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Routine: DVBCWDI2

DVBCWDI2.m

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  1. DVBCWDI2 ;ALB/JEH DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
  1.  ;;2.7;AMIE;**69**;Apr 10, 1995
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;When a Diabetes Mellitus examination is requested, begin with this
  1.  ;;worksheet. For each diabetic complication manifested by the veteran,
  1.  ;;complete appropriate additional worksheets.
  1.  ;;
  1.  ;;Chronic complications from diabetes include vascular and nonvascular
  1.  ;;complications.  Vascular complications include microvascular
  1.  ;;(eye disease, neuropathy, nephropathy) and macrovascular complications
  1.  ;;(coronary artery disease, peripheral vascular disease, cerebrovascular
  1.  ;;disease).   Nonvascular complications include gastroparesis, sexual
  1.  ;;dysfunction, and skin changes.
  1.  ;;
  1.  ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
  1.  ;;
  1.  ;;
  1.  ;;A. Review of Medical Records:
  1.  ;;
  1.  ;;
  1.  ;;B. Medical History (Subjective Complaints):
  1.  ;;   As pertains to Diabetes Mellitus or its complications, comment on:
  1.  ;;
  1.  ;;      1.  Age of onset.
  1.  ;;
  1.  ;;      2.  Frequency of ketoacidosis or hypoglycemic reactions.
  1.  ;;
  1.  ;;      3.  Hospitalizations per year for ketoacidosis or hypoglycemic
  1.  ;;          reactions.
  1.  ;;
  1.  ;;      4.  Restricted diet.
  1.  ;;
  1.  ;;      5.  Weight loss or gain since last exam.
  1.  ;;
  1.  ;;      6.  Describe any restriction of activities on account of the
  1.  ;;          diabetes (e.g., avoiding strenuous activity to prevent
  1.  ;;          hypoglycemic reactions).
  1.  ;;
  1.  ;;      7.  Treatment - oral hypoglycemic, insulin (frequency of injections).
  1.  ;;
  1.  ;;      8.  Frequency of visits to diabetic care provider.
  1.  ;;
  1.  ;;      9.  Other symptoms, such as anal pruritus, loss of strength.
  1.  ;;
  1.  ;;     10.  Visual problems.  
  1.  ;;             Refer to examination worksheet: Eye examination, if  
  1.  ;;             indicated. 
  1.  ;;
  1.  ;;     11.  Vascular (including hypertension, if appropriate) or cardiac
  1.  ;;          symptoms.
  1.  ;;             Refer to examination worksheet(s): Hypertension, Heart,
  1.  ;;             Arteries, Veins, and Misc., etc., if indicated.
  1.  ;;
  1.  ;;     12.  Neurologic symptoms.
  1.  ;;             Refer to examination worksheets(s): Peripheral Nerves, etc.,  
  1.  ;;             if indicated.
  1.  ;;
  1.  ;;     13.  Bladder or bowel functional impairments.
  1.  ;;             Refer to examination worksheets(s): Genitourinary, Rectum
  1.  ;;             and Anus exam, etc., if indicated.
  1.  ;;
  1.  ;;C. Physical Examination (Objective Findings):
  1.  ;;
  1.  ;;Assess for chronic complications of diabetes mellitus.  Complete
  1.  ;;appropriate additional worksheets.
  1.  ;;
  1.  ;;      1.  Cardiovascular examination to include blood pressure and status
  1.  ;;          of peripheral arteries, presence of peripheral edema.
  1.  ;;
  1.  ;;      2.  Neurologic examination.
  1.  ;;
  1.  ;;      3.  Eye examination.
  1.  ;;
  1.  ;;      4.  Skin examination.
  1.  ;;
  1.  ;;      5.  Examination of extremities, including feet.
  1.  ;;
  1.  ;;D. Diagnostic and Clinical Tests:
  1.  ;;
  1.  ;;Provide:
  1.  ;;
  1.  ;;      1.  Fasting blood sugars, or other laboratory evaluation if
  1.  ;;          necessary to establish the diagnosis.
  1.  ;;
  1.  ;;      2.  Blood sugars.
  1.  ;;
  1.  ;;      3.  Evaluation for kidney function including: urinalysis with urine
  1.  ;;          for microalbumenuria; blood urea nitrogen (BUN) and creatinine
  1.  ;;          (Cr).
  1.  ;;
  1.  ;;      4.  Include results of all diagnostic and clinical tests conducted
  1.  ;;          in the examination report.
  1.  ;;
  1.  ;;E. Diagnosis:
  1.  ;;
  1.  ;;      1.  State whether the veteran has diabetes mellitus.  Indicate type.
  1.  ;;
  1.  ;;      2.  Specifically list each identified complication of the veteran's
  1.  ;;          diabetes.  Indicate these conditions as complications of the
  1.  ;;          veteran's diabetes. If the veteran has peripheral edema,
  1.  ;;          indicate whether it is a consequence of diabetic kidney disease
  1.  ;;          or other non-diabetic related etiology.
  1.  ;;
  1.  ;;      3.  For each identified complication of the veteran's diabetes,
  1.  ;;          provide a brief rationale for your conclusion.  You may base
  1.  ;;          your rationale on such things as the duration of the veteran's
  1.  ;;          diabetes, whether the veteran's diabetes has been poorly
  1.  ;;          controlled, the onset of the condition that you deem to be a
  1.  ;;          complication of the veteran's diabetes in relation to the onset
  1.  ;;          of the veteran's diabetes, the severity of the complication, or
  1.  ;;          anything else you consider relevant.
  1.  ;;
  1.  ;;      4.  Where the veteran has visual impairment, cardiovascular disease
  1.  ;;          (including hypertension), kidney disease, neurologic disease,
  1.  ;;          amputations, or any other disabilities which, in your opinion,
  1.  ;;          are not complications of the veteran's diabetes, please state so
  1.  ;;          and provide a supporting rationale as to the basis for your
  1.  ;;          conclusion.
  1.  ;;
  1.  ;;      5.  Where the veteran has a condition that is worsened or increased
  1.  ;;          by the veteran's diabetes but is not a diabetic complication,
  1.  ;;          discuss the relationship between the condition and the veteran's
  1.  ;;          diabetes. In particular, discuss what the degree of disability
  1.  ;;          is of the condition over and above the degree of disability that
  1.  ;;          existed prior to aggravation/worsening by the diabetes.  Provide
  1.  ;;          your rationale.  Indicate if this is not possible to do without
  1.  ;;          resorting to speculation.
  1.  ;;
  1.  ;;
  1.  ;;Signature:                           Date:
  1.  ;;END