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Old 07-08-2011
kemoo's Avatar
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Question Two questions about DM ?

1)why in DM type 2 failure of medication occur and we need to switch to insulin

i remember this concept was in step 1?

2) another question do we need to do eye examination for DM type 1?

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Old 07-08-2011
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1) as time goes on, the pancreas is exhausted and cannot produce more and more and more insulin in type 2 DM. we know that type 2dm has insulin resistance and the pancreas thinks that its produce is not sufficient and makes more and more and more and finally stops. Thats when the insulin secreatogouge's don't work and thats when we start giving insulin in type 2DM.

2) type 1dm presents early and may present in ketotic state and thus we diagnose it in an earlier state. Since all chronic complications of diabetes happen when diabetes is present for a long time (say 10years, thats why we call them chronic complications), the retino/nephro/neuropathies are not present at diagnosis in type1, so we defer eye testing for 5 yrs after diagnosis in type 1dm.

Hope this helped!
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arunjose (07-08-2011)
Old 07-08-2011
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Here is a little bit more organized about eye screen in diabetes
  • In patients with diabetes, we recommend screening for diabetic retinopathy. Screening must be performed by those with expertise and can be accomplished with dilated fundus examination or retinal photography.
  • In patients with type 1 diabetes, we suggest initiating screening three to five years after diagnosis. In patients with type 2 diabetes, we suggest initiating screening soon after the time of diagnosis
  • In patients found to have no abnormalities on the initial screening examination, we suggest annual follow-up examinations Some experts suggest less frequent examinations (every two to three years) in low risk patients with normal examinations.

    Follow-up in patients with retinal abnormalities depends upon the type and severity of the abnormalities. Patients with macular edema, severe nonproliferative retinopathy, or proliferative retinopathy should be closely followed by an ophthalmologist experienced in the management of diabetic retinopathy.
Pregnant women
  • Women with diabetes who are planning pregnancy should be counseled on the risk of development and/or progression of diabetic retinopathy.
  • In pregnant women with preexisting diabetes who would not otherwise be due for screening, we suggest that such screening be performed during the first trimester. More frequent retinal evaluations are required during pregnancy and for one year postpartum.

    This guideline does not apply to women who develop gestational diabetes, as these women are not at increased risk for diabetic retinopathy.
Reference : UpToDate
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Endocrinology-, Internal-Medicine-

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