Abnormalities of the kidneys and bladder are usually detected during the health history and through diagnostic tests. For example, a history of frequent urinary tract infections (UTls) may be an early sign of kidney disease. When examined, a urine sample may be foul smelling and cloudy, suggesting a UTI. Long-standing diabetes can also cause neurogenic bladder and incontinence.
Complications of Diabetes
A physical examination of a patient who has already been diagnosed with diabetes will help you identify the effects of acute and chronic complications. You may also discover body changes that have occurred as a result of therapy, especially insulin injections and blood glucose level monitoring.
Hypoglycemia sometimes causes no signs or symptoms and must be detected by blood glucose monitoring. If hypoglycemia goes undetected, the sudden collapse of a patient may be the first warning sign. Here’s what happens: Because the nerves of the autonomic nervous system are coated with glucose for a long time, nerve transmission slows. And because of this slowing, the patient doesn’t experience the early signs and symptoms of hypoglycemia. Instead, she experiences unexpected hypoglycemic episodes, such as a collapse.
Because diabetes is commonly treated by tightly controlling blood glucose levels, you should examine your patient for and ask her about signs and symptoms of hypoglycemia. One of the major adverse effects of tight control is an increase in the number and severity of hypoglycemic episodes. If your patient has diabetic retinopathy, tight control may briefly worsen the condition, so immediately report any changes in your patient’s visual acuity.
Be sure to examine the sites where your patient has injected insulin and drawn blood for self-monitoring. If she uses pork or beef insulin, you may note skin abnormalities, such as fatty accumulations under the skin or areas of atrophy, which appear as hollow spots. Repeated injections into the same spot cause these abnormalities and can adversely affect insulin absorption. To find out if your patient is actually performing blood glucose monitoring, examine her fingertips for puncture marks and calluses. A callus may be an ideal area from which to draw blood because the patient will experience less discomfort and be more likely to test her blood regularly.