2. Introduction
This work is only designed to cover how a case of diabetes could
present in PACES station 5 examination.
3. History taking in patients with diabetes
For the purpose of efficient history taking in patients with diabetes it is
essential to cover the followings;
• Chronology; age of onset – duration – type of DM.
• Control; most recent blood glucose level reading – most recent
HBA1C% reading.
• Medications; insulin or OHGAs – doses and possible side-effects.
• Lifestyle; diet and exercise.
• Complications; visual – vascular – renal – neurological – footcare –
hypoglycemic episodes.
5. Diabetic Neuropathy; Clinical Approach -
History
Full diabetic history
Full neuropathy history
• Sensory symptoms; -ve or
+ve symptoms
• Motor symptoms; weakness.
• Autonomic symptoms;
nausea – vomiting – altered
bowel habit – erectile
dysfunction.
• Gait
Ask about other common
possible causes of chronic
neuropathy
• Vitamin B12 deficiency.
• Folate deficiency.
• Uremia.
• Hypothyroidism.
• Vasculitis.
• Paraneoplastic syndrome.
6. Diabetic Neuropathy; Clinical Approach –
Examination
Overall inspection
Skin
• Trophic changes.
• Ulcers
• Callus
• Hair distribution in
lower limbs
Vascular input Pulses and Capillary Refill.
Neurological examination
• Sensory examination for all
modalities of sensation.
• Motor examination.
• Gait
• Romberg’s test
Tell the examiner that you would like
to complete your examination by
performing complete neurological
examination and dipsticking urine for
glycosuria and proteinuria.
9. Diabetic neuropathic ulcer; Clinical approach
– History
Full diabetic history
Full neuropathy history
Ulcer history
Location – Size – Edges – Color –
Odor – Surrounding skin – Pain.
Vascular history
Intermittent claudication –
Angiogram or Angioplasty
History of recent trauma
Footcare and orthopedist
Follow up
10. Diabetic neuropathic ulcer; Clinical approach
– Examination
Overall inspection
Skin
• Trophic changes.
• Ulcers
• Callus
• Hair distribution in lower
limbs
Ulcer examination
Location – Size – Edges – Color –
Odor – Surrounding skin – Pain.
Vascular input
Pulses and Capillary Refill.
Tell the examiner that you would like
to complete your examination by
performing complete neurological
examination and dipsticking urine for
glycosuria and proteinuria.