CLIN Diabetes Hx, Exam & Investigations - Week 12

Question 1

Diabetes SR Qs (for initial diagnosis/screening)

Answer 1

• Polyphagia
• Polydipsia
• Polyuria
• Poor wound healing
• Recurrent infections
• Weight gain/overweight/obese.

Question 2

Diabetes SR Qs for hypoglycaemia. SR Qs for hyperglycaemia.

Answer 2

(Hyperglycaemia)
⦁ Polyuria
⦁ Polydipsia
⦁ Thirst
⦁ Nocturia
⦁ Lethargy
⦁ Blurred vision
⦁ Infections
⦁ Weight change
⦁ Disturbance of conscious state
⦁ Abdominal pain
⦁ Vomiting/nausea
(Hypoglycaemia)
⦁ Tremor
⦁ Sweating
⦁ Morning headaches
⦁ Weight gain
⦁ Seizures
⦁ Disturbance of conscious state.

Question 3

Diabetes SR Qs for Complications - in classifications/groups of complications (e.g, microvascular).

Answer 3

Microvascular
* Retinopathy
* Nephropathy/renal dysfunction
* Neuropathy
o Mononeuropathy
 CN III, IV, VI
 Median
 Ulnar
o Polyneuropathy
 Distal symmetrical
 Polyneuroatphy
 Stocking & gloves distribution
o Autonomic
 Tachycardia
 Postural hypotension
 Erectile disfunction
 Diarrhoea
 Sweating
Macrovascular
* CAD
* CVD
* PVD
Non-vascular
* Infections (e.g., Candida, UTIs)
* Skin changes
* Glaucoma
* Cataract
* Dehydration.

Question 4

Diabetes Exam GI

Answer 4

a. ‘Noting body habitus’
b. Dehydration
c. Endocrine facies
d. Pigmentation
e. Comatose
f. Kussmaul’s breathing.
13. Vital signs

Question 5

Diabetes Exam Feet

Answer 5

14. Feet
    a. Look
    i. Btw toes
    b. Assess
    i. Capillary return
    ii. Temperature
    iii. Touch/pressure
15. Ask pt to close eyes
16. Touch 9 points w monofilament.

Question 6

Diabetes Exam Ankle & Knees

Answer 6

15. Ankle
    a. Look
    i. Charcot’s joint
    ii. Skin damage
16. Knees
    a. Look
    i. Charcot’s joint.

Question 7

Diabetes Exam Thighs

Answer 7

17. Thighs
    a. Look
    i. Insulin injection sites
    ii. Fat atrophy
    iii. Fat hypertrophy
    iv. Quadriceps muscle wasting/Diabetic amyotrophy.

Question 8

Diabetes Exam Legs

Answer 8

18. Legs
    a. Look
    i. Hair loss
    ii. Atrophy
    iii. Ulcers
    iv. Superficial skin infections
    v. Pigmented scars/diabetic dermopathy
    b. Palpate
    i. Insulin injection sites
    ii. Peripheral pulses
19. Femoral
20. Popliteal
21. Post tibial
22. Dorsalis pedis.

Question 9

Diabetes Exam Fingernails - Axilla

Answer 9

20. Fingernails
    a. Look
    i. Infection
21. Hands
    a. Assess
    i. Capillary refill
    ii. Tissue turgor
22. Elbows
    a. Assess
    i. BP
23. Lying
24. Standing
25. Axilla
    a. Assess
    i. Acanthosis nigricans.

Question 10

Diabetes Exam Head Region

Answer 10

24. Face
    a. Look
    i. Argyll Robertson pupils
    (With opthalamoscope)
    ii. Rubeosis
    iii. Cataracts
    iv. Non-proliferative changes – dot haemorrhages, blot haemorrhages, microaneurysms, hard exudates, soft exudates
    v. Proliferative changes – changes in blood vessels, detached retina, laser scars, cranial nerves 3, 4, 6, rhinocerebral mucormycosis
    b. Assess
    i. Visual acuity
25. Ears
    a. Look
    i. Infection
26. Mouth
    a. Look
    i. Infection
    ii. Oral thrush
    iii. Dentition
    iv. Fetor hepaticus.

Question 11

Diabetes Exam Neck

Answer 11

a. Examine
i. Carotid arteries.

Question 12

Diabetes Exam Back

Answer 12

29. Back
    a. Look
    i. Acanthosis nigricans
    ii. Scleroedema diabeticorum.

Question 13

Diabetes Exam Abdomen

Answer 13

30. Abdomen
    a. Palpate
    i. Hepatomegaly.

Question 14

Finger prick random BGL measurement process. Normal BGL range.

Answer 14

1. Explain the procedure to the patient (including risks).
2. Obtain verbal consent.
3. Collect equipment: glucometer, testing strips, lancet or auto-lancing device,
4. cotton wool balls or gauze swabs, sharps container, non-sterile gloves.
5. Perform hand hygiene and don non-sterile gloves.
6. Ensure the patient’s hands are also recently washed.
7. Insert the electrode end of testing strip into testing port on glucometer.
8. Prepare the lancet device.
9. Perform a finger prick when “blood drop” symbol flashes on glucometer screen.
10. Puncture the side of finger with lancet to obtain capillary blood sample.
11. Touch the blood drop to yellow area on the protruding end of the testing strip. The blood will be “drawn up” by osmosis onto the strip.
12. Apply pressure to puncture site.
13. Dispose of contaminated waste including lancet appropriately.

Normal range = 4.7-8mmol/L.

Question 15

What can lead to dehydration in diabetic pts?

Answer 15

Osmotic diuresis, triggered by high glucose load in the urine -> massive fluid loss.

Question 16

Endocrine facies may indicate what condition?

Answer 16

May indicate cause (e.g., Cushing’s syndrome or acromegaly) of secondary diabetes.

Question 17

Kussmaul’s breathing may indicate what condition?

Answer 17

DKA.

Question 18

Charcot’s joint may indicate what symptoms in diabetes pts?

Answer 18

Grossly deformed/disorganised joint - formed due to a loss of proprioception, pain or both -> recurrent & unnoticed injury to the joint.

Question 19

Fat atrophy &/ fat hypertrophy may indicate what?

Answer 19

Suggest impure insulin injection -> localised immune reactions. Relatively rare now that genetically engineered, more pure insulin is widely used.

Question 20

Quadriceps muscle wasting/diabetic amyotrophy may indicate

Answer 20

Femoral nerve mononeuropathy.

Question 21

Hair loss and atrophy may indicate

Answer 21

May indicate small vessel vascular disease & resultant ischaemia.

Question 22

What condition can cause postural hypotension in diabetes pts and how can this be assessed?

Answer 22

BP lying vs standing. Diabetic autonomic neuropathy.

Question 23

Acanthosis nigricans may indicate

Answer 23

Insulin resistance.

Question 24

Scleroedema diabeticorum appearance

Answer 24

Thickening over the upper back & shoulders.

Question 25

Hepatomegaly may indicate what liver pathologies.

Answer 25

Fatty infiltration or haemochromatosis.

Question 26

FPG Dx of DM

Answer 26

> 7mmol/L.

Question 27

OGTT FPG Dx of DM

Answer 27

OGTT FPG >7mmol/L and/or 2hr plasma glucose >11.1mmol/L.

Question 28

HbA1c Dx of DM. Normal HbA1c.

Answer 28

> 6.5%. <7%.

Question 29

RPG Dx of DM

Answer 29

> 11.1mmol/L.

Question 30

Normal FPG

Answer 30

<6mmol/L.