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DIABETES MELLITUS EXAMINATION

If FBS 7.8 mmol/L. or the 2 hour postprandial BSL of 11.1 mmol/L or


more in more than one occasion.
Primary: either type I
or type II.
Secondary: hormone induced state (acromegally, Cushings syndrome,
phaeochromocytoma, and glucagonoma).
Drugs: steroid, thiazide, phenytoin, the contraceptive pills, and
diazoxide).
Pancreatic disease (carcinoma, chronic pancreatitis,
haemochromatosis).

MUSCLE WASTING:
-

Note any Quadriceps muscle wasting due to femoral nerve


mononeuropathy. This is called Diabetic Amyotrophy.
KNEE:

GENERAL SYMPTOMS:
Polyuria, polydiapsia, polyphagia, blurred vision, weakness, tiredness,
lethargy, infections, groin itch, weight loss, disturbance of conscious state,
rash (pruritis vulvae, balanitis).

GENERAL APPEARANCE:
-Evidence of dehydration
(osmotic diuresis).
-Obesity (type II DM).
-Recent weight loss (evidence of uncontrolled glycosuria).
-Abnormal endocrine facies (acromegally, Cushings syndrome).
-Pigmentation (haemochromatosis bronze diabetes).
-Kussmals breathing Air Hanger (diabetic ketoacidosis)

Skin infections boils, cellulitis & fungal infections (


glucose, ischemia).
Pigmented scar (late diabetic dermopathy).
Necrobiosis Lipoidica Diabeticorum: over the skin & it is a
central yellow scarred area, which surrounded by a red
margin when the condition is active.
Insulin injection sites (usually in the thigh): may associated
with localized fat atrophy &/or hypertrophy.

Rare Charcots joint : grossly deformed & disorganized


joint due to loss of proprioception or pain or both.

PALPATION:
-

Injection sites for fat atrophy or hypertrophy.


Feel all peripheral pulses, temperature, and tests the capillary
return if -(peripheral vascular disease).
NEUROLOGICAL EXAMINATION:

Check for sensation, muscle power & tap reflexes.

LOWER LIMBS:
UPPER LIMBS:
INSPECTION:
SKIN:
-

Hairless & atrophied (small vessels vascular diseases &


resultant ischemia).
Leg ulcers on the toes or any pressure areas- (ischemia,
peripheral neuropathy).

-Nail: for signs of candidal infections.


-Inspect & feel for the injection sites over the forearm.
-Take blood pressure lying & standing autonomic neuropathy
which may leads to postural hypotension.
FACE EXAMINATION:

EYES:
-

-Evidence of Malignant Otitis Externa caused by Pseudomonas


Aeruginosa.
-Facial nerve palsy (in 50 %).

Visual acuity, which may be:


Permanent: due to retinal diseases.
Temporarily: due to disturbed the shape of the lens
associated with hyperglycemia & water
retention.

Argyll Ropertson pupils: which is rare in DM.


Rubeosis iridis, cataract: due to deposition of sorbitol
in the lens.
Diabetic retinopathy:
Non-proliferative: dot & blot hemorrhage, microaneurysms,
heard & soft exudates.
Proliferative: new vessels formation, which may lead to
vitreal hemorrhage, scar formation &
eventually retinal detachment.
Check for Laser scars (small brown or yellow spots).
Assesses the 3rd, 4th & 6th cranial nerves esp. 3rd nerve palsy from
ischemia which tends to spares the pupils.
- Other cranial nerve palsies (due to CVA by large atheroma).
Rhinocerebral mucormycosis (rare in uncontrolled patient
causing periorbital & perinasal swelling & cranial nerve
palsies).
EARS:

MOUTH:
-Evidence of candidal infections.
NECK & SHOULDERS:
-Examine carotid artery for evidence of vascular diseases.
-Check for the thickening of the upper back & shoulders (evidence of
Scleroderma).
-Acanthosis nigricans (in insulin resistant cases).
CHEST:
-

For signs of infections.


ABDOMIN:

Palpate hepatomegally due to fatty infiltration or due to


haemochromatosis