Evaluating a patient for microvascular complications of diabetes mellitus.
Thanks, Subodha Sugandika for your comprehensive answer.
I will just add what's missing in red and willstrikethrough what is not that relevant.
Microvascular complications of diabetes are diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy.
1) Questions to ask from the patient:
Nephropathy:
do u have a history of frothy urine? Have you noticed a change in the volume of urine you pass?Or have u experienced dysuria or fever recently? Is there Increased frequency of urination?
have u experienced any visual impairments recently?
Neuropathy:
Do not forget that there are different types of nerves!
Sensory
do u have numbness in your hands and feet? Are the limbs painful at night? Do you lose your slippers when you are walking? When you are walking barefoot do you feel as if you are walking on cotton?
Autonomic
Do you feel dizzy when you stand up from the bed or chair? Do you sweat profusely after meals? Do you get explosive diarrhea early in the morning? Do you have erectile dysfunction?
Diabetic amyotrophy
Have you ever experienced pain and weakness in your thigh muscles?
Other mononeuropathies (Cranial / Peripheral)
Have you ever developed double vision? Have you developed any sudden onset weakness of hands or feet in the past?
2)Physical findings:
Nephropathy: ankle edema, Periorbital swelling
Neuropathy: glove and stocking type sensory loss, non-healing ulcers, flat foot, wasting of small muscles(this is motor). Postural blood pressure drop.
3) Investigations
Nephropathy: Test for microalbuminuria, proteinuria, Serum Creatinine and calculated eGFR, USS abdomen to look at the kidneys if GFR abnormal.
Retinopathy: ophthalmoscopic findings to see, dot and blot hemorrhages, cotton wool spots
Neuropathy: nerve conduction studies
I will just add what's missing in red and will
Microvascular complications of diabetes are diabetic nephropathy, diabetic retinopathy, and diabetic neuropathy.
1) Questions to ask from the patient:
Nephropathy:
do u have a history of frothy urine? Have you noticed a change in the volume of urine you pass?
have u experienced any visual impairments recently?
Neuropathy:
Do not forget that there are different types of nerves!
Sensory
do u have numbness in your hands and feet? Are the limbs painful at night? Do you lose your slippers when you are walking? When you are walking barefoot do you feel as if you are walking on cotton?
Autonomic
Do you feel dizzy when you stand up from the bed or chair? Do you sweat profusely after meals? Do you get explosive diarrhea early in the morning? Do you have erectile dysfunction?
Diabetic amyotrophy
Have you ever experienced pain and weakness in your thigh muscles?
Other mononeuropathies (Cranial / Peripheral)
Have you ever developed double vision? Have you developed any sudden onset weakness of hands or feet in the past?
2)Physical findings:
Nephropathy: ankle edema, Periorbital swelling
Neuropathy: glove and stocking type sensory loss, non-healing ulcers, flat foot, wasting of small muscles(this is motor). Postural blood pressure drop.
3) Investigations
Nephropathy: Test for microalbuminuria, proteinuria, Serum Creatinine and calculated eGFR, USS abdomen to look at the kidneys if GFR abnormal.
Retinopathy: ophthalmoscopic findings to see, dot and blot hemorrhages, cotton wool spots
Neuropathy: nerve conduction studies
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