Things to Ask a Diabetic Patient

It’s important to be detailed when taking patient history to get a good picture of what is going on. For every type of patient, there are specific sets of questions that need to be asked. During our rotation, we learn to follow patients, present our patients to our attending physicians, and observe our attendings examen the patients. For every rotation, there will be times when our attendings will ask us a question about our patient to which we would realize that we had forgotten to ask that particular question during the patient interview or check for that particular sign in the physical exam. We would reply, “I did not ask,” and subsequently, we would then be given a lesson (to put in nice terms) about the importance of detail. Its all a part of the rotation learning experience, and after enough mistakes, eventually, doing a history and physical would become second nature to us.

I’ve had my fair share of incomplete histories, and because of this, I decided to personally make a list of the basic things I will ask or look for whenever I see a patient with a certain condition, like diabetes. Besides the basic interview questions (HPI, PMH, FH, SH, ROS, etc.), here is my list of other specific things to make sure to ask for in a diabetic patient:

What to ask the diabetic patient:

  • How long have you had Diabetes? Type 1 or Type 2?
  • Glucose
    • When do you check your glucose?
    • What is your glucose level at those times?
    • How long has it been that high?
    • Have you had hypoglycemia?
      • Can you recognize the symptoms?
      • What symptoms do you get?
      • When?
      • How often?
      • What do you do whenever you experience hypoglycemic symptoms? Do you carry sugar pills with you?
      • What do you do to prevent episodes from happening?
  • Oral Medication (if applicable)
    • What medications are you taking for Diabetes? ┬áDose?
    • Any side effects or issues?
    • Need refills for today?
  • Insulin (if applicable)
    • When/What times do you take insulin?
    • How much insulin do you take?
    • What kind of insulin do you take?
    • Insulin in pen or bottle/syringe?
    • Do you need a refill today?
  • Diet
    • What do you eat for breakfast/lunch/dinner?
    • Do you eat snacks in between meals? Soda?
    • What times do you eat breakfast/lunch/dinner?
    • Which meal is the biggest?
    • Do you eat vegetables? Drink lots of water?
    • Do you ever skip meals?
    • Educate them on healthy eating habits, like making half your plate colorful veggies, a quarter white-colored meats, and a quarter brown-colored carb foods.
  • Exercise
    • Do you exercise?
    • Educate them on the importance of exercise.
  • Symptoms and Complications
    • Nerves — tingling/numbness/cramps? when? where? taking meds for it?
    • Kidney — polydipsia/polyuria/nocturia?
    • Eyes — blurry vision? cataracts? see eye doctor?
    • Feet — see foot doctor?
    • Weight loss?

Things to look for in physical exam of diabetic patient:

  • Striae
  • Thyromegaly
  • Onychomychosis/fungus between toes
  • Acanthosis nigricans
  • Edema in lower extremities

Things to look for in labs of diabetic patient:

  • Trends/changes in glucose. Any improvement?
  • Check A1C. Is it up to date (if more than 120 days)? Check CBC — A1C is not valid with anemia.
  • BUN/Creatinine/GFR levels (can indicate nephropathy). Albumin in urine?