Next, check your patient’s height and weight. Patients with Type I diabetes are usually underÂweight or average weight, whereas patients with Type 2 diabetes are usually overweight at the time of diagnosis. A recent rapid weight loss is a common sign of Type 1 diabetes. Poorly controlled diabetes may cause stunted growth in children.
Skin
Skin abnormalities are common with diabetes . With prolonged hyperglycemia, the skin can appear dry and flaky. If the skin is itchy, the patient may have scratch marks. The skin may be flushed and warm in patients with DKA or pale and cool in those with HHNK
syndrome, depending on the blood glucose level. A patient with hyperglycemia may have no diaphoresis when she has a fever because of the dehydration caused by polyuria.
When a patient’s diabetes goes undetected or is poorly controlled, glucose accumulates under the skin and causes skin infections. Candidiasis, a common infection, may cause redness, maceration, and oozing. The patient also may have small pustular lesions. Infections usually occur in areas that have a lot of moisture, such as under the arms, under the breasts, and in the groin.
Your patient’s legs and feet may show signs of peripheral vascular disease caused by prolonged hyperglycemia. The skin may appear shiny and thin and be cool to the touch. You may also see evidence of hair loss. Toenails may appear thick and ridged. And the patient may have leg or foot ulcers. You may note brown spots on your patient’s shins-a sign of small internal hemorrhages resulting from minor trauma to the area. The hemorrhages are harmless in themselves, but they do indicate that changes have occurred to peripheral blood vessels as a result of diabetes.