Apart from this temporary state, most diabetics may treat vision impairments not caused by the disease just as anyone else would do, with contact lenses or glasses. Of these two, contact lenses is a choice that has become increasingly popular the last twenty years, This is due to lower prices, less need of maintenance and care than before, and of course due to a generally improved product. Modern contact lenses are extremely soft and comfortable, are very gentle to the eyes and can very easily be ordered over the Internet.

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A family history of diabetes may influence your patient’s feelings and attitudes about the disease. A family member who has had major complications from diabetes or who doesn’t comply with the treatment plan can be a source of fear and misunderstanding for your patient. Uncovering a family history of diabetes provides an opportunity for you to explore your patient’s attitudes, misconceptions, and fears about the disease.

Health History

A health history performed to identify the signs and symptoms of diabetes is similar to any other health history. It should cover your patient’s biographical information, chief complaint, history of her present illness, medical history, family history,psychological and social history, and a review of her body systems.

If your patient has already been diagnosed with diabetes, you’ll also need to review her treatment plan, the problems she encounters in living with diabetes, and any acute and chronic complications. The health history can also help you uncover problems with treatment compliance and patient concerns.

History of Present Illness

Investigating your patient’s present illness adds to the information you’ve already gathered about her chief complaint. Find out when the present illness started, what the first symptoms were, and if any recent treatments have relieved them.

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Insulin

• What type of insulin do you use? How much? When?
• Into which part of your body do you inject the insulin?
• Do you rotate your injection sites?
• Do you inject your insulin or does someone do it for you?
• Have you missed any injections in the last 2 weeks? How many?
• Do you have any problem drawing up the correct amount of insulin?

Oral antidiabetic drugs

• What is the name of your antidiabetic drug?
• How many pills are you supposed to take each day? How many do you actually take?
• Have you missed any pills in the last 2 weeks? How many?

Diet and exercise

• Has your physician recommended that you follow a diet to control your diabetes or to lose weight?
• How many calories are you supposed to have each day? Do you stick to that limit?
• What time do you usually eat your meals? What about snacks?
• Have you skipped any meals in the last 2 weeks? How many? Which meals?
• Who shops for your food? Who prepares your food?
• What’s the hardest part of your diet?
• Has your weight changed in the last year? By how much?
• Is exercise part of your regimen?
• What kind of exercise do you do? How often? For how long?

Blood glucose control

• How often have you checked your blood glucose level in the last month?
• In the past 2 weeks, have you felt tired, very thirsty, confused, or shaky? Have you had to go to the bathroom two or more times during the night? Have you had nightmares or bad dreams?
• How do you feel when you have a reaction to low blood glucose levels? How often have you felt that way in the last 2 weeks?
• How do you treat a reaction from low blood glucose levels?

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Although allergies aren’t considered a risk factor for diabetes, they may pose a problem in managing the disease. For example, a patient who needs insulin therapy but is allergic to beef or pork can use only human insulin. A patient who’s allergic to sulfa will not be able to take sulfonylureas.

Because managing diabetes requires the patient to master several skills, you should ask about injuries and impairments. A patient who has poor eyesight or a hand injury may not be able to draw up the correct dose of insulin, inject insulin, or monitor her blood glucose levels without help from someone else or the use of assistive devices, such as magnifiers or dose aids. Knowing about your patient’s injuries and impairments will help you individualize her treatment plan.

Also, gather information about the patient’s diet, medications, level of activity, and use of alcohol and tobacco.

Diet is one of the cornerstones of diabetes management. And noncompliance and lack of knowledge are two key causes of uncontrolled diabetes. To find out about your patient’s eating habits, have her do a 3-day diet recall. For variety and accuracy, one of the days should be a non-workday. Explore your patient’s likes and dislikes, the types and quantities of food she eats, her mealtimes, and snack habits. Assess her knowledge of nutrition, her attitudes about food, and her understanding of food’s relationship to obesity. Eating disorders such as an­orexia nervosa and bulimia can make glucose control especially difficult. The following ques­tions may help you uncover these disorders:

• What concerns do you have about your weight?
• Have you ever made yourself vomit or used laxatives to control your weight?
• What do you think of your body when you look in the mirror?

Your patient’s current drugs may interact with drugs used to treat diabetes. Or they may cause hyperglycemia or hypoglycemia, making it difficult for her to control her blood glucose levels .

A sedentary lifestyle is also a risk factor for diabetes. Ask your patient about her exercise habits and the activities she performs on workdays and non-workdays. Ask her about exercise likes and dislikes and any exercise programs that she has undertaken in the past. This information will help when you and she plan the exercise portion of her long-term treatment. Your patient is more likely to comply with her exercise program if she gets to choose an activity that she enjoys.

Finally, ask your patient about her use of alcohol and tobacco. Alcohol can alter blood glucose levels in a patient with diabetes and place her at risk for hypoglycemia and hyperglycemic emergencies such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar non ketotic (HHNK) syndrome. Smoking decreases insulin’s effectiveness. It also increases the risk of amputation if your patient already has peripheral vascular disease as a result of undiagnosed or poorly managed diabetes.

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The patient’s financial situation can have a major impact on her willingness to purchase the supplies she needs to help control blood glucose levels. If you recognize a patient’s financial concerns early on, give her an appropriate referral so that she can get the assistance she needs to manage her diabetes.

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