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DVBCWDI4.m

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DVBCWDI4 ;ALB/RLC DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004

 ;;2.7;AMIE;**131**;Apr 10, 1995;Build 4

 ;

 ;

TXT ;

 ;;When a Diabetes Mellitus examination is requested, begin with this

 ;;worksheet. For each diabetic complication manifested by the veteran,

 ;;complete appropriate additional worksheets.

 ;;Chronic complications from diabetes include vascular and nonvascular

 ;;complications.  Vascular complications include microvascular

 ;;(eye disease, neuropathy, nephropathy) and macrovascular complications

 ;;(coronary artery disease, peripheral vascular disease, cerebrovascular

 ;;disease).   Nonvascular complications include gastroparesis, sexual

 ;;dysfunction, and skin changes.

 ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.

 ;;

 ;;

 ;;A. Review of Medical Records:

 ;;

 ;;B. Medical History (Subjective Complaints):

 ;;

 ;;   As pertains to Diabetes Mellitus or its complications, comment on:

 ;;

 ;;      1.  Age of onset.

 ;;      2.  Number of episodes of ketoacidosis or hypoglycemic reactions

 ;;          requiring hospitalizations per year.  Location.

 ;;      3.  Restricted diet.

 ;;      4.  Weight loss or gain since last exam.

 ;;      5.  Describe any restriction of activities on account of the

 ;;          diabetes (e.g., avoiding strenuous activity to prevent

 ;;          hypoglycemic reactions).

 ;;      6.  Treatment - oral hypoglycemic, insulin (frequency of injections),

 ;;          side effects.

 ;;      7.  Current frequency of visits to diabetic care provider due to

 ;;          ketoacidosis or hypglycemic reactions or within past year.

 ;;      8.  Other symptoms, such as anal pruritus, loss of strength.

 ;;      9.  Visual problems.  Refer to examination worksheet:  Eye

 ;;          examination, if indicated.

 ;;     10.  Vascular (including hypertension, if appropriate) or cardiac

 ;;          symptoms.  Refer to examination worksheet(s): Hypertension,

 ;;          Heart, Arteries, Veins, and Misc., etc., if indicated.

 ;;     11.  Neurologic symptoms.  Refer to examination worksheet(s):

 ;;          Peripheral Nerves, etc., if indicated.

 ;;     12.  Bladder or bowel functional impairments.  Refer to examination

 ;;          worksheet(s): Genitourinary, Rectum and Anus exam, etc., if

 ;;          indicated.

 ;;     13.  Effects of the condition on occupational functioning and daily

 ;;          activities.

 ;;

 ;;C. Physical Examination (Objective Findings):

 ;;

 ;;   Assess for chronic complications of diabetes mellitus.  Complete

 ;;   appropriate additional worksheets.

 ;;

 ;;      1.  Eye examination.

 ;;      2.  Cardiac examination to include blood pressure and status of

 ;;          peripheral arteries, presence of peripheral edema.

 ;;      3.  Neurologic examination.

 ;;      4.  Skin examination.

 ;;      5.  Examination of extremities, including feet.

 ;;

 ;;D. Diagnostic and Clinical Tests:

 ;;

 ;;   Provide:

 ;;

 ;;      1.  Fasting blood sugars or other laboratory evaluation, such as

 ;;          glucose tolerance test, if necessary to establish the diagnosis.

 ;;      2.  Blood sugars.

 ;;      3.  Evaluation for kidney function including: urinalysis with urine

 ;;          for microalbumnuria; blood urea nitrogen (BUN) and creatinine (Cr).

 ;;      4.  Other test to confirm or evaluate complications.  Follow

 ;;          appropriate worksheets for guidance on the tests.

 ;;      5.  Include results of all diagnostic and clinical tests conducted

 ;;          in the examination report.

 ;;