Assessment

You can use a health history and physical examination in two distinct ways to investigate diabetes. When you suspect that a patient has the disorder, you can perform a health history and physical examination to discover the characteristic signs and symptoms and confirm your suspicion. When you already know that a patient has diabetes, you can use a health history and physical examination to help monitor the disease and uncover any complications.

Diabetes looks different in different patients. The signs and symptoms, the severity, and even the type of diabetes can vary. But one thing is always the same, hyperglycemia.

Any patient with diabetes has one or both of these problems. She either produces little or no insulin, or her body can’t use insulin effectively. As a result, she has difficulty metabolizing carbohydrates, fats, and proteins, so hyperglycemia develops.

To diagnose diabetes, a physician needs to determine if a patient has hyperglycemia. Depending on the patient’s history and her signs and symptoms, one of three tests may be performed. For a patient with the typical signs and symptoms of diabetes, such as polydipsia, polyuria, polyphagia, blurry vision, and unexplained weight loss, a physician can base the diagnosis on a single random blood glucose level of 200 mg/dl or more. If a patient doesn’t have the typical signs and symptoms of diabetes, the physician needs a fasting blood glucose level of 126 mg/dl or more to make the diagnosis. For a patient who is at risk for developing diabetes (for example, someone who has a family history of diabetes or who is obese) and who has a normal fasting blood glucose level, a physician will use the 2-hour oral glucose tolerance test. He’ll make a diagnosis of diabetes if an initial test and one follow-up test reveal blood glucose levels of 200 mg/dl or more.

Treating diabetes consists of keeping blood glucose levels as close to normal as possible, using a combination of medication, diet, exercise, and stress control. By closely monitoring blood glucose levels and keeping them as close to normal as possible, a patient can reduce the risks of acute and long-term complications. The acute life-threatening complications of diabetes include hypoglycemia, diabetic ketoacidosis (DKA), and hyperglycemic hyperosmolar nonketotic (HHNK) syndrome. Long-term complications, which develop because chronic hyperglycemia causes damage to organs and tissues, include nephropathy, cardiovascular disease, peripheral vascular disease, cerebral vascular disease, neuropathy, and retinopathy.