Monday, 14 April 2014

Diabetic melitus History Template

  • Identification
    • Name 
    • Age 
      • young age à more likely type 1 diabetes
      • old à type 2 diabetes
    • occupation à sedentary life style, drug compliance
  • Presenting Complaint
    • Polyuria, polydypsia, pholyphagia
    • Lethargy, weakness, loss of weight
    • Infection
    • Complications
      • microvasular 
      • macrovascular
  • History of presenting complaint
    • When was he/she is diagnosed to be diabetic
    • What were the symptoms he/she had
    • What were the treatments given
    • Adherence to treatments
    • Problems with treatment/ side effects
    • Was he/she advised regarding hypoglycemic attacks
    • Was he/she advised about diet control
    • Was he/she referred to eye clinic
    • was he/she advised regarding foot care
    • How many hospital admissions since then, for what illness, what was done
    • Macrovascular complications
      • Ischemic heart disease
      • Perepheral vascular disease
        • Leg ulcers
        • Claudication
      • Strokes/Transient ischemic attacks
    • Microvascular complications
      • Visual disturbances
      • frothy urine, oliguria, red colored urine
      • Nuropathies
        • eripheral nuropathy - Loss of sensation, abnormal sensation, tingling of feet
        • Mononuropathies - Symptoms of carpel tunnel syndrome/tarsal tunnel syndrome
        • Autonomic nuropathy - impotence, gustatory sweating, urinary retension, incontenance, constipation, diarrhea, dizziness, recurrent nausea and vomiting
        • Nuroglycopenic symptoms - impaired interlectual activity, diminished psychomotor skills, severe agitation, confusion, coma, epileptiform seizures
    • Immunological complications
      • Recurrent infections
      • Urinary tract infections
      • Balanitis
      • pruritus vulvae
  • Past Medical History
    • strokes
    • Ischemic heart disease
    • Dyslipidemias 
    • Fits
    • Bronchial asthma
    • Strokes
  • Past Surgical History
    • Amputations
  • Drug History
    • antidiabetic drugs, side effects, compliance
  • Allergic History
    • Drug, food, laster allergies
  • Family History
    • Diabetes, premature heart diseases, Strokes, young deaths in first degree relatives 
  • Social History
    • Educated up to 
    • Occupation
    • Lives with
    • Income
    • Exercise
    • Alcohol intake 
    • Smoking
    • Nearest hospital 
  • Dietary history
    • Regularity of meals
    • Quality of content
      • Fatty greasy food 
      • Fruit and vegetable content
      • Sugar and sugary foods
      • Salt