Physical Exam
Screening for early signs and symptoms of diabetes, followed by regular physical examinations for those diagnosed, cannot be overemphasized. In fact, nearly 25% of diabetic diagnoses are made during a routine physical examination, according to the National Institutes of Health (NIH). In addition, nearly half of adults diagnosed with Type II diabetes indicated that they had no symptoms of the disease at the time they were diagnosed, and most people have had the disease an average of 10 years prior to diagnosis.
Based on these statistics, there are an estimated 10 million North Americans who have diabetes and have not yet been diagnosed. In addition, approximately 40% of American adults between the ages 40 and 74 (about 41 million people) have prediabetes, according to the NIH. Prediabetes places these individuals at an increased risk for developing cardiovascular disease and Type II diabetes. Prediabetes is defined as having an elevated glucose (blood sugar) level that is above normal, but not high enough to be considered diabetes.
A physical examination is, therefore, an important part of detecting prediabetes. Detection of prediabetes or metabolic syndrome X can provide important time and motivation to make dietary and lifestyle changes, which will delay or even prevent a future diabetes diagnosis. Even if a diagnosis of diabetes has been made, regular physical examinations help to minimize the risk of developing serious complications.
Physical Exam for Diabetes
- · Height and weight measurement. Being overweight or obese is an important risk factor for Type II diabetes. Children and teens should have their height and weight compared to standards that are normal for their age groups.
- · Blood pressure. BP tends to be elevated in metabolic syndrome and diabetes.
- · Dilated eye exam. Typically done by an ophthalmologist, this test looks for changes in the small blood vessels at the back of the eye.
- · Skin examination for dry, scaly skin, poor wound healing, fungal infections.
- · Thyroid exam. Thyroid dysfunction often co-exists with blood sugar irregularities.
- · Peripheral pulses. Pulses in the wrists, foot, and groin help to detect peripheral occlusions, which are a complication of diabetes.
- · Foot exam for fungal infections, sores, etc. Seeing a podiatrist who treats diabetics may be indicated.
- · Neurological exam. This includes pinprick and vibratory sensation in the extremities because peripheral neuropathy is a common complication of elevated blood glucose.
Laboratory Tests
- Oral glucose insulin tolerance test (GITT) is indicated if hyperinsulinemia is suspected.
- Fasting plasma glucose is the typical diagnostic test for diabetes mellitus.
- Hemoglobin A1c is a useful measure of average blood glucose over a 2- to 3-month time span.
- Serum lipids (triglycerides, LDL, HDL, total cholesterol), lipoprotein A, and homocysteine are useful to assess cardiovascular risk.
- Cortisol and DHEA tests to assess adrenal function because increased cortisol and decreased DHEA are typical in insulin resistance.
