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
- 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
- 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
No comments:
Post a Comment