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ASSIGNMENT 1
How ill you evaluate a 26 year old male coming for the first time
with Diabatesmellitus.

I will evaluate this 26 year old male coming for the first time with
Diabatesmellitus by detailed assessment of his history of the disease, clinical
features, physical examination & laboratory evaluation

1. HISTORY&CLINICAL FEATURES

Clinical Symptoms
Dietary habits, weight history
Physical activity
Infections, particularly skin, foot, dental and genitourinary
organs.
Symptoms and treatment of complications associated with
diabetes: eye, heart, kidney, nerve, genitourinary (including
sexual function), and peripheral vascular and cerebrovascular
systems.
Current medications including dietary Supplements and alternative
therapies with a focus on medications known to induce diabetes-s
(e.g., steroids)

Psychosocial, cultural and economic factors that might
influence the management of diabetes
Alcohol/drug use


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2. PHYSICAL EXAMINATION

Weight, height, body mass index (BMI), waist circumference,
Hip circumference, & W/H ratio
Cardiovascular system: heart, blood pressure, peripheral
vascular including pulses and bruits (abdominal, carotid,
femoral arteries)
Thyroid examination
Foot: nails, web spaces, ulcers, pulses, calluses, structural
deformities, protective sensation and shoes. Palpation of
dorsalis pedis & posterior tibial pulses, ankle brachial
index.Propioreception, vibration & monofilament sensation.
Other examinations as guided by the patient's symptoms
and/or concerns:
Skin: infections or diseases such as acanthosis nigricans, skin
tags
Neurological symptoms: sensory state of hands and feet,
muscle wasting, deep tendon reflexes
Mental health: screen for depression and/or anxiety
Dilated retinal examinations.
Referral to a dentist to assess oral health

3. LABORATORY EVALUATION

Fasting plasma glucose &Posy prandeal plasma glucose
Hb A1C
Lipid profile: total cholesterol, high-density lipoprotein (HDL
cholesterol), low-density lipoprotein (LDL cholesterol) and
triglycerides
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RFT: Serum creatinine & Blood urea
GFR
Haemogram
TSH I in case of dyslipedemia
Liver function test: alanine aminotransferase (ALT) or
aspartate aminotransferase (AST)
Urine: ketones, glucose, protein, microalbuminuria, albumin to
creatinine ratio, protein to creatinine ratio and culture if
microscopic is abnormal or symptoms of infection present
Urine micro albumin tests can identify patients with early
diabetic nephropathy when intervention may be most
effective in delaying or preventing end-stage renal disease.
Single tests for urinary micro albumin and urinary creatinine
can accurately detect urinary micro albumin excretion.
Biothesimetry, Peripheral arterial Doppler study.
ECG, X-ray chest, echocardiogram if needed.









DR.K.A.NAZAR
JUNIOR ADMINISTRATIVE MEDICAL OFFICER
DMO (H), PALAKKAD