Diabetes Mellitus Examination

General Examination

·         General built

·         BMI

·         Ketone odour

·         Eyes

o   Corneal arcus

o   Xanthalasma

·         Dry mouth / Mucous membrabes

·         Acanthoosis nigricans

·         Injection sites à lipohypertrophy, lipoatrophy

·         reduced skin turgor

·         Capillary refill time

·         Diabetic cheiroarthropapthy (stiff hand syndrome)

·         Carpel tunnel syndrome (Tinel’s sign, Phalen’s sign, thenar eminence wasting)

·         Granuloma annulare

·         Pustules, abscesses, carbuncle

·         Necrobiosis lipoidica diabeticorum (anterior shin)

·         Vitiligo

·         Diabetic dermopathy

·         Bullosis diabeticorum (tense blistering on the feet)

·         Fungal nail infections

·         Deformity

·         Callus

·         Ulcerations

·         Nail care

·         Neuropathic joint à Charcot neuroarthropathy

Cardiovascular System Examination 

  

·         BP       

o   Pulse

§  PR à tachycardia (dehydration)

§  Peripheral pulses

o   Blood pressure

§  Hypertension

§  Hypotension à dehydration

§  Postural hpotension

o   Auscultaion

§  Carotid and femoral bruits

Respiratory System Examination 

·         Kussmaul breathing

Central Nervous System Examination

·         Eye

o   Reduces pupillary response à diabetic autonomic neuropathy

o   Visual acuity

o   Funduscopy

§  Cataract à loss of light reflex

§  Lens for opacities

§  Green light to see microaneurysms

o   Proximal motor neuropathy

§  Diabetic amyotrophy

§  Femoral neuropathy

o   Mononeuropathies

§  Median nerve (Carpel Tunnel Syndrome)

§  Tarsal tunnel syndrome

§  3^rd and 6^th nerve palsies

o   Autonomic neuropathy

·         Sensation

o   Great toe

o   Metatarsal heads

o   Dorsum

o   Peripheral sensory neuropathy

·         Reflexes

o   Loss of ankle jerk à early diabetic peripheral sensory neuropathy