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cingulate_gyrus2006
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Medicine - Intensive management of diabetes mellitus (AIIMS
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11.09.07 (10 months ago)
#1
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Which of the following is not included in intensive management of diabetes mellitus:
a. Pregnancy..
b. Postural hypotension due to autonomic neuropathy
c. DM
with acute MI
d. Post kidney transplant
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cingulate_gyrus2006
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12.22.07 (8 months ago)
#2
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Thnaks shardul to the reply and reference
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Staphylococcus
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12.22.07 (8 months ago)
#3
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but if the question is only autonomic neuropathy.... i'l go fo MI coz its a macrovasc. cmplication.. others microvasc. complications.. harrison clearly states intensive diabetic mgmt in microvasc,. abn.
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cingulate_gyrus2006
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12.24.07 (8 months ago)
#4
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| Staphylococcus wrote: |
| but if the question is only autonomic neuropathy.... i'l go fo MI coz its a macrovasc. cmplication.. others microvasc. complications.. harrison clearly states intensive diabetic mgmt in microvasc,. abn. |
Yes u seems to be right according to Harrison..
Speed gives the answer as autonomic neutropathy causing postural hypotension..
so what to do if the question repeats…
They gave reference as some journel “Journel of diabetis vol 12 Number 2 199 Pages 84-88”
It says intensive comprehensive care both acutely and chronically may help diabetic patients with MIs and reduce serious and often fatal complications..
I think better to go for ur answer
Here is Harrison Quote….
Diabetis melitis...Harri Page 2172 -2173 --17 th edi
Intensive Management
Intensive diabetes management has the goal of achieving euglycemia or near-normal glycemia. This approach requires multiple resources including thorough and continuing patient education, comprehensive recording of plasma glucose measurements and nutrition intake by the patient, and a variable insulin regimen that
matches glucose intake and insulin dose. Insulin regimens usually include multiple-component insulin regimens, multiple daily injections (MDI), or insulin infusion devices (each discussed below).
The benefits of intensive diabetes management and improved glycemic control include a reduction in the microvascular complications of DM
and a possible delay or reduction in the macrovascular complications of DM
. From a psychological standpoint, the patient experiences greater control over his or her diabetes and often notes an improved sense of well-being, greater flexibility in the timing and content of meals, and the capability to alter insulin dosing with exercise. In addition, intensive diabetes management in pregnancy reduces the risk of fetal malformations and morbidity. Intensive diabetes management is strongly encouraged in newly diagnosed patients with type 1 DM
because it may prolong the period of C-peptide production, which may result in better glycemic control and a reduced risk of serious hypoglycemia.
Although intensive management confers impressive benefits, it is also accompanied by significant personal and financial costs and is therefore not appropriate for all individuals. Circumstances in which intensive diabetes management should be strongly considered are listed in Table 323-10.
TABLE 323-10 Indications for Intensive Diabetes Management
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• Otherwise healthy adults with either type 1 or type 2 diabetes (selected adolescents and older children)
• Purposeful, therapeutic attempt to avoid or lessen microvascular complications
• All pregnant women with diabetes; all women with diabetes who are planning pregnancy
• Management of labile diabetes
• Availability of health care professionals with appropriate expertise
• Patients who have had kidney transplantation for diabetic nephropathy
So i think autonomic complication comes under microvacular complication here that answer is MI...
By the fraim of the question also I think the examiner is has the above logic in mind...
Please opine... U experts....
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cingulate_gyrus2006
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12.24.07 (8 months ago)
#5
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Help...
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cute_angel
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12.27.07 (8 months ago)
#6
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if we strictly follow harrisons the answer should be DM
with acute mi.. though it sounds more dramatic..
but the catch here is that even though it is a macrovascular complication here the pt is coming to us in emergency..
please substantiate the answer
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Staphylococcus
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12.27.07 (8 months ago)
#7
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see guys if the option is only autonomic neuropathy , then go for MI... if it is wid postural hypotension, then go for autonomic neuropahty..
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cingulate_gyrus2006
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12.27.07 (8 months ago)
#8
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| cute_angel wrote: |
if we strictly follow harrisons the answer should be <a href="http://www.t9space.com/power/s2/http/www.rxpgonline.com/forum54.html">DM
</a> with acute mi.. though it sounds more dramatic..
but the catch here is that even though it is a macrovascular complication here the pt is coming to us in emergency..
please substantiate the answer |
Yea ..But in that case priority for managment is given for MI know, Treatment of diabetic part comes as second prioriy...
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