The presentation covers clinical aspects of diabetes mellitus. Common Symptoms. Acute Presentation. Examination of different systems.Hyperglycemic Hyperosmolar state. Diabetic Ketoacidosis. Hypoglycaemia, Hyperglycaemia

1. DIABETES MELLITUS
HISTORY & EXAMINATION
Bhoopendra Kumar
8th Semester
MBBS AIIMS Delhi

2. INTRODUCTION
 Diabetes mellitus, commonly known as diabetes, is a
group of metabolic disorders characterized by a high
blood sugar level over a prolonged period of time
 There are three main types of diabetes mellitus:
 Type 1 diabetes results from failure of the pancreas to
produce enough insulin due to loss of beta cells. The
loss of beta cells is caused by an autoimmune response
 Type 2 diabetes begins with insulin resistance, a
condition in which cells fail to respond to insulin
properly.[2] As the disease progresses, a lack of insulin
may also develop
 Gestational diabetes is the third main form

3. TYPE 1 VS. TYPE 2

4. HISTORY: CARDINAL SYMPTOMS
 Polyuria: Urine output >3L/day
 Polydipsia: Abnormal or Excessive thirst. (d/d:- DI,
Psychogenic.)
 Polyphagia: abnormally strong sensation of hunger or
desire to eat often leading to or accompanied by
overeating

5. OTHER COMMON SYMPTOMS
 Lethargy & Weakness
 Recurrent Skin Infection
 Dry, Scaly Skin
 Delayed Wound Healing
 Palpitation & Breathlessness
 H/S/O Claudication
 Numbness/Tingling/ Pain in extremities
 White Vaginal Discharge & white oral patches(
Candidiasis)
 Erectile Dysfunction
 Blurred vision/ Floaters/ Sudden LOV

7. ACUTE PRESENTATION
Symptoms
Altered
Mental
Status
Coma
Focal/
Diffuse
Neurological
Deficit
Hyperglycemic Hyperosmolar State

8. Abdominal pain
Nausea/Vomiting
Deep & Heavy
Breathing
Fruity Smell
Apathy &
Tiredness
Diabetic Ketoacidosis

9. UNCOMMON SYMPTOMS
 Malignant Otitis Externa: otorrhoea for 1-2 weeks,
followed by otalgia which can be followed by facial
nerve paralysis and features of meningitis
 Rhinocerebral Mucormycosis: nasal obstruction and
discharge, followed by headache/facial pain along
with features of multiple cranial nerve palsies,
proptosis and vision loss.

10. SYMPTOMS OF HYPOGLYCEMIA

11. CLINICAL EXAMINATION
 General Physical Examination
 Locoregional Examination

12. GPE
 Altered Consciousness
 Altered Mental Status
 BMI, Waist-Hip Ratio
 Vitals- Pulse, BP, Respiration(Kussumaul),
Hydration Status( Skin & Mucus Membrane)

14. LOCOREGIONAL EXAMINATION
 Diabetes can affect almost every system of the
body. So, A patient suspected of having diabetes
should be examined thoroughly from head to toe.

15. EXAMINATION OF HEAD AND NECK
 Xanthelasma
 Cranial Nerve Palsy(3,4,6 & 7)
 Eye movements
 Ptosis
 Hirsutism
 Carotid Pulse
 Carotid Bruit
 Thyroid Enlargement

16. EXAMINATION OF EYES
 Visual Acuity
 Anterior Segment Examination
1. Corneal Arcus
2. Whitish Pupillary Reflex(Cataract)
3. Sluggish Pipillary Light Reflex
 Fundus Examination

18. EXAMINATION OF BUCCAL CAVITY
 Puffy, Red gums
 Plaque deposition
 Dacayed teeth
 Bad breath of Periodontitis

19. EXAMINATION OF SKIN AND NAIL
Acanthosis Nigricans Granuloma Annulare Diabetic Dermopathy
Bullosis Diabeticorum Necrobiosis Lipoidica Diabeticorum Fungal Nail Infection

20. EXAMINATION OF HANDS
Diabetic Cheiroarthropathy
(Prayer Sign)
Trigger Finger Dupuytren’s Contracture
Tinel’s Sign
Phalen’s Test
Sensory Loss and
Muscle wasting may
be present

21. EXAMINATION OF INJECTION SITES
 Areas to be examined:
1) Anterior abdominal wall
2) Upper Thighs/Buttocks
3) Upper outer arm
 Possible Findings:
1) Bruising
2) Lipodystrophy
3) Lipohypertrophy
4) Lipoatrophy
Lipohypertrophy
Lipoatrophy

22. ABDOMINAL FINDINGS
 Hepatomegaly( due to NAFLD)
 Abdominal Tenderness( due to DKA)

23. EXAMINATION OF LEGS
 Calf and thigh muscle atrophy
 Sensory abnormality
 Dry skin and hair loss
 Absent/weak femoral pulse
 Femoral bruit
 Loss of knee/ankle jerks
Elicitation of Ankle Jerk

24. EXAMINATION OF FEET
 Inspection:
1) Charcot Neuroarthropathy/ Claw Toe
2) Callus
3) Loss of Plantar Arch
4) Diabetic Foot Ulcer
5) Discoloration of skin d/t ischaemia
6) Fungal Infections
Claw Toe Charcot Neuroarthropathy Diabetic Foot Ulcer

25. EXAMINATION OF FEET(CONT…)
 Peripheral Pulse:- Palpated at
1) Posterior Tibial Artery
2) Dorsalis Pedis Artery
3) Also examine for nail fold refilling
 Test for Sensation
1) Light touch (using monofilament)
2) Crude touch (using blunt end of pin)
3) Pain ( tip of pin)
4) Temperature
5) Vibration( using 128Hz Tuning fork)
6) Propioception

26. THANK YOU!
HAVE A NICE DAY 