Diabetic Foot Exam Flashcards
Diabetes focused ROS
Constitutional, peripheral burning numbness tingling, skin issues, discolouration, in grown toenails, bladder or bowel control issues, impotence
Diabetes focused PMHx
Diagnosis, control, last blood glucose, last A1C, past foot infections
Inspection of diabetic foot
Look, odour, digits, ulcers, colour, skin, swelling, deformities, hair
Palpating the diabetic foot
Temp, cap refill, pulses, reflexes, tenderness, ROM
Sensation testing diabetic foot
Vibration sensation, pressure sensation, proprioception, reflexes
Gait in diabetic feet
Walk and turn, symmetry, turning, abnormalities, stance, steps, turning
Examining diabetic footwear
Note pattern of wear on the soles, check size, check insides
Plan for diabetic patient
Promote optimal glycemic control (HbA1C <7%), check bottoms of toes and in between the feet, wear slippers around the house and shoes outside
Feeling a monofilament on the toe
Decreases risk of future amputation
Not feeling monofilament
Higher risk of subsequent ulcer formation
Signs of peripheral vascular disease in a diabetic
Cool feeling feet with long cap refuel
Signs of cellulitis
Hot lower legs, swollen, red
Diagnosing diabetes
2 abnormal tests on 2 seperate days
First line treatment for Type 2 DM
Metformin
Goal dose for metformin
1000mg PO BID
After metformin, what drug should you add for DM
A second anti-hyperglycemic agent like SGLT2 inhibitor
Starting dose for insulin
0.5 units/kg (then titrate up)
Breakdown of basal vs rapid insulin
50% as basal, other 50% divided up and given before meals as rapid insulin
