W1L1 His Taking & GE DM

Question 1

History in a diabetes patient

Answer 1

1. History regarding illness
   - Type of diabetes
   - Glycemic control/Drug history
   - Complications
   - Diabetes education
2. Personal History
3. Family History
4. Past & social History

Question 2

History for type of diabetes

Answer 2

• Type1
• Type2
• Secondary
– Pancreatic – Endocrine – Drugs
• MODY
• Rare forms of diabetes
• Onset symp at diag
• Weight prior to diag
• Bl gluc value & ketone at diag
• Method for glycemic control
• Insulin dependancy
• Other autoimmune diseases
• Abd pain, malabsorption, Cushing’s & acromegaly.

Question 3

History for glycemic control

Answer 3

• Method of monitoring blood glucose

• Glucometer - Lab
• Glycated hemoglobin

• Hyperglycemia

• Ongoing osmotic symp & weight loss
• Admission hyperglycemic crises

• Hypoglycemia
- Duration, timing, severity, documentation, relief, dietary pattern

Question 4

History for complications

Answer 4

• Microvascular
-Retinopathy, Nephropathy, Somatic Neuropathy, Autonomic neuropathy
• Macrovascular
-Coronary artery dis, Cerebrovascular dis, Peripheral vas dis
• Nonretinal ocular
-Ocular mononeuropathy, Corneal, Glaucoma, Lens, Optic disc
• Gastrointestinal
-Dyspagia, Diarrhea, Abd pain
• Musculoskeletal
-Periarthritis shoulder, Cheiroarthropathy, Neuroarthropathy
• Infective
-UTI, Genital inf, Upper resp, Lower resp
• Neuropsychiatric
-Dementia, Motor difficulty, Depress

Question 5

History for assessing diabetes education

Answer 5

• Glycemic control
-Target bl gluc value & glycated Hb

• Medications

• Timing OHA intake
• Insulin(storage, site, inject)

• Hypoglycemiacare
-Symp, glucose, candies

• Sick day rules
-Fluids, glycemia & ketone monitor, insulin dose adjustment

• Complications
-Period monitor for comp

• Footcare
-Type foot wear & socks, care of foot

• Pregnancy
-Maternal & fetal morbidity, plan preg

Question 6

History regarding lifestyle

Answer 6

• Type food taken
• Nonvegetarian
• Type milk
• Artificial sweetener
• Food excha
• Amount fruit & vege
• Physical acti–exercise pattern

Question 7

Family history

Answer 7

• Generation affected
• Earning member of fam
• Financial support
• Emotional support from fam
• Incorporate lifest cha in younger fam mem

Question 8

Social history

Answer 8

• Pattern school/working
• Info responsible person regard dis
• Difi transport & store insulin in work
• Stigmas regard inject insulin & check bl gluc in work

Question 9

Dif OSA & depress

Answer 9

OSA(3S)
-Snore -Sleep -Sig his apnea

Depress

• Sleep and rest -Crying Spells
• Suicide thought -Attempts

Question 10

Physical examination

Answer 10

• Anthropometric measure:

• Ht, wt, BMI, W:H ratio
• waist circumference(N: M<102, F<88)
• neck circumference

• General examination- NOT TO OMIT -peripheral pulses -Genitalia

• Postural drop in bp
• Exam foot, footwear -Skin & nails

Question 11

Skin Problems in Diabetes(30%)

Answer 11

• Acanthosis Nigirican
• Scleroderma diabeticorum
• Vitiligo -Diabetic Dermopathy
• Cheiroathropathy

Question 12

System examination

Answer 12

• CVS
• CNS
- fundus exam
- cranial nerves(symp)
- Cerebellar signs

• Abdomen
- Hepatosplenomegaly

• Respiratory system