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.