Assessing Diabetes With a Physical Exam

While some people can quickly become aware they have diabetes, some do not. The sooner diabetes is detected, the sooner a treatment plan can be put in place. If you do have symptoms that suggest diabetes, it’s important to see a doctor right away. If you are at risk of developing diabetes, you need to be screened. When there are risk factors present, like other family members having diabetes, the doctor needs to know too.  In any case, diagnosis and assessment boil down to one specific item: the physical exam conducted by your doctor.[1]

The Initial Examination

The physical needs to be complete whether a child or adult gets the medical exam. With this in mind, the doctor will perform a number of tests designed to detect symptoms of diabetes and will also order tests that verify whether you are prediabetic or diabetic. Below is a list of tests your doctor may do for you.

  • Height and weight – Your doctor will measure your height and weight and then use them to compute your body mass index (BMI). This will provide information on whether you are at a healthy weight for your height.
  • Blood Pressure – Your doctor will take your blood pressure.
  • Lab tests – To officially make the diagnosis of diabetes, you must have confirmation by blood tests. Your doctor will arrange for blood tests when you have been fasting (nothing but water for 8-10 hours). If the initial tests indicate your glucose is too high, he will likely retest it a couple of days later to confirm the result. [2] You will also have your cholesterol levels checked among other tests.
  • Eyes  – The overhead lights will be dimmed. The doctor will then use a ophthalmoscope to examine the back of each eye looking for signs of retinopathy.
  • Nose, Ears, Mouth – Although the doctor may examine these areas, it is not expected that abnormalities will be found that are related to diabetes
  • Neck – When it comes to the neck, the doctor is focusing specifically on the glands. The thyroid gland is checked for enlargement. In addition, the doctor will look for signs of abnormalities in the lymph nodes.
  • Chest – The doctor will check your heartbeat and lungs. Most doctors will also want to get an electrocardiogram (EKG; ECG) as part of your initial diagnosis of diabetes. This is not usually requested for a child.
  • Abdomen- When palpitated, there should be no sensitive areas or conspicuous organs. They may also listen for a bruit, which may indicate an abdominal aortic aneuysm.
  • Arms – This will involve a general inspection of the skin as well as muscle bulk. The doctor may run his or her fingers lightly over the skin looking for variations in skin sensitivity.
  • Legs – The skin and muscle bulk of the legs is inspected and any asymmetry noted; reflexes are tested at knees and ankles; feet are examined with care, noting any deformity of toes due to pressure exerted by shoes (red areas) or congenital abnormalities like an arch abnormality or great toe. A simple tuning fork may be used to test vibration sense at the ankle. Variations in skin sensation are also noted. The foot exam is one of the more important exams for diabetic patients because peripheral neuropathy may make it difficult for a diabetic to feel any damaged skin or ulcers.

If the physical examination indicates that the patient may have diabetes, it will be necessary to arrange for a barrage of further tests that go beyond the physical exam. Most of the physical exam tests will become part of every doctor appointment following your official diagnosis.[3]

Referrals

When you have been diagnosed with diabetes, your doctor will refer you to several specialists.[4] Among these are:

  • The endocrinologist – This is a doctor who specializes in diabetes and is often needed for more complex diabetic patients. He or she may order special blood tests. Most diabetics can be managed by their primary care physician.
  • The optometrist – This medical specialist will place drops in the patient’s eyes to dilate the pupils in order to obtain the best possible view of the eye’s interior. Additional eye tests may be ordered. Annual eye exams should be done.
  • The Registered Dietician – This purpose of this professional is to help ensure the patient and his or her family understands the nutritional requirements of a diabetic and will follow the instructions of the endocrinologist in regards to diet and nutrition.
  • Diabetes education specialist – This individual is trained to handle all your questions about diabetes. The education specialist will explain the purpose of a diabetes “coach.”  Part of the job description is to provide as much support to the patient and the family as possible. This individual can also recommend reading material for the diabetic and the family.
  • Dentist – A dentist will examine the teeth and gums because the sugar imbalances in diabetics often lead to gum disease.
  • Clinical psychologist – While most patients do not need to see a psychologist, it may be helpful to talk to a professional regarding changes in lifestyle and the pattern of the diabetic’s life as part of disease management.  It is this professional who will arrange to talk to all members to make sure they are willing to be supportive of the changes and will treat the diagnosis with the care and seriousness it needs. A clinical psychologist may suggest behavioral changes or talk about empowerment.[5]

Conclusion

Detecting and diagnosing diabetes requires several tests, including blood work, to confirm a diagnosis. Treatment often includes working with a number of medical professionals to determine the necessary lifestyle changes you will have to make to properly manage the disease. In the end, you will have a medical team that will help you and your family learn how to live with diabetes in as healthy manner as possible.

References

[1]Warshaw, HS; and Pape, J (2009). Real-Life Guide To Diabetes. Alexandria, VA: ADA.

[2] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

[3] Stanley, K (2009). 50 Things You Need To Know About Diabetes. Alexandria, VA: ADA.

[4] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA

[5] Warshaw, HS; and Pape, op. cit.

This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.