Sunday, April 30, 2017

Examining a Diabetic Patient



Diabetes mellitus is a clinical syndrome characterized by chronic hyperglycemia and disturbances in carbohydrate,lipid and protein metabolism. A patient with diabetes need a complete physical examination to look for any related complications and to manage accordingly.

General Appearance
  • Check the weight and look for obesity and measure BMI
  • Facial appearance: note any features of cushings disease
  • State of hydration
Lower Limbs
  • Inspect and look for any ulceration, infection, hair loss, skin atrophy.
  • Check injection sites on the thigh and note any skin atrophy due to insulin use.
  • Palpate all the peripheral pulses that includes femoral, popliteal, posterior tibial, dorsalis pedis.
  • Check pedal edema that can be present due to nephropathy.
  • Feel the tempreture as the feet may be cold due to ischemia.
  • Do the neurological assessment by checking the sensations including those of dorsal column.
  • Reflexes may be diminished due to neuropathy and also look for any signs of proximal muscle wasting.
  • Joints for Charcot’s joints ( loss of proprioception )
Upper Limbs
  • Nails : for candidiasis
  • Feel upper limb injection sites
  • Check Blood pressure in supine and standing to detect autonomic neuropathy
  • Palpate upper limb pulses .
Eyes
  • Visual Acuity: because cataract is common
  • Examine 3rd 4th & 6th cranial nerves ( palsy may be present )
  • Fundoscopy for retinopathy
  • Any periorbital or perinasal swelling or infection that may be due to infection.
Head and Neck
  • Look for oral ulcers and candidiasis
  • Check the ear for malignant otitis externa a common but serious finding due to pseudomonas infection.
  • Feel for carotid bruit
Abdomen
  • Examine the liver and measure the liver. Hepatomegaly might be present.

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