Diabetes

Diabetes is a disease that can have serious effects on many parts of your body, sometimes permanently. If left untreated, diabetes can lead to heart and kidney disease, amputations, blindness and other serious problems. 85,000 adults have been diagnosed with diabetes in El Paso.

Over 7.4 % of  Hispanics have been diagnosed with diabetes in El Paso and there are probably thousands more that have diabetes, but have simply not been diagnosed. The danger of diagnostic imaging a patient with diabetes is based on the decline of renal function in and the use of contrast materials. Intravascular administration of iodinated contrast may cause acute renal failure in a small percentage of individuals, particularly those patients with preexisting, or a predisposition to renal compromise (e.g., diabetics). Proper hydration may prevent contrast-induced renal compromise and for this reason, patient teaching on the need for hydration is extremely important.

Diabetics taking Glucophage (metformin) are at risk for lactic acidosis renal failure if metformin is taken concurrently with iodinated contrast media. Metformin (Glucophage) is a biguanide oral antihyperglycemic agent used to treat patients with non-insulin-dependant diabetes mellitus. The most significant adverse drug effect from Metformin is the development of lactic acidosis in the susceptible patient. Metformin appears to cause increased lactic acid production by the intestines.

The primary route of Metformin excretion is via the kidneys. Any factors that decrease Metformin excretion, such as renal insufficiency, or decrease lactate metabolism, such as liver disease, and cardiac or critical leg ischemia, place the patient at risk for Metformin associated lactic acidosis. Patient mortality in reported cases is approximately 50%.  For this reason, metformin cannot be taken for 48 hours after a contrast study and should not be restarted until Serum Creatinine is confirmed to baseline.

Radiologic contrast agents are not an independent risk factor for patients taking Metformin but are of concern only in the presence of underlying renal failure. Contrast media induced renal failure is rare in patients with normal renal function. Serum creatinine levels, however, may inaccurately reflect depressed glomerular filtration rate, particularly in elderly patients with reduced muscle mass.

Metformin should be temporarily withheld in patients who receive intravenous iodinated contrast media. If acute renal failure or insufficiency were to develop secondary to contrast administration, Metformin could accumulate, with subsequent lactate accumulation. The patients at highest risk, therefore, are patients with known, borderline, or incipient renal dysfunction

Diagnostic Outpatient Imaging provides diagnostic equipment that require no contrast media  to be used in order to get the same results. This is beneficial for diabetic patients or for those that may be at risk.

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