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Session
by Dr Omar Hasan Kasule Sr. for 4th year medical students on
December 31, 2013
Comparison of two types of diabetes
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Type 1 (insulin dependent)
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Type 2 (non insulin dependent)
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Age
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<30 yr
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>30 yr
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Weight
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Lean
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Overweight
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Heredity
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Genetic susceptibility
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Genetic determination
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Metabolic syndrome
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Associated (HT, CVA, MI, obesity, lipids etc)
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Pathogenesis
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Auto immune? environment
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Not auto immune, Insulin resistance
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Other factors
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Environment
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Early malnutrition
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Insulin
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Deficiency
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Partial deficiency
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Complications
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Ketoacidosis
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Hyperosmolar state
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Biochemical
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C-peptide eventually disappears
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C-peptide persists
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Clinical presentation
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Asymptomatic
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Symptoms:
thirst, polyuria, weight loss, polyphagia,
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Symptoms due to
complications: Skin infections / ulcers,
vision problems, polyneuropathy, sexual problems, arterial /macrovasculsr
complications problems (HT, MI, gangrene), microvascular complications
(diabetic retinopathy, cataract), diabetic nephropathy (albuminuria, renal
failure, anemia, UTI), diabetic neuropathy (sensory polyneuropathy, acute painful neuropathy), muscle wasting, autonomic
neuropathy (tachycardia due to vagal neuropathy, postural hypotension due to
loss of sympathetic tone, bladder dysfunction, male erectile dysfunction),
diabetic foot.
Two forms of diabetic foot: ischemic vs neuropathic
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Ischemic
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Neuropathic
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Symptoms
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Claudication, pain at rest
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Usually painless, may be painful
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Appearance
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Redness, skin changes
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No skin changes, toes clawed
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Palpation
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Cold, pulseless
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Warm. Strong pulse
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Ulceration
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Painless on heels and toes
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Painless on plantar aspect
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2
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3
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4
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1.0 DEMOGRAPHIC INFO
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Name
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Age and date of birth
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Residential address
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Occupation
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2.0 HISTORY OF PRESENTING COMPLAINT(s)
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Complaint #1: Onset, course, location (site), radiation,
severity, time of day, duration, diurnal variation, character, aggravating
factors (food, cough etc ), relieving factors, associated symptoms
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Complaint #2:
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Complaint #3:
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Complaint #4:
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What does the patient think is going on?
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Treatments already given
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Effect: work, daily life, sports,
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3.0 PAST MEDICAL / SURGICAL HISTORY
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Chronic illnesses
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Hospitalizations
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Surgeries
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4.0 ALLERGY HISTORY
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Reactions to medications: type and drug
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Food allergies
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Environmental allergies
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5.0 MEDICATION HISTORY
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List of current medications doses and why: prescribed or OTC?
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List of chronic medications
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Medicine
stopped
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Herbal or complimentary medications
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6.0 FAMILY HISTORY
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Parents: age, height, weight, health status, consanguinity,
region of origin
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Siblings: names, nicknames, age, height, weight, health status
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Significant problems
maternal & paternal sides: arthritis, DM, HT, renal disease,
anemia, headache, TB
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Diseases that run in the family
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Specific question about illnesses resembling presenting complaint
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7.0 SOCIAL HISTORY
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Type of housing, location (city vs rural), how many people in
house
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Education, occupation, income, religion and culture, smoking
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Health insurance
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Contact with animals
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8.0 DIET/NUTRITIONAL HISTORY
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Early childhood
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Foods: types and frequency, recent changes
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9.0 RISK FACTORS
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10.0 REVIEW OF SYSTEMS (If not covered in presenting complaints
and PMH)
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Skin: skin rash, pigmentation, bruising, ulcers, pain/loss of
sensation
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CVS and RES: chest pain, cough (hemoptysis), dypnea (orthopnea,
nocturnal dyspnea), cyanosis, palpitations, ankle swelling,
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Hematological: pallor, jaundice, bone pain, bruises, epsitaxis
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GIT: Vomiting, nausea, dyspepsia, dysphagia, abd pain, diarhoea /
constipation, Bowel habits, feeding, weight loss / gain, rectal bleeding
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Urinary tract: dysuria, enuresis, frequency., nocturia,
hematuria, incontinence, urethral discharge
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Genital: menstruation (regularity, length, volume), impotence,
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CNS: irritability, drowsiness, collapse / blackout, abnormal movements (seizures), headache,
numbness, dizziness and loss of balance, vision, hearing, headache
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Musculoskeletal: joint swelling, joint pain, skin rash, movement
restrictions, muscle wasting, spasms,
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