About Diabetes Mellitus....
In a diabetic patient, examination involvess multiple system of the body. General inspection may give a clue to any underlying cause of DM. Look at the face (e.g. Cushing syndrome and acromegaly, which are the causes of secondary DM).Generalized pigmentation occurs in haemochromatosis called bronze diabetes.Also, general examination may show any complication (e.g. diabetic foot, nephropathy and so on).However there may be other instructions by the examiner described as follows:
Proceed as follows:
- Look at the patient for:
*Cachexia or obesity
*Generalized pigmentation
*kussmaul breathing or air hunger.
2)Look at the face for:
*sign of Cushing syndrome,
thyrotoxicosis or acromegaly, which
may cause DM.
*Ear infection,
xanthelasthma,corneal
arcus,ocular palsy and other
obvious cranial nerve palsy.
3)Examine the oral cavity for oral candidiasis.
- Examine the neck for thyromegaly.
5)Examine the neck and axilla for acanthosis nigri-cans.
6)Look for dehydration and sweating or oedema.
7)Examine the skin for hypopigmentation, diabetic dermopathy,ulcers, infection, necrobiosis lipidica diabeticorum,fat atropy.
8)Look for any obvious muscle wasting.
- Feel the peripheral pulses,look for fixed heart rate,
10)Bp.
11)At the end, examine the urine for sugar, proteinuria and keton bodies.
Next lower limbs.....