Diabetic Assessment

Question 1

what needs to be done before the appointment?

Answer 1

HbA1c
cholesterol, triglycerides, HDL:LDL
creatinine, U&E
microalbumin:creatinine

Question 2

when they first arrive what needs to be done before the consultation?

Answer 2

blood pressure
weight and BMI
urinalysis
visual acuity

Question 3

what complications are screened for and how?

Answer 3

angina

• do you get chest pain?
• is it on exertion?
• do you get other symptoms on exertion?

intermittent claudication

• do you get muscular limb pain when walking?
• is it relived by rest?

impotence
- ask directly

neuropathic symptoms

• pain or tingling in feet
• pain in lower limbs at night
• lack of sensation

lifestyle

• sedentary
• diet
• overweight

Question 4

what are the aspects of examination?

Answer 4

foot
fundoscopy
gait

Question 5

how do you examine the foot?

Answer 5

couch at 45
lower legs and feet exposed
inspect
- colour, skin, ulcers, swelling, calluses, filling, deformity
palpate
- temperature, capillary refill, pulses
sensation
- monofilament - sternum, close eyes, big toes4 places on ball of foot
- vibration - sternum, close eyes, feel and stop, big toe

Question 6

how do you examine gait?

Answer 6

symmetry, balance
turning
abnormalites
footwear

could do proprioception - big toe up and down
could do ankle jerk

Question 7

what should hopefully have been done instead of fundoscopy?

Answer 7

annual retinal screening

Question 8

what do you need to go through with the patient?

Answer 8

the results from the tests before the consultation
assess educational need
- diet, exercised, risk, treatment target, insulin administration

Question 9

what do you need to do at the end of the consultation

Answer 9

plan
targets for next year
educational update if needed
organise more review if poor control