DIABETIC REVIEW

Dr Holly Baker-Rand

Diabetes

Increased capillary blood glucose.

Fasting normal = 4-6mmol

Random normal = <11.1mmol

6.1-7mmol and 7-11.1mmol = impaired glucose tolerance and increased vasc risk.

Types

1. Autoimmune. Presents in young/adolescent with weight loss, polyuria and polydipsia.

2. Strong genetic link. Middle age/obese. First px with macrovascular disease.

3. Secondary to endocrinopathies, also MODY.

4. Gestational

What is the purpose of a review?

1. To screen for complications.

2. To identify and manage risk factors.

3. To assess control and educate.

Control

Do they have their blood glucose diary?

How often are they testing?

Any problems – always high in the morning?

Do they have hypos? Are they aware of them?

Treatment regimen.

Control

Complications

MACROVASCULAR

Ischaemic heart disease, peripheral vascular disease, stroke, hypertension.

MICROVASCULAR

Nephropathy, retinopathy, autonomic neuropathy.

Risks/Symptoms

Altered vision. Last retinal screening?

Angina/chest pain

Pain/paraesthesia in limbs.

Nausea/diarrhoea

Erectile dysfunction

Are they overweight?

Diet/exercise/smoking hx

Injection sites - lipodystrophy

Regular foot checks. Visit to chiropodist?

Head Visual acuity

Snellen chart.

Cranial nerves III & VI

Fundoscopy Dark room, dilated pupils.

Red reflex.

Examination of disc and vessels.

Disc = nasal

Neck and Arms

Carotid, brachial, radial pulses.

BP

140/80mmHg in diabetic

130/80mmHg in diabetic with complications.

Sensation in hands and capillary glucose testing sites.

Heart Heart sounds

Evidence of increased effort.

Atrial fibrillation.

ECG Evidence of

ischaemia: T wave inversion, ST depression, LVH.

Silent MI

Kidneys and Injection Sites

Urine dip

Microalbuminuria

Blood tests

Inspect injection sites for lipodystrophy

Legs and Feet

End of the bed Proximal muscle wasting – amytrophy

Charcot’s joint

PVD – necrosis, amputations

Inspect feet Ulcers, calluses

Assess sensation – Ipswich touch test.

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