1.Outpatient care for DM: 
-ask about hypoglycemia
-ask about sugar control
-screen foot exam annually (inspection, foot pulses, 10-g monofilament plus testing any one of the following: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold)
-protinuria screen yearly
-dilated eye yearly
-A1C every 3-6 mos dpending control
-lipids annually
-vaccinations
-Stress test if they have sx, anbl ekg, abnl exam.
-aspirin?
2. Inpatient management of DM
-Things affecting glucose control: NPO, loss appetite, acute stress
-Avoid hypoglycemia (death)
-Hyperglycemia will impair immune response and healing.
-Goal 110 fasting 180 postprandial
-Don't stop oral hypoglycemics if they can eat
-If they're really sick or will need studies, hold PO hypoglycemics
3. Inpatient management of DM-- insulin 
-Drop basal insulin by 1/2 to 2/3 if theyre going to be NPO
-Don't stop all their meds and replace with SSI: maintain home insulin regimen +SSI if needed.
-Total insulin 0.6 u/kg/day, or home dose, half if crcl<60
-Half of total dose basal, half prandial - if eating, divide prandial dose by # meals.
4. Sliding Scale:  
-Low schedule (<40 u/day)
BG 150-199: 1 unit bolus Insulin (regular or rapid-acting)
BG 200-249: 2 units bolus Insulin
BG 250-299: 3 units bolus Insulin
BG 300-349: 4 units bolus Insulin
BG Over 350: 5 units bolus Insulin
-Medium schedule (40-81 u/day)
BG 150-199: 1 unit bolus Insulin (regular or rapid-acting)
BG 200-249: 3 units bolus Insulin
BG 250-299: 5 units bolus Insulin
BG 300-349: 7 units bolus Insulin
BG Over 350: 8 units bolus Insulin
-High schedule (Insulin-resistant) (>81 u/day)
BG 150-199: 2 unit bolus Insulin (regular or rapid-acting)
BG 200-249: 4 units bolus Insulin
BG 250-299: 7 units bolus Insulin
BG 300-349: 10 units bolus Insulin
BG Over 350: 12 units bolus Insulin
5. DKA
-Gap acidosis
-+ketones (B-OH-butyrate)
-More common in DM1
-Usually stress trigger - look for it.
-Tx with fluid bolus (avg deficit 5-7 L). Give 0.9 NS
-Tx w insulin (start with insulin drip until the gap is corrected, then transition to SQ long acting insulin with an overlap of several hours)
6. HONC 
-More common in DM2
-Sugars > 600
-No ketones, no acidosis, serum osmolality > 320
-Tx with fluids (avg deficit 10L) 0.9 NS. Avoid LR because it has K and lots of people have renal failure
-Give insulin, but less than for DKA
7. Secondary DM
-Drug induced: steroids, tacrolimus, cyclosporine, thiazides, B-blockers
-Other disease: cushings, gestational, pancreas dx, CF, hemochromatosis
8. When to get EKG
-Baseline - people at risk for heart disease
-Maintenance - people with heart disease that you want to monitor
-Diagnosis - people with symptoms.
9. EKG
-large box 0.5 mV given normal scaling.
-small box 0.04s, large box 0.2 s
-Rhythm: if there is a p before every qrs, and qrs after every p = p:qrs ratio = 1
-P wave should be upright in 2, and down in AVR
10.