CLIN Diabetes Hx, Exam & Investigations - Week 12 Flashcards
Diabetes SR Qs (for initial diagnosis/screening)
- Polyphagia
- Polydipsia
- Polyuria
- Poor wound healing
- Recurrent infections
- Weight gain/overweight/obese.
Diabetes SR Qs for hypoglycaemia. SR Qs for hyperglycaemia.
(Hyperglycaemia)
⦁ Polyuria
⦁ Polydipsia
⦁ Thirst
⦁ Nocturia
⦁ Lethargy
⦁ Blurred vision
⦁ Infections
⦁ Weight change
⦁ Disturbance of conscious state
⦁ Abdominal pain
⦁ Vomiting/nausea
(Hypoglycaemia)
⦁ Tremor
⦁ Sweating
⦁ Morning headaches
⦁ Weight gain
⦁ Seizures
⦁ Disturbance of conscious state.
Diabetes SR Qs for Complications - in classifications/groups of complications (e.g, microvascular).
Microvascular
* Retinopathy
* Nephropathy/renal dysfunction
* Neuropathy
o Mononeuropathy
CN III, IV, VI
Median
Ulnar
o Polyneuropathy
Distal symmetrical
Polyneuroatphy
Stocking & gloves distribution
o Autonomic
Tachycardia
Postural hypotension
Erectile disfunction
Diarrhoea
Sweating
Macrovascular
* CAD
* CVD
* PVD
Non-vascular
* Infections (e.g., Candida, UTIs)
* Skin changes
* Glaucoma
* Cataract
* Dehydration.
Diabetes Exam GI
a. ‘Noting body habitus’
b. Dehydration
c. Endocrine facies
d. Pigmentation
e. Comatose
f. Kussmaul’s breathing.
13. Vital signs
Diabetes Exam Feet
- Feet
a. Look
i. Btw toes
b. Assess
i. Capillary return
ii. Temperature
iii. Touch/pressure - Ask pt to close eyes
- Touch 9 points w monofilament.
Diabetes Exam Ankle & Knees
- Ankle
a. Look
i. Charcot’s joint
ii. Skin damage - Knees
a. Look
i. Charcot’s joint.
Diabetes Exam Thighs
- Thighs
a. Look
i. Insulin injection sites
ii. Fat atrophy
iii. Fat hypertrophy
iv. Quadriceps muscle wasting/Diabetic amyotrophy.
Diabetes Exam Legs
- Legs
a. Look
i. Hair loss
ii. Atrophy
iii. Ulcers
iv. Superficial skin infections
v. Pigmented scars/diabetic dermopathy
b. Palpate
i. Insulin injection sites
ii. Peripheral pulses - Femoral
- Popliteal
- Post tibial
- Dorsalis pedis.
Diabetes Exam Fingernails - Axilla
- Fingernails
a. Look
i. Infection - Hands
a. Assess
i. Capillary refill
ii. Tissue turgor - Elbows
a. Assess
i. BP - Lying
- Standing
- Axilla
a. Assess
i. Acanthosis nigricans.
Diabetes Exam Head Region
- Face
a. Look
i. Argyll Robertson pupils
(With opthalamoscope)
ii. Rubeosis
iii. Cataracts
iv. Non-proliferative changes – dot haemorrhages, blot haemorrhages, microaneurysms, hard exudates, soft exudates
v. Proliferative changes – changes in blood vessels, detached retina, laser scars, cranial nerves 3, 4, 6, rhinocerebral mucormycosis
b. Assess
i. Visual acuity - Ears
a. Look
i. Infection - Mouth
a. Look
i. Infection
ii. Oral thrush
iii. Dentition
iv. Fetor hepaticus.
Diabetes Exam Neck
a. Examine
i. Carotid arteries.
Diabetes Exam Back
- Back
a. Look
i. Acanthosis nigricans
ii. Scleroedema diabeticorum.
Diabetes Exam Abdomen
- Abdomen
a. Palpate
i. Hepatomegaly.
Finger prick random BGL measurement process. Normal BGL range.
- Explain the procedure to the patient (including risks).
- Obtain verbal consent.
- Collect equipment: glucometer, testing strips, lancet or auto-lancing device,
- cotton wool balls or gauze swabs, sharps container, non-sterile gloves.
- Perform hand hygiene and don non-sterile gloves.
- Ensure the patient’s hands are also recently washed.
- Insert the electrode end of testing strip into testing port on glucometer.
- Prepare the lancet device.
- Perform a finger prick when “blood drop” symbol flashes on glucometer screen.
- Puncture the side of finger with lancet to obtain capillary blood sample.
- Touch the blood drop to yellow area on the protruding end of the testing strip. The blood will be “drawn up” by osmosis onto the strip.
- Apply pressure to puncture site.
- Dispose of contaminated waste including lancet appropriately.
Normal range = 4.7-8mmol/L.
What can lead to dehydration in diabetic pts?
Osmotic diuresis, triggered by high glucose load in the urine -> massive fluid loss.
Endocrine facies may indicate what condition?
May indicate cause (e.g., Cushing’s syndrome or acromegaly) of secondary diabetes.
Kussmaul’s breathing may indicate what condition?
DKA.
Charcot’s joint may indicate what symptoms in diabetes pts?
Grossly deformed/disorganised joint - formed due to a loss of proprioception, pain or both -> recurrent & unnoticed injury to the joint.
Fat atrophy &/ fat hypertrophy may indicate what?
Suggest impure insulin injection -> localised immune reactions. Relatively rare now that genetically engineered, more pure insulin is widely used.
Quadriceps muscle wasting/diabetic amyotrophy may indicate
Femoral nerve mononeuropathy.
Hair loss and atrophy may indicate
May indicate small vessel vascular disease & resultant ischaemia.
What condition can cause postural hypotension in diabetes pts and how can this be assessed?
BP lying vs standing. Diabetic autonomic neuropathy.
Acanthosis nigricans may indicate
Insulin resistance.
Scleroedema diabeticorum appearance
Thickening over the upper back & shoulders.
Hepatomegaly may indicate what liver pathologies.
Fatty infiltration or haemochromatosis.
FPG Dx of DM
> 7mmol/L.
OGTT FPG Dx of DM
OGTT FPG >7mmol/L and/or 2hr plasma glucose >11.1mmol/L.
HbA1c Dx of DM. Normal HbA1c.
> 6.5%. <7%.
RPG Dx of DM
> 11.1mmol/L.
Normal FPG
<6mmol/L.
