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Diabetic Exam

Diabetic Exam

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The Patient

General Features

Age, gender, general comfort
Body Habitus

Weight (change), BMI, waist-hip ratio
Fluid Status

Tachycardia, hypotension, dry oral mucosa
Breathing

Respiratory rate, Cheyne-Stokes, Kussmaul
The Skin

Rashes

The Hands

Nails

Onycholysis, paronychia
Capillary Refill

Compress the nail, normal if refill in <2 seconds
Dupuytren's Contracture

Fixed flexion deformity of MCP joints

The Face

The Eyes

Acuity, pupils, fundoscopy, eye movement
Visual Acuity

With spectacles if worn, with pinhole if poor acuity

Snellen Chart or equivalent, one eye at a time
Pupils

Equal, light reflexes, accommodation
Fundoscopy

Disc, retina, fundus, vessels and macula
The Mouth

Candidiasis, dentition

The Neck

Carotid Pulsation

Palpate individually for contour, amplitude
Carotid Bruits

Auscultate while patient holds breath

The Legs - Inspection

Colour

Redness, pallor, cyanosis
Trophic Changes

Thin / dry / shiny skin, absence of hair, poor nail growth
Ulceration

White (arterial) / red (venous) / neuropathic
Deformity

Charcot foot, claw toe

The Legs - Palpation

Temperature

Feel with the back of the hand
Peripheral Oedema

Pitting vs. non-pitting - apply pressure for 15 sec
Lower Limb Pulses

Femoral, popliteal, posterior tibial, dorsalis pedis

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

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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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Read More...

Abousayed M, Kwon JY. Hallux claw toe. Foot and ankle clinics. 2014;19:59.

Boulton AJM, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes care. 2008;31:1679-1685.

Duff M, Demidova O, Blackburn S, Shubrook J. Cutaneous manifestations of diabetes mellitus. Clinical diabetes : a publication of the American Diabetes Association. 2015;33:40-48. Furqan S, Kamani L, Jabbar A. Skin manifestations in diabetes mellitus. Journal of Ayub Medical College, Abbottabad : JAMC. 2014;26:46. Goyal A, Raina S, Kaushal SS, Mahajan V, Sharma NL. Pattern of cutaneous manifestations in diabetes mellitus. Indian journal of dermatology. 2010;55:39-41. Mumoli N, Camaiti A. Charcot foot. Canadian Medical Association journal. 2012;184:1392-1392. Rigopoulos D. Acute and chronic paronychia. Am Fam Physician. 2008;77:339. Rogers LC, Frykberg RG, Armstrong DG, et al. The Charcot foot in diabetes. Journal of the American Podiatric Medical Association. 2011;101:437. Rogers LC, Frykberg RG. The Charcot foot. The Medical clinics of North America. 2013;97:847.

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