Anamnesis and Physical Examination in Diabetes Mellitus

1. Anamnesis

• Signs and Symptoms

  • Hyperglycemia: thirst, polyuria, weight loss, hunger, extreme fatigue

  • Acute Complications:

    • DKA: nausea, vomiting, diffuse abdominal pain

    • HHS: nausea, vomiting, obnubilation

    • Hypoglycemia:

      • Autonomic symptoms: palpitations, tremor, sweating, nausea, anxiety, hunger

      • Neuroglycopenic symptoms: confusion, fatigue, dizziness, headache, diplopia, abnormal behavior, amnesia, seizure, coma

  • Chronic Complications:

    • Neuropathy:

      • Autonomic: gastrointestinal symptoms, impotence, bladder dysfunction, dizziness

      • Sensory: numbness, pain, muscle weakness

    • Retinopathy: blindness, blurred vision

    • Arteriopathy: claudication

    • Ischemic Heart Disease: angina, dyspnea

    • Stroke: dizziness, headache, coma

  • Comorbidities: fever, angina, abdominal pain, vomiting

2. Family History

• Diabetes & Related Conditions:

  • Diabetes (e.g. MODY)

  • Obesity

  • Hypertension, myocardial infarction, stroke, nontraumatic lower extremity amputation

  • Blindness, renal replacement therapy, other diseases

3. Personal History

• Diabetes History:

  • Prediabetes, GDM, diabetes duration, characteristics of onset

  • Type and doses of therapy

  • Metabolic control: HbA1c, glycemic profile

  • DKA/hypoglycemic episodes: frequency, severity, awareness

  • Chronic Complications:

    • Microvascular: retinopathy, nephropathy, neuropathy, foot ulcers

    • Macrovascular: arteriopathy, stroke, myocardial infarction

• Other Comorbidities: hypertension, dyslipidemia, cancer, hepatitis, pancreatitis, polycystic ovarian syndrome

4. Physiological Personal History

• Birth details: number of births, fetal birth weight

  • Fetal macrosomia or small-for-gestational-age weight

• Miscarriages

5. Conditions of Living and Working

• Lifestyle Elements:

  • Eating patterns

  • Physical activity habits

  • Smoking status

  • Alcohol consumption

  • Therapeutic adherence

• Working program

• Patient's living situation: living alone or with family/friends trained in hypoglycemia first aid

6. Physical Examination

• Anthropometric Evaluation: height, weight, waist measurements, BMI

• Blood Pressure: lying and standing positions

• Skin Examination: for insulin injection sites

• Peripheral Pulses: dorsalis pedis, posterior tibial

• Sensations Assessment: proprioception, vibration, monofilament sensation (10-g monofilament test)

• Lower Limbs Examination: for foot lesions

• Reflexes: presence of patellar and Achilles reflexes

• DKA Signs: Kussmaul respirations, acetone foetor, poor skin turgor, Krause sign

7. 10-g Monofilament Test Instructions

• Hold perpendicular to skin, apply pressure until it buckles, hold for 1 second, then release. Perform at highlighted sites with patient’s eyes closed.

Diabetic Ulcers

• Neuropathic Ulcer: Bottom of toes, pad, and heel of foot

• Arterial Ulcer

• Healthwise Incorporated: Refer to diagnostic classifications

• Foot Gangrene

Additional Conditions

• Charcot Foot

• Lipodystrophy: at insulin injection site