Diabetes

Question 1

What are the steps of a diabetic foot exam?

Answer 1

1. Introduction, check name and DOB
2. Wash hands and explain:
   “This is to check your feet in relation to your diabetes”
3. Ask them to walk (limp, pain, gait, foot drop)
4. Look at shoes:
   - comfortable and well fitting
   - soles worn evenly
5. Wash hands
6. Uncover feet
7. Skin (dry, cracked, eczema)
8. Nails (infections)
9. Between toes (ulcers, blisters, calluses)
10. Muscles (wasting)
11. Bone structure
12. Toe shape (claw toe, hammer toe)
13. Arches (present)
14. Blood supply:
    - Capillary refill
    - Warmth
    - Posterior tibial pulse
    - Dorsalis pedis pulse
15. Touch sensation: 10g monofilament, demonstrate first, “say yes/no and if it is left or right foot”, check five places
16. Vibration
17. Pin prick: toe down to ankle
18. Check achiles tendon reflex
19. Wash hands
20. Follow up:
    - check HBA1C and fasting glucose
    - fundoscopy
    - full neurological exam

Question 2

What are the steps of fundoscopy?

Answer 2

1. Introduction, Check name and DOB
2. Clean hands
3. Check equipment: battery, size of illumination, power of lens (zero)
4. Ask them to focus on the wall (normally use pupil dilating drugs and a dim room)
5. Start far away: use opposite eye, 1 metre, check for red reflex
6. Move closer until you can see the retina in detail
7. Find a retinal vessel, follow it to the optic disc
   - optic disc: shape, colour, contour
8. Check for four retinal arteries
9. Check peripheries
10. Ask patient to look directly at light, check macula
11. Wash hands