Diabetes Medical Examination

Non-Insulind Dependent Diabetes Mellitus Medical Examination

Diabetes History:

Patients with diabetes commonly present with the following symptoms: polyuria, polydipsia, nocturia, weight loss, and polyphagia, blurred vision, recurrent infections mainly in the genital region such as fungal infections,

Ask about past episodes of hypoglycemia, which present with: palpitations, sweating, anxiety, hunger, tremor, confusion

If severe hypoglycemia, patients may have experienced: amnesia, seizures, coma

Ask about risk factors for diabetes such as: age, obesity, physical inactivity, family history, race (asian, black, aboriginal), high blood pressure, coronary artery disease (CAD), hyperlipidemia, if female, a history of gestational diabetes

Ask about symptoms of long-standing diabetes complications through the review of systems going over:  eye, cardiovascular, neuro, renal, dermatological

 
Diabetes Physical Examination

The physical examination of a diabetes patient should include:
            General: height, weight, waist:hip ratio, body mass index (BMI)
            Vitals: heart rate, blood pressure
            Chest: routine examination
            Cardiovascular: examination for signs of congestive heart failure (CHF) such as crackles, S3, peripheral pulses, bruits
            Abdominal examination: routine
            Genitourinary: examination for fungal infections such as jock itch and yeast infections in women
            Musculoskeletal: examination of feet and joint mobility and laxity for arthropathy
            Neurological examiantion: examine for vibration sense, proprioception and reflexes.
            Skin examination: look for skin infections and signs of hyperlipidemia

Diabetes Examination Investigations:

Laboratory Investigations should include: CBC, BUN, Creatinine, Electrolytes, TSH, Fasting Glucose, Fasting Lipid Profile, HbA1c
Routine and macroscopic urinalysis for protein, glucose, ketones and microalbumin
Electrocardiogram if patient older than 40 years

Diagnosis of Diabetes:

1. Random Glucose > 11.1 mM AND symptoms of diabetes as mentioned above (fatigue, polyuria, polydipsia and weight loss)
2. Fasting blood glucose > 7.0 mM
3. Oral glucose tolerance test (OGTT) (2 hour sample) > 11.1 mM

Management of Diabetes:

Initial Management of a patient with diabetes includes:
1. Lifestyle: changes in nutrition, exercise, stop smoking, educational and social support
2. If lifestyle does not control glucose then, start patient on an oral hypoglycemic agent such as:
- Glyburide (a sulfonylurea) if NOT obese
- Metformin (a bigaunide) if obese
3. Combine oral agents
4. Add long-acting insulin for nocturnal control with or without oral agents

Diabetes Monitoring:

Complete History and Physical as above regularly
Diet (low in fat, low in salt, avoid snacks)
Exercise assessment
Self-monitoring of blood glucose and adjustments in diet and intake
HbA1c every 3-6 months (ideal < 0.07)
Urinalysis, BUN, Creatinine to screen for early nephropathy
Lipids to screen for coronary artery disease, high blood pressure
Electrocardiogram
Ophthalmology to see patient yearly for routine eye examination to screen for early changes
Foot care to prevent ulcers
Monitor and screen for microvascular and macrovascular complications