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Retinopathy

Non-proliferative (background)

Pre-proliferative

Proliferative Advanced Retinopathy

Maculopathy

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Pre-proliferative

Venous beading / loops

Intraretinal microvascular abnormalities (IRMA)

Multiple cotton wool spots

Non-urgent referral to an ophthalmologist

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Nephropathy

Covered in detail Urinary Module(Systemic diseases affecting the kidney)

Microalbuminuria overt proteinuria

ACEi / ARB

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Autonomic Neuropathy

CVS tachycardialoss of sinus arrhythmia

postural hypotension

GIT - gastroparesis

nocturnal diarrhoea Bladder - loss of tone

incomplete emptying & stasis infection

Male erectile dysfunction

commondue to - anxiety, depression, alcohol, drugs (thiazides,beta-blockers), inadequate vascular supply

counselling of both partners

Phosphodiesterase type-5 inhibitors (sildenafil)

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DKA Management

Diagnosis - Hyperglycaemia - blood glucoseKetonaemia - ketostixAcidosis - blood gas

Investigations - Blood glucoseUrea and electrolytesFull blood countBlood gasesBlood and urine cultureChest X-rayECGCardiac enzymes

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Phase 2 Management When blood glucose falls to 10-12 mmol/L change

infusion fluid to 1 L 5% dextrose plus 20 mmol KCl 6-hourly

Continue insulin with dose adjusted according to hourlyblood glucose test results

Phase 3 Management Once stable and able to eat and drink normally, transfer

patient to four times daily subcutaneous insulin regimen

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