Live Blog: Diabetes Examination

This week we welcomed back Dr. Paige Comstock, PGY3, for a talk on the diabetic examination. 

At the start of a diabetic exam, the vital signs-- specifically blood pressure targeted at 130/80-- are the most important.

Skin findings in diabetics:

• Velvety, hyperpigmented areas called Acanthosis Nigracans
• Diabetic dermopathy found in 50% of diabetics. They have microvascular complications like neuropathy.

Eye complications of diabetes:

• diabetic retinopathy
• cataract
• glaucoma.

The foot examination:

• Necessary because there is a 25% lifetime risk to develop ulcers due to neuropathy, deformity, and trauma.
• Look for 
• sweating
• ABI (Ankle Brachial Index) if indicated
• callouses because of neuropathy
• nail dystrophy
• paronychia
• areas of abnormal erythema
• check interdigitally.
• Deformities (rigidity, claw toe, hammer toe, charcot foot) lead to increased pressure in some points of the foot which leads to more trauma. 
• For the neurologic exam, perform the microfilament test on various pressure points on the foot. 
• Other neurologic tests include ankle reflexes, pin prinks, and tuning fork on the foot.
• Vascular exam includes palpating the distal pulses to check whether there is poor blood supply. This is a risk factor for recurrent ulcerations.