Clinical Pearls

• Diabetes Mellitus is one of the most important concepts in medicine to have a good grasp on, as so many people in the US have it

• Quite literally, nearly every person in the US has at least one family member with the disease

• Subsequently, it is imperative that you have a good working knowledge of it, not only for your success at HEA, but also for your future in medicine

• Diabetic eye changes are a large part of what we see here at HEA!

Diabetes has 2 major types

1) Diabetes Mellitus Type 1 (AKA: "DM 1" or "DM I")

• Insulin Deficient/Dependant

• These patients have the beta cells in their pancreas destroyed usually from autoimmune disease, and therefore, cannot produce insulin

2) Diabetes Mellitus Type 2 (AKA: DM 2 or DM II)

• Insulin Resistance

• This is the most common type and the most important to understand!

• There is so much insulin in the blood for years on end, that eventually, insulin receptors on cells surface  suffer a "burnout effect" and no longer respond to it

• DM 2 can have elements of insulin deficiency involved, but is mostly insulin resistant

Diabetic Eye Exam

Any patient that has diabetes needs the following documented at the bottom of the intake for the day

1) Hemoglobin A1c ("HbA1c" or "A1c")

• This is one of the most important lab values in a diabetic patient! It is the gold standard for monitoring a patient's diabetes.

•  It is a measure of the percentage of glucose that is bound to hemoglobin in the blood over a 2-3 month period (the lifecycle of an Erythrocyte).  

• This essentially gives us a look at how well a patient's blood sugar has been controlled over this period.  

• Every person has a normal amount (less than 6.5%) but values above this are suspicious for type 2 Diabetes

• Ask the patient when their last A1C was and what the value was. If they do not know, then document this

2) Fasting Blood Sugar (FBS)

• This value is indicative of a person's blood glucose after an 8- 12 hour fast. This is usually done right in the morning before consuming anything. 

• Values above 100 mg/DL could indicate diabetes or pre- diabetes, but HbA1c is still the best for monitoring a patient's diabetes

• Many people have a continuous glucose monitor embedded into the back of their arms 

• Ask the patient when their last FBS was and what the value was. If they do not know, then document this