- Diagnosis
- History
- Examination
- Investigations
- History
- Management
- Procedures
Diabetic Exam
Diabetic Exam
Poor diabetic control may manifest in many different ways, with macrovascular and microvascular complications. The diabetic examination is useful for diagnosing these complications, particularly when it comes to the vascular and neurologic examination of the lower limb.
The Patient
The Hands
The Neck
The Legs - Inspection
The Legs - Palpation
The Legs - Neurological
Tone
Passive movement of hips, knees, ankles
Power
0/5 no flicker, 3/5 vs. gravity, 5/5 normal
Movement against gravity & resistance, R vs. L
Reflexes
0 no response, 2+ normal, 3+ brisk, 4+ clonus
Biceps, supinator, triceps, patellar, achilles
Sensory Assessment
Tactile, pain, vibration, proprioception
Peripheral neuropathy
Visual Acuity
Overview
How to Assess
Ask the patient to cover one eye, look at a Snellen chart (wall-mounted at 6m or handheld at arm's length) and identify the smallest line that they can read.
- If the patient wears corrective lenses, perform the test with and without them.
- If the patient's visual acuity is poor, use a pin hole over their eye to test for refractive error.
Causes of Poor Visual Acuity
- Refractory error
- Corneal opacification - cataract, infection, trauma
- Vitreal opacification - intraocular haemorrhage
- Retinal disorders - macular degeneration, retinal detachment, diabetic retinopathy, retinal artery occlusion
- Optic nerve disorders - glaucoma (raised intraocular pressure), ischaemia, optic neuritis
- Intracranial disorders - pituitary disorders, aneurysm
Last updated on November 28th, 2019
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