DVBCWDI2 ;ALB/JEH DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
 ;;2.7;AMIE;**69**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;When a Diabetes Mellitus examination is requested, begin with this
 ;;worksheet. For each diabetic complication manifested by the veteran,
 ;;complete appropriate additional worksheets.
 ;;
 ;;Chronic complications from diabetes include vascular and nonvascular
 ;;complications.  Vascular complications include microvascular
 ;;(eye disease, neuropathy, nephropathy) and macrovascular complications
 ;;(coronary artery disease, peripheral vascular disease, cerebrovascular
 ;;disease).   Nonvascular complications include gastroparesis, sexual
 ;;dysfunction, and skin changes.
 ;;
 ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
 ;;
 ;;
 ;;A. Review of Medical Records:
 ;;
 ;;
 ;;B. Medical History (Subjective Complaints):
 ;;   As pertains to Diabetes Mellitus or its complications, comment on:
 ;;
 ;;      1.  Age of onset.
 ;;
 ;;      2.  Frequency of ketoacidosis or hypoglycemic reactions.
 ;;
 ;;      3.  Hospitalizations per year for ketoacidosis or hypoglycemic
 ;;          reactions.
 ;;
 ;;      4.  Restricted diet.
 ;;
 ;;      5.  Weight loss or gain since last exam.
 ;;
 ;;      6.  Describe any restriction of activities on account of the
 ;;          diabetes (e.g., avoiding strenuous activity to prevent
 ;;          hypoglycemic reactions).
 ;;
 ;;      7.  Treatment - oral hypoglycemic, insulin (frequency of injections).
 ;;
 ;;      8.  Frequency of visits to diabetic care provider.
 ;;
 ;;      9.  Other symptoms, such as anal pruritus, loss of strength.
 ;;
 ;;     10.  Visual problems.  
 ;;             Refer to examination worksheet: Eye examination, if  
 ;;             indicated. 
 ;;
 ;;     11.  Vascular (including hypertension, if appropriate) or cardiac
 ;;          symptoms.
 ;;             Refer to examination worksheet(s): Hypertension, Heart,
 ;;             Arteries, Veins, and Misc., etc., if indicated.
 ;;
 ;;     12.  Neurologic symptoms.
 ;;             Refer to examination worksheets(s): Peripheral Nerves, etc.,  
 ;;             if indicated.
 ;;
 ;;     13.  Bladder or bowel functional impairments.
 ;;             Refer to examination worksheets(s): Genitourinary, Rectum
 ;;             and Anus exam, etc., if indicated.
 ;;
 ;;C. Physical Examination (Objective Findings):
 ;;
 ;;Assess for chronic complications of diabetes mellitus.  Complete
 ;;appropriate additional worksheets.
 ;;
 ;;      1.  Cardiovascular examination to include blood pressure and status
 ;;          of peripheral arteries, presence of peripheral edema.
 ;;
 ;;      2.  Neurologic examination.
 ;;
 ;;      3.  Eye examination.
 ;;
 ;;      4.  Skin examination.
 ;;
 ;;      5.  Examination of extremities, including feet.
 ;;
 ;;D. Diagnostic and Clinical Tests:
 ;;
 ;;Provide:
 ;;
 ;;      1.  Fasting blood sugars, or other laboratory evaluation if
 ;;          necessary to establish the diagnosis.
 ;;
 ;;      2.  Blood sugars.
 ;;
 ;;      3.  Evaluation for kidney function including: urinalysis with urine
 ;;          for microalbumenuria; blood urea nitrogen (BUN) and creatinine
 ;;          (Cr).
 ;;
 ;;      4.  Include results of all diagnostic and clinical tests conducted
 ;;          in the examination report.
 ;;
 ;;E. Diagnosis:
 ;;
 ;;      1.  State whether the veteran has diabetes mellitus.  Indicate type.
 ;;
 ;;      2.  Specifically list each identified complication of the veteran's
 ;;          diabetes.  Indicate these conditions as complications of the
 ;;          veteran's diabetes. If the veteran has peripheral edema,
 ;;          indicate whether it is a consequence of diabetic kidney disease
 ;;          or other non-diabetic related etiology.
 ;;
 ;;      3.  For each identified complication of the veteran's diabetes,
 ;;          provide a brief rationale for your conclusion.  You may base
 ;;          your rationale on such things as the duration of the veteran's
 ;;          diabetes, whether the veteran's diabetes has been poorly
 ;;          controlled, the onset of the condition that you deem to be a
 ;;          complication of the veteran's diabetes in relation to the onset
 ;;          of the veteran's diabetes, the severity of the complication, or
 ;;          anything else you consider relevant.
 ;;
 ;;      4.  Where the veteran has visual impairment, cardiovascular disease
 ;;          (including hypertension), kidney disease, neurologic disease,
 ;;          amputations, or any other disabilities which, in your opinion,
 ;;          are not complications of the veteran's diabetes, please state so
 ;;          and provide a supporting rationale as to the basis for your
 ;;          conclusion.
 ;;
 ;;      5.  Where the veteran has a condition that is worsened or increased
 ;;          by the veteran's diabetes but is not a diabetic complication,
 ;;          discuss the relationship between the condition and the veteran's
 ;;          diabetes. In particular, discuss what the degree of disability
 ;;          is of the condition over and above the degree of disability that
 ;;          existed prior to aggravation/worsening by the diabetes.  Provide
 ;;          your rationale.  Indicate if this is not possible to do without
 ;;          resorting to speculation.
 ;;
 ;;
 ;;Signature:                           Date:
 ;;END