Assessing a Diabetic Patient
Assessing a Diabetic Patient
Doctors use regular assessments of their diabetic patients not only to monitor the progress of the disease, but also as opportunities to counsel patients on how to maintain their overall health.
With so many comorbidities, doctors want patients to know that many of them are preventable, despite the presence of diabetes. For those that are unavoidable, knowledge and information are key to the prevention of complications.
General Health Assessment
The patient is reviewed for overall health, with the doctor taking weight, blood pressure and temperature readings, auscultating (listening to) heart sounds and carotid blood flow, listening to the passage of air in the lungs, palpating the thyroid, visualizing the eyes, ears, inside of the nose and throat and palpating the internal organs through the abdomen.
The doctor will ask lots of questions about any complications or hospitalizations that the patient may have had over the past year that were related to diabetes, including incidents of hypoglycemia, ketoacidosis or hyperosmolar hyperglycemic non-ketotic coma.
The doctor will also ask about any cardiovascular events the patient may have experienced, such as myocardial infarction, transient ischemic attacks (TIA), strokes, diabetic retinopathy and evidence of kidney disease. The question of erectile dysfunction may arise, as this can be an early warning of cardiovascular damage.
Testing specific to the diabetes diagnosis will include checking the feet and toes for healthy pulse or injuries, doing a test for neuropathic pain in areas of the extremities (hands and feet), and requesting urinalysis to look for proteins and ketones, as well as blood tests to check A1c, lipid levels, kidney and liver functions and look for inflammation.
Type 1 diabetics may be checked at injection sites for development of lipoatrophy and lipodystrophy or lipohypertrophy.
The doctor may recommend a flu shot and/or a pneumonia vaccination. They will discuss the patient’s view of whether they are eating right and getting enough exercise and whether they need help to stop smoking.
The doctor will also discuss how the patient is managing their diabetes, and whether they feel confident that they have enough information to make the right choices with regard to diet and any treatment they are receiving. If they are taking insulin, the doctor will review testing and dosing recommendations.
If the patient is having difficulty maintaining a steady blood glucose level, the physician may refer him or her to a diabetes specialist for further evaluation.
In the event that damage resulting from diabetes is beginning to occur, the primary physician may recommend consultation with appropriate specialists, including cardiac, kidney, liver, vascular, eye, foot and blood specialists, as well as dieticians and diabetes specialists.
Photo image courtesy NCI