Please examine this patient for complications of diahetes mellitus ~ introduction and rapport - exposure but sensitivity General inspection = conscious state (hyperglycaemia / hvpostvcaemia) ~ ~ signs of dehydration (dry mucous membranes, reduced tissue turgor, high HR, low BP)... ~ weight loss (IDDM), obesity (NIDDM) signs of Cushing's, acromegaly, hacmochromatosis (pigmcntati ~ ketoacidosis (Kussmaul's breathing, dehydration, ketone breath) * Lower limbs => peripheral vascular disease = skin hairless, shiney, pigmented skin, presence of ulcere, callicee (look b/w toes, under heel) .. ~ palpate vessels and capillary return ~ feel temperature => neuropathy + test for peripheral neuropathy of tnes. = test reduced power and impaired reflexes ~ presence of Charcot’s joints (painless deformed ankles; bilateral) + awed wes ~ high foot arches => other + presence of skin lesions e.g Necrobiosis lipoidica diabeticorum sign of skin infection c.g boils, collulitis, fungal infeutivn - look for quad muscle wasting ~ inspect and palpate injection sites for fat atrophy/hypertrophy - thomberg’s test (close eyes. Look for unsteadiness = peripheral neuropathy) + upper limb ~ inspect and palpate injection sites ~ take pulse and measure blood pressure (look for postural hypotension) + signs of infection e.g boils, candida under nails * ENT - look for signs of infection * Face + test visual acutty (Sneen's chart) wll - test pupil reflex to light (CN I: dilated) wd ~ test eye movements (CN II, CN VD A - look for Argyll Robertson pupils dl=> fundoscopy ~ cataracts (absent red eye reflex) - proliferative retinopathy (increased vessel formation) ~ dot hacmorthages - microaneurysms ~ hard and sofi exudates - hypertensive changes - macular degeneration * neck ~ feel carotid pulse and listen for bruits ~ tel tor skin thickening associated with scleroderma * chest = auscultate lungs for infection, cardiac disease * angomen - palpate for hepatomegaly ~ palpate for kidnevs ~ inspect and palpate injections sites for fat necrosis/nypertrophy * urinalysis: ~ glucose, proteinuria, ketones, nitrite/blood (infection) ed 6