Question

A 64-year old diabetic man reports he has numbness and burning sensations in his toes for the past 6 months. Discuss what questions you would ask the patient, what physical exam, and what future testing to perform.

Answer 1

Uncontrolled diabetes damages peripheral nerves including hands and feet result in interference with nerve signals.

The question to be asked the patients about:

History of blood sugar fluctuations:- this can reveal blood sugar levels.

The severity of the problem: this helps to understand the degree of damage.

Asking the client about the motor and sensory deficit:- this helps to understand the motor and sensory abilities

What are the Symptoms:

How long patient had the problem

What makes the sensation worse and better.

Kind of physical activity.

Lifestyle factors such as smoking and alcohol consumption

The patient can be asked regarding adherence to medications and diabetic diet

PHYSICAL EXAMINATION

The patient will be assessed for touch, pressure, temperature, vibration.

Touch sensation can be assessed using a wisp of cotton on the affected foot

Temperature sensation can be assessed using a cold metal tuning fork held to a leg

Vibrations can be checked using a vibrating running fork held to a leg

Muscle strength can be assessed

Reflexes of the affected leg

Pulse and blood pressure can be assessed.

THE FOLLOWING FUTURE TESTING CAN BE PERFORMED.

1.ankle reflex test: It can be performed with a reflex hammer

2.monofilament test: Monofilament can be used to assess the sensory and pressure sensation

3.Neuropen: it includes monofilament and calibrated sterile neuro trip to assess pressure and pain sensation.

4.Ipswich touch test: to assess the touch sensation.

5.vibratory tuning fork test: to assess the vibration perception.