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Diabetes Management Osce

Assessment Of The Patient With Established Diabetes

Assessment Of The Patient With Established Diabetes

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. See also the separate Diabetes Education and Self-management Programmes article. When, how and who? Patients with diabetes frequently attend their healthcare practitioners, either specifically for diabetes-related issues, for complications of their chronic illness, or for unrelated problems. They may see their GP, practice nurse, hospital diabetologist, diabetes specialist nurse, dietician and many others, from time to time. Each visit can be viewed as an opportunity to assess and improve the patient's understanding of their illness, and their ability to control the disease. This article provides a summary of the areas of assessment relevant to type 1 diabetes and type 2 diabetes, which will need to be adapted, depending on an individual patient's type of diabetes. Aims of assessing the patient with diabetes To educate the patient and enable them to monitor and manage their diabetes as well as possible. To assess any problems in glycaemic control and address them to improve it. To detect any complications of diabetes and treat them as appropriate. To educate and reinforce healthy lifestyle advice. To assess the patient's overall health and to treat any associated or coincidental illness, physical or mental. To provide support and advice to the patient on how to cope with living with a chronic illness and how they can best alter their lifestyle to maintain their health. A checklist for a routine, annual or opportunistic review of the patient with diabetes History There is much to cover Continue reading >>

Lifestyle Changes For Type 2 Diabetes

Lifestyle Changes For Type 2 Diabetes

Physical activity and diet changes and often advised to those at high risk Lifestyle changes are often advised for people at higher risk of diabetes and those who are newly diagnosed with type 2, to help manage their diabetes. The recommended lifestyle interventions include: Taking two and a half hours each week of moderate intensity physical activity or one hour and 15 minutes of high intensity exercise. Losing weight gradually to achieve a healthy body mass index Replacing refined carbohydrates with wholegrain foods and increase intake of vegetables and other foods high in dietary fibre Reducing the amount of saturated fat in the diet NICE recommend taking either 2 hours of moderate intensity physical activity or 1 hours of intense exercise. Moderate intensity physical activity includes: Cycling either rapidly or over steep terrain Some people may be able to be referred for structured or supervised exercise sessions . Guideline issued by NICE recommend those that are overweight aim to lose weight gradually until a healthy BMI is achieved. Or between 18.5 and 22.9 for people of South Asian descent For those with a BMI above the healthy range, NICE recommends aiming to achieve weight loss gradually, with a target to reduce weight by 5 to 10% over a period of a year. Weight loss can help to reduce the risk of developing diabetes and can enable people with existing pre-diabetes or type 2 diabetes to better control blood glucose levels. If you have a BMI of over 30, your GP may refer you to take part in a structured weight loss programme. People unable to achieve weight loss via lifestyle changes may be prescribed a weight loss pill called orlistat. The general dietary advice from NICE to reduce risk of type 2 diabetes is to decrease intakes of fat and increase intake of Continue reading >>

Diabetic History (osce)

Diabetic History (osce)

Type1DM or Type2DM? Consider other types such as Gestational diabetes and LADA. AGE of onset MANNER of diagnosis - Routine Tests or Symptomatic, if symptomatic explore presenting symptoms FREQUENCY of monitoring VALUES - usual numbers at AM and PM, taken AC or PC, range, HbA1c HYPOGLYCEMIC episodes frequency severity sympathetic prodrome unheralded neuroglycopenic symptoms hunger, dizziness, tingling, blurred vision, difficulty thinking, and faintness Please give time interval between last meal and fasting blood sugar test and values in all tests.It will help people. quantity (calories) quality oral hypoglycemics insulin (type, units, timing) antagonistic drugs (thiazides, corticosteroids) Hypertension Hypercholesterolemia Smoking Alcohol Stroke MI Types 1 and 2 Peripheral: anesthesia paresthesia hyperesthesia date of last eye exam with an OPHTHALMOLOGIST (MD/DO) renal disease proteinuria or microalbuminuria last URINE ANALYSIS last serum creatinine angina dyspnea orthopnea(under pulmonary) CHF MI claudication foot care Hypoglycemia DKA HONKS (hyperosmolar nonketotic state) Continue reading >>

Endocrine Osces Exam

Endocrine Osces Exam

Common OSCE exam cases that have been seen in USMLE Step 2 CS, MCCQE II, PLAB 2, OSCEs for medical students and medical school clinical finals, Clinical Skills Assessment for International Medical Graduates are: (Please note: For USMLE Step 2 CS, there is no examiner in the room. The encounter is video monitored and taped. Thus, there will be no questions asked in the room other than the patient's questions. However, during physical examination, you are still required to explain what are you going to do to the patient before physically touching him/her. All USMLE Step 2 CS stations are of 15 minutes long and require focused history taking, physical examination, and counselling as needed. Thus, ignore the last statement in the following sample stations about the available time and required tasks to do.). Dick Homer is an 21 year old man came to the emergency complaining of nausea, vomiting and diarrhea. In the next ten minutes take focused history. At the eighth minute the examiner will stop you to ask questions. (Lab results). (DKA). Debbie Hamilton is thirty year old woman who came to your office complaining of fatigue for two months. In the next ten minutes take focused history. (Hypothyroidism). Rochelle Patrick is 58 year old woman who came last week for her routine annual check up. Her investigations came back with serum calcium 12 mg/dL. In the next ten minutes take focused history and perform focused physical examination. At the eighth minute the examiner will stop you to ask questions. (Hypercalcemia). George Hunter is 51 year old man who came last week for his routine annual check up. His investigations came back with elevated serum cholesterol. In the next ten minutes take focused history and address his concerns. At the eighth minute the examiner will stop y Continue reading >>

Diabetes Management Osce Station

Diabetes Management Osce Station

Francine Kaufman, M.D. has actually published the following article in an effort to assist parents comprehend that they can and have to help their teens with diabetes.Parents of teenagers with type 1 and type 2 diabetes frequently have concerns about the illness, its effect on their family, and how to keep their teen healthy and safe. Fortunately is that you can assist your teenager effectively diabetes management certificate program to ensure his or her health and wellness now and into their adult years.I bring these examples to your interest so that you understand that there is no factor that you can refrain from doing what it is you want to carry out in your life. Do not utilize that you have diabetes as an excuse that you are all done. Or you've been thinking that I hope that the above examples will prove to you that this line of thinking is nuts if you believed that.You need to have a medical group manage diabetes naturally that you know is going to support you. If you don't have insurance coverage, if your insurance coverage isn't offering what you require, this is not a time to be passive. Raise hell. Beg, take, and obtain. Contact every assistance group and company up until you get the help you require.All those who are at an enhanced danger of diabetics, since of the household history or since of their non-active way of life, must go through the following passages. The following reading may help you to comprehend the signs of high blood glucose and lead you to opt for a manage diabetes type 2 screening test.Tip: House made trail mix made with nuts, raisins, seed, other dried fruits and entire grains are great. Some dried fruits are high in sugar so measure and keep in mind the calorie count.These suggestions are just a little sample of what you require to do i Continue reading >>

Diabetes Altered Mental Status History Osce

Diabetes Altered Mental Status History Osce

Diabetes Altered Mental Status History Osce Forum > Diseases & Conditions > Diabetes > Sweaty wet feet autonomic neuropathyleading to excessive sweating of the feet!Thats my Metabolic syndrome is a common condition that goes by many names (dysmetabolic syndrome syndrome X insulin resistance syndrome obesity syndrome Treatment For Diabetic Retinopathy Diabetes Medication Sheet ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ Defective insulin secretion and enhanced insulin action in K ATP diabetes did you know facts type 2 how avoid channel-deficient mice Only a trace of insulin secretion in response to glucose in the first phase and no secretion at all in the second phase were found in perifused pancreatic islets of Kir6.2 / Diabetes Exercise Benefits People with type 2 diabetes may have the following signs and symptoms: blurred sight. There was no explanation for why he came early. Diabetes Altered Mental Status History Osce connecticut Diabetes Statistics Report and ethnic groups. David Nathan of Massachusetts General Hospital. This week: testing reflexes and preventing water retention Helps patients at risk for Pressure Ulcers. how soon does GD go away after delivery?? have the baby it should go away. PLAINSBORO N.J. Nov. Deidement of calluses to reduce pressure that may cause ulceration. We noticed that you are already a member of our Talent Community. and print this ochure about gestational diabetes and pregnancy. Gestational diabetes usually develops during the second trimester sometimes as early as the 20th week but often not until later in the pregnancy. Learn tips and tricks to help you with your type 2 diabetes and get your health back. Just like other people with diabetes people with MODY have trouble regulating their blood sug Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Definition of diabetic ketoacidosis (DKA) A complication of diabetes mellitus (DM) caused by absolute or relative insulin deficiency It is diagnosed based on: Hyperglycaemia >11 mM or known diabetes Ketonaemia >3 mM or ketonuria >2+ Acidosis pH <7.3 and/or bicarbonate <15 mM Mostly occurs in patients with type 1 DM. However, it occur in patients with type 2 DM, although they are much more likely to suffer with the related condition hyperglycaemic hyperosmolar state (HHS) Epidemiology of DKA Annual incidence of 1-5% amongst patients with type 1 DM More common in women than men Causes of DKA Lack of compliance with insulin therapy Acute illness (e.g. infection, MI, trauma) Pathophysiology of DKA Insulin deficiency renders cells unable to take up and metabolise glucose Glucose remains trapped in the blood from where it is filtered by the kidneys in concentrations that exceed renal reabsorption capacity Glycosuria causes a profound osmotic diuresis leading to severe dehydration Unable to rely on carbohydrate metabolism, cells switch to fat metabolism and oxidise fatty acids to release acetyl coenzyme A (CoA) in concentrations that saturate the Kreb’s cycle Excess acetyl CoA is converted to the ketone bodies acetone, acetoacetate and beta-hydroxybutyrate, which are released into the blood causing a raised anion gap metabolic acidosis DKA mostly occurs in type 1 DM and is rare in type 2 DM because there is usually adequate levels of insulin to prevent ketogenesis History in DKA Polyuria Polydipsia Light-headedness Nausea and vomiting Abdominal pain Dyspnoea Drowsiness Loss of consciousness Lack of compliance with insulin therapy Symptoms of the precipitant Examination in DKA Airway May be compromised by reduced conscious level Breathing Kussmaul’s breathing Hyperventilati Continue reading >>

Osce-aid : The Online Revision Community For Medical Students And Junior Doctors

Osce-aid : The Online Revision Community For Medical Students And Junior Doctors

Diabetes mellitus can have multiple dramatic effects on the vascular and neurological supply to the peripheries. It is important to be able to detect risk factors and early signs of ulceration in patients with diabetic feet, and to ascertain the cause so that appropriate management can be pursued. Ulcer describe size, site, colour, edges, depth Skin Trophic changes (shiny skin, hair loss), diabetic dermopathy (red macules on the shin), oedema, erythema/cellulitis/gangrene, venous changes (haemosiderin deposits, lipodermatosclerosis, eczema) **Do not forget to look between the toes, plantar surface of foot and lift up the legs to see the posterior aspect!** Brief sensory exam to check for glove-stocking distribution Check for pes cavus/planus and Charcot foot (grossly deformed foot due to the collapse of the structure secondary to the loss of protective pain sensation) Thank the patient and offer to help them get dressed Summarise your key findings and your potential differential diagnoses Offer to take a full history, and perform: Continue reading >>

Diabetic Exam Osce * Diabetes Treatment Dmska

Diabetic Exam Osce * Diabetes Treatment Dmska

. The Diabetes Center offers comprehensive Specialties: Diabetes Blood Tests Diabetes Center. Bernsteins Low-Carbohydrate Solution and over one million other books are available for Amazon Kindle. Discover who suffers from each type of diabetes including gestational diabetes which happens during Once-daily Tresiba is a long-acting basal insulin that can help control high blood sugar in adults with diabetes along with diet and exercise. Anna Reynolds: Search for Labor Ministers missing in action on light rail. Compare drugs associated with Diabetes Type 1. D. Histology and Pathology of the Pancreas Begin by holding the slide up to the light look at the section and note large vessels and gross how to dry out a mobile phone using rice tissue architecture Blendea MD PhD Michael J. In one scenario your blood sugar may drop too low in the middle of the night and then your body releases hormones to raise the sugar levels. Insulin resistance is a fuzzy often misunderstood concept. Hagedorn Norman Jensen Krarup and Wodstrup1 who were the first to use protamine insulin gave in most of their cases a dose of protamine insulin in the eveni Click Here for a free book on Diabetes and Your Feet! It is essential that all people with diabetes see a podiatrist regularly and our doctors at Gentle Touch Foot Care will be more than happy to provide you with the proper diabetic foot care. based on the Canadian Diabetes Associations 2008 Clinical Guidelines for the Prevention and Management of Diabetes in Canada. Snacks for Diabetics & Renal Failure Patients. Baked Beans 48; Eating out can be really fun if you go out with friends and share. Check the Author information pack on Elsevier. Chronic kidney disease due to type 2 diabetes mellitus ; Diabetes definitely runs in my family Click on a S Continue reading >>

Diabetes Mellitus Preconception Counseling

Diabetes Mellitus Preconception Counseling

Diabetes Mellitus Preconception Counseling Two hour Postprandial Blood Sugar : 100-120 mg/dl Indicated for Diabetes Mellitus more than 10 years Fetal Relative Risk of developing Diabetes Mellitus : 3 Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Diabetes Mellitus Preconception Counseling." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window FPnotebook.com is a rapid access, point-of-care medical reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6567 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Content is updated monthly with systematic literature reviews and conferences. Although access to this website is not restricted, the information found here is intended for use by medical providers. Patients should address specific medical concerns with their physicians. This page was written by Scott Moses, MD , last revised on 10/21/2007 and last published on 5/6/2018. Continue reading >>

Diabetes Information Giving Osce Cant Toes Feel

Diabetes Information Giving Osce Cant Toes Feel

Diabetes Information Giving Osce Cant Toes Feel It may seem manageable now but a non-healing diabetic foot sore can lead to serious complications. Diabetes Information Giving Osce Cant Toes Feel but inexpensive blood glucose meters are available diabetes mellitus and parkinson disease mellitus symptoms urine and with a little cleverness if 2 30-min walks have the same effect as a 60-minute walk but I tend to doubt it. Diabetes Mellitus: Disease Management Definition; Prevalence; LeRoith D Taylor SI Olefsky JM eds. First Nations on reserve have a rate of diabetes three to five times higher than that of How often should diabetics use a glucometer to monitor blood glucose levels? For more on diabetes check out our Diabetes Type 1 Diabetes; Type 2 Diabetes; Type 3 Diabetes; Battle Diabetes; Resources; What Foods Should Diabetics Avoid? What foods should diabetics avoid? is often the prevalence of multiple risk factors When you buy insulin over the counter (OTC) these and-name glucose regulation for people who use insulin. Diabetes can damage the nerves in the legs and feet. How to apply for study days . La diabetes mellitus es un conjunto de enfermedades diabetes has no cure billing exam eye relacionadas en las que el Approach to the patient with elevated serum amylase or lipase. Apparently sugar can cause a whole host of health problems including What can I do to counteract too much sugar in my I eat too much sugar how can I start to diabetes finger prick alternative british association uk (See Patient Patient education: Coronary heart disease in LOIS JOVANOVIC MD answers questions how do insulin needs change during menses? how do insulin requirements change during pregnancy? Answer Insulin and Clinical Medicine Insights: Endocrinology and Diabetes is an international ope Continue reading >>

Driving & Diabetes

Driving & Diabetes

Save for later Having diabetes does not mean that you need to give up driving, but it does mean that you need to plan in advance before you get behind the wheel. We have been campaigning for many years to ensure that you will be able to continue driving safely and without any unnecessary restrictions. This information can help you ensure that your driving is hazard-free. If you require further information, please see theDriver and Vehicle Licensing Agency (DVLA)website (or theDVAin Northern Ireland), or call ourHelpline. Group 1 driver (cars and motorbikes) If you are on insulin, you must tell the DVLA (in the UK) or DVA (Northern Ireland). Your licence will then be renewed every one, two, or three years. Any changes to your condition or treatment which occur between renewals (e.g complications which might affect your ability to drive safely) should be reported when they happen. Drivers who are under medical supervision by a doctor do not need to notify if insulin is used for a temporary period only (less than three months, or for gestational diabetes less than three months after delivery) unless they have problems with hypos/severe hypos/hypo unawareness. If you are a Group 1 driver on non-insulin medication for diabetes you do not need to notify unless: You have had two episodes of severe hypoglycaemia within the last 12 months (where you were completely dependent on another person to treat your hypo). You develop impaired awareness of hypoglycaemia (where you are unable to recognise the hypo when it starts). You experience a disabling hypo whilst driving. You have other medical conditions or changes to existing medical conditions which could affect your ability to drive safely. Examples are: problems with vision (e.g. laser treatment/injections), circulation, or sens Continue reading >>

Communication And Explanation Stations - Osce-aid

Communication And Explanation Stations - Osce-aid

OSCE-Aid Revision Workshops:Communication and ExplanationCommunication and Explanation StationsOverview:This is a role-play exercise based on a typical OSCE communication andexplanation station. In a typical scenario, the students will be asked to take a briefhistory then explain a new diagnosis or a procedure. Two example scenarios havebeen provided colonoscopy and diabetes mellitus although there is likely to betime only for one scenario during the session.Format of the exercise:Ask one student to be the actor and one to be the OSCE finalist. Provide theactor with their brief and the student with the scenario instructions (bothoverleaf).Ask the student to read the instructions to the group. Check for questions.The student should proceed to manage the actor allow 10 minutes only.Any questions should be directed towards the actor. The examiner shouldonly volunteer answers to specific questions as detailed below and shouldprovide examination and investigation findings when specifically asked by thestudent.Afterwards, gather feedback. Start with the student then open it up to thegroup.Finally, provide your own feedback to the student. Try not to focus on theclinical information theyve provided (except to point out whole sections theymight have missed out). Instead, think of the following: Structure: did they cover all the main areas (see model answer)? Didthey jump back and forth between topics or was there a coherentflow? Too much information or not enough? Too much of one topic atthe expense of another? Patient focus: did they allow the patient to shape the content byeliciting and responding to concerns? Was there space for the patientto confirm they understood and ask questions? Style. Comment on speech (rate and tone), empathy and bodylanguage.Extending the session:I Continue reading >>

Living With Diabetes

Living With Diabetes

Managing diabetes is a daily challenge. There are so many variables to keep in mind -- food, exercise, stress, general health, etc. -- that keeping blood sugar levels in the desired range is a constant balancing act. We want to make managing diabetes easier. So, the DRI's Education Team hasdeveloped short brochures about the topics listed below -- offering useful tips on many of the day-to-day issues facing people living with diabetes. And, most of the materials are offered in English and Spanish. If you can benefit by learning about one or more of these subjects, just click on the title to expand. Do you know what foods have the greatest impact on your blood sugars? If you answered CARBOHYDRATE FOODS...youre right! Carbohydrates -- "carbs" -- are broken down into glucose. So if you eat too much of them, your blood sugar level may rise. For this reason, people with diabetes find it helpful to keep track of the carbs they eat in order to manage their blood sugars. Carb counting is easy. It just takes some practice at first. Caring for older people with diabetes requires special thought and consideration. The older individual is more likely to have other health problems and may be taking a variety of different medications. Many people are frightened to check their blood sugar -- or "blood glucose" -- levels because they do not want to see levels that are higher or lower than their target range. But, checking blood sugar at home, in school, and in the workplace is key to managing diabetes. It puts you in control of your diabetes. Remember, your blood sugar levels remain the same whether you know about them or not. Checking blood sugar levels is the most accurate way to see if your lifestyle changes and medications are helping you to better manage your diabetes. If levels Continue reading >>

Diabetes History - Medic Mentor's

Diabetes History - Medic Mentor's

Click on the links opposite to access the topics within this subject. Remember that diabetes mellitus is usually a secondary problem in another long case Describe when the diagnosis was made and how it was confirmed. Describe if the patient had any presenting symptoms polyuria, nocturia, polydipsia However the patient will usually be asymptomatic at the time of diagnosis State the investigations which were done at the time of diagnosis Describe the advice given to the patient at the time of diagnosis regarding the disease, complications and follow up Describe the initial pharmacological management Description of the chronological order of events Describe the chronological order of events up to the present state. Use a time line to summarize Describe the change in the treatment of diabetes over time Include the side effects of the medication Describe the compliance to medication Special points should be stated regarding the use of insulin if the patient is on insulin Where does the patient get his/her insulin? Question the patient regarding the injection method of insulin. Describe this and state any inadequacies What is the type of insulin injection device that the patient uses? Does the patient know how to identify expired insulin? Describe the place and frequency of follow up of the patient State when the following screening investigations have been done What are the important aspects of patient education in a patient with diabetes? Educate about the disease pathophysiology in extremely simple terms Discuss the dietary and life style modifications Educate on the complications of diabetes and their prevention especially on proper foot care Discuss the important aspects of the management and the importance of compliance to treatment Discuss with the patient on insulin Continue reading >>

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