Diabetes Examination Component What to do/look for and rationale Vitals Does the patient look well? Weight loss -> T1DM Weight gain -> T2DM Dehydration and hydration status Rotten fruity breath General inspection Kushmal’s breathing Pigementation E.g. hemochromatosis Injection sites: Brusing Lipohypertrophy Lipoatrophy Vitiligo (autoimmune) Pigmentation Skin Axillary acanthosis nigricans in insulin resistance. Granuloma annulare Bullosis Eyelids Xanthelasma CN palsy Esp CN III Eye movements Eyes Ptosis Fundoscopy Cataracts against red reflex Retinopathy Visual acuity Mouth Candidiasis Carotid pulses/bruits Neck Check thyroid gland for goitre (autoimmune) Injection sites. Skin lesions Blood pressure Peripheral pulses Arms and Hands Carpal tunnel syndrome Dupturenon’s contracture Muscle wasting Limited joint movement Hepatomegaly Abdomen Fatty liver Look for: Signs of candida infection Ulcers Necrosis Muscle wasting Edema Feel for peripheral pulses Look for features of PDA: Pale Feet and legs Pulseless Paraesthesia Pain Paralysis Skin: Colour Ulcers Gangrene Look in between the toes for infection Charcot’s joints Test for sensations: Sensations Neuropathic foot ulcers Charcot neuroarthropathy Assess for diabetic emergencies Diabetic ketoacidosis Hypoglycaemia Establish the presence of complications Neuropathy Eyes and retinopathy Kidney disease Aims for physical examination in diabetes Skin changes including ulcerations, cardiovascular risk factors: blood pressure, stigmata of hyperlipidaemia, wright and BMI revealing signs of auto-immune disease: vitiligo thyroid disease assessment of injection sites urinalysis: glucose ketones Others proteins blood pressure and pulse lying and standing