Home

Introduction
History
Physical Exam
Laboratory Tests
Counseling
Drug Therapy
Immunizations
Referrals

Forms/Links
Quiz

Prompt diagnosis and treatment of diabetes is extremely important in order to establish a patient's risk for related diabetic complications as well as to implement an appropriate treatment program.

While the vast majority of the patients that you will care for at the GOODLIFE/SHARING Clinics will be diagnosed with diabetes mellitus type 2, it is important to understand that two different types of diabetes exist. Patients with type 1 diabetes are often diagnosed during childhood and have an absolute deficiency of the hormone insulin. As you may recall, insulin is secreted by pancreatic beta cells in response to elevated blood glucose levels, such as those that occur after eating a carbohydrate meal. Without insulin, patients are unable to utilize glucose as an energy source and must rely on metabolism of proteins and lipids.

The focus of this web site is to expand your knowledge of diabetes mellitus type 2 and how to both assess and treat a diabetic patient. In diabetes type 2, the patient has a relative insulin deficiency because of resistance to the actions of insulin in muscle, fat, and the liver as well as an inadequate response by the pancreatic beta cells. This pathophysiologic abnormality results in decreased glucose transport in muscle, elevated hepatic glucose production, and increased breakdown of fat.

It is important to realize that both microvascular and macrovascular disease can develop in a diabetic patient as a result of poor glycemic control. Microvascular disease is defined as disease of smaller vessels such as those of the retina, kidneys, or peripheral nerves, the latter of which can reduce sensation. Macrovascular disease is defined as changes in larger vessels that can accompany diabetes, such as the coronary, cerebral, and large peripheral blood vessels.

If a patient’s blood glucose and other parameters known to play a role in development of complications (e.g., blood pressure and lipids) are monitored and maintained at appropriate levels, both micro- and macrovascular complications can be minimized. The key to treating diabetic patients is to understand that management of the disease is truly in their hands. Counseling and supporting patients throughout the course of the disease is vital.

The goal of the following sections is to help you feel more comfortable assessing a diabetic patient in clinic. The first portion discusses pertinent parts of the patient’s history followed by particular physical exam maneuvers necessary to investigate the possibility of microvasuclar and macrovascular complications. Important laboratory studies are also provided along with a description of common diabetic medications and suggestions for counseling. The final part consists of a post-test to help you gauge your understanding of diabetes, its assessment, and treatment.