glucose
7. Cholesterol
8. Blood pressure
9. Blood glucose
10. Self-care
11. Vaccination
12. Annual ophthalmological and dental check-up

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• Monitoring is based on the adaptation of the interventions to the characteristics and needs of the patients.
• The systematic search for barriers to achieving therapeutic adherence and achieving a negotiated solution with the
patient and their family is the basis for increasing the percentage of cases in control.

Ramiro is a 32-year-old man whose reason for consultation is the onset of diabetes. His father died at age 45 from
kidney failure; He had type 2 diabetes mellitus diagnosed at age 25. His mother is 70 years old and apparently healthy.
He has four brothers and two healthy children. Two of his older brothers have type 2 diabetes diagnosed at ages 25 and
28 respectively. He smokes a pack of cigarettes a day. He has little physical activity. He has been of medium build since
childhood. In the last year it has remained stable at 73 kg.

For six months he has had easy fatigue, postprandial drowsiness, and nocturnal paresthesias in his lower limbs. He
reported dizziness when changing position, postprandial fullness, and self-limiting explosive diarrhea once a week.
Sometimes there is identifiable fat in the stool. The diarrhea subsides during fasting periods but the consumption of dairy
products aggravates it. Due to prolonged fasting, he has developed hypoglycemia.

On physical examination, his weight was 73 kg and his height was 170 cm. Blood pressure was 145/85 mm/Hg and heart
rate was 95 beats/min. His waist diameter was 85 cm. Thinning of the lower limbs was found. Laboratory tests showed
the following results: glucose 155 mg/dl, HbA1c 9.5%, creatinine 1.1 mg/dl, uric acid 2.1 mg/dl, cholesterol 254 mg/dl,
triglycerides 90 mg/dl and HDL-cholesterol 38 mg/dl. dl. General urine examination: glucosuria ++++, albuminuria
negative.

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28/3/2020 Diabetes Course
9. Of the following symptoms that Ramiro presents, which ones are due to hypoglycemia?

1. Cold sweating
2. Exhaustion
3. Dizziness and headache
4. Dream

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Prolonged fasting can cause hypoglycemia and the symptoms you may experience are: cold sweats, weakness, dizziness
and headache. So if you have them, the ideal is to check your glucose at the moment and if it is less than 70 mg/dl, take
15g of carbohydrates (equivalent to half a glass of juice or three candies), let 15 minutes pass and check again. glucose
level to confirm that the symptoms have disappeared or decreased.
10. Identify the category to which the patient belongs:

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According to the “Global Alliance for the Effective Treatment of Diabetes” and based on their diagnosis and according to
the severity of their disease, the case is stratified into the group with a history of chronic hyperglycemia, with
complications attributable to diabetes.
11. Diabetes education includes training for the following except:

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Diabetes Education:
Includes training for:

1. Measure capillary blood glucose and blood pressure at home,

2. Foot care, footwear selection,
3. The adaptation of treatment during the days in which there is an intercurrent illness,
4. Prevention and treatment of hypoglycemia,
5. The insulin administration and storage technique (if applicable) and
6. The gradual empowerment of the patient to achieve self-care.
7. The adjustment of diet and physical activity based on the results of capillary blood glucose or variations in food
consumption.

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