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The Diabetic History

 
 
 
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Overview

Diabetes is a common disease, and is often poorly controlled. When assessing a patient with diabetes it is important to get an idea of how long they have had diabetes, what microvascular and macrovascular complications they have had, how good their control is, and whether they have had any hypoglycaemic episodes.
  • Ask About

  • Diagnosis - type of diabetes; age at diagnosis; presenting symptoms
  • Control - HbA1c, home BSL monitoring, admissions
  • Complications - acute, microvascular, macrovascular, infections
  • Hypoglycaemia - awareness, symptoms, frequency, BSLs, management
  • Management - non-pharmacologic, oral hypoglycaemics, insulins
  • Follow up - who manages their diabetes (e.g. GP or endocrinologist); regular podiatry visits; regular optometrist visits

Diabetic Diagnosis

  • Ask About

  • Type of diabetes - type 1, type 2, late autoimmune diabetes in adults (LADA), steroid-induced diabetes, gestational diabetes
  • When the patient’s diabetes was diagnosed
  • Symptoms at diagnosis - polyuria, polydipsia, thirst, weight loss, ketoacidosis, asymptomatic glycosuria
  • What test was used to diagnose their diabetes

Glycaemic Management

  • Ask About

  • Type 1 Diabetes

  • Insulin regimen - basal-bolus, insulin pump
  • Type 2 Diabetes

  • Diet
  • Exercise
  • Weight loss
  • Oral hypoglycaemics - doses, side effects
  • Insulin - basal, basal-bolus, mixed
  • Both

  • Latest HbA1c - and the target, if they know it
  • BSL monitoring - whether they measure their BSLs at home and
  • Carbohydrate counting - patients on pre-meal insulin, to guide dosing

Complications

  • Complications of Diabetes

  • Glycaemic Instability

  • Diabetic ketoacidosis (mainly type 1, can occur with type 2) - ICU admissions, hospitalisations
  • Hyperglycaemic hyperosmolar state - ICU admissions, hospitalisations
  • Hypoglycaemic episodes
  • Microvascular Complications

  • Diabetic nephropathy - degree of chronic kidney disease; whether they see a nephrologist
  • Diabetic retinopathy - regular optometry review; past photocoagulation
  • Peripheral neuropathy - ulcers, amputations
  • Autonomic neuropathy - syncope, erectile dysfunction, gastroparesis, nocturnal diarrhoea
  • Macrovascular Complications

  • Ischaemic heart disease
  • Peripheral vascular disease
  • Cerebrovascular disease - past stroke / TIA
  • Infections

  • Mucocutaneous infections - candidiasis, Staphylococcus
  • Urinary tract infections - cystitis, pyelonephritis
  • Pulmonary infections - pneumonia

Hypoglycaemic Awareness

  • Ask About

  • Past hypoglycaemic episodes
  • Symptoms of these episodes
  • Frequency of hypoglycaemic episodes
  • BSLs at the time
  • Management of hypoglycaemia
  • Symptoms of Hypoglycaemia

  • Autonomic symptoms - palpitations, tremor, anxiety, sweating, hunger, paraesthesiae
  • Neuroglycopaenic symptoms - confusion, fatigue, visual changes, seizure, loss of consciousness
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