Lecture: Approach to Assessing a Patient with Diabetes Mellitus

Question 1

What do you ask when taking a history from a diabetic patient?

Answer 1

• When diagnosed, how diagnosed
• Type/cause
• Complications:
  
  • Acute emergencies (DKA, HHS, hypoglycaemia)
  • Chronic (macrovascular, microvascular)
• Management:
  
  • Adherence, difficulties
  • Education
  • Non-pharmacological Mx
  • Glycaemic control (HbA1c)
  • CVD risk, weight history
• Insulin:
  
  • SC injection: what is basal insulin and dose?
  • CSII pump

Question 2

What are the risks of insulin?

Answer 2

• Hypo
• DKA: if withheld in T1DM, pancreatic diabetes

Question 3

What are the risks of sulphonylureas?

Answer 3

Hypo- not eating/fasting, AKI

Question 4

What are the risks of SGLT2i?

Answer 4

Ketoacidosis: not eating/fasting, physiological stress

CEASE until discharge

Question 5

What are the risks of metformin?

Answer 5

Lactic acidosis: AKI, physiological stress

CEASE until stable and AKI recovered

Question 6

When should patients be self blood glucose monitoring?

Answer 6

• At risk of hypoglycaemia
• Insulin
• Engaged patients wanting to optimise non-pharmacological interventions

Question 7

What are the glucose targets for SBGM?

Answer 7

5-6: after overnight fast
7-8: 2 hours post-prandially

Question 8

What history do you take when a diabetic patient has a hypoglycaemic episode?

Answer 8

• Frequency
• Severity (did they need a third party to treat)
• Awareness of symptoms
• What situations cause them? (food, exercise, alcohol)

Question 9

What do you look for on physical examination of a patient with diabetes?

Answer 9

• Insulin injection sites
• Weight/BMI
• CVS examination: BP, postural drop
• Peripheral vascular and neurological examination, foot examination
• UA
• Fundoscopy, visual acuity

Question 10

How do you assess a diabetic high risk foot?

Answer 10

History:
- Previous amputation or ulcer
- Neuropathic Sx or vascular insufficiency Sx

Examination:
- Skin
- Deformities
- Vascular insufficiency
- Neuropathy: pink prick, vibration, ankle jerks, monofilament test
- Foot ware

Question 11

What can you see on fundoscopy of non-proliferative diabetic retinopathy?

Answer 11

• Aneurysm
• Hard exudate
• Haemorrhage

Question 12

What can you see on fundoscopy of proliferative diabetic retinopathy?

Answer 12

Growth of abnormal blood vessels