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1DVBCWDI2 ;ALB/JEH DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
2 ;;2.7;AMIE;**69**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;When a Diabetes Mellitus examination is requested, begin with this
7 ;;worksheet. For each diabetic complication manifested by the veteran,
8 ;;complete appropriate additional worksheets.
9 ;;
10 ;;Chronic complications from diabetes include vascular and nonvascular
11 ;;complications. Vascular complications include microvascular
12 ;;(eye disease, neuropathy, nephropathy) and macrovascular complications
13 ;;(coronary artery disease, peripheral vascular disease, cerebrovascular
14 ;;disease). Nonvascular complications include gastroparesis, sexual
15 ;;dysfunction, and skin changes.
16 ;;
17 ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
18 ;;
19 ;;
20 ;;A. Review of Medical Records:
21 ;;
22 ;;
23 ;;B. Medical History (Subjective Complaints):
24 ;; As pertains to Diabetes Mellitus or its complications, comment on:
25 ;;
26 ;; 1. Age of onset.
27 ;;
28 ;; 2. Frequency of ketoacidosis or hypoglycemic reactions.
29 ;;
30 ;; 3. Hospitalizations per year for ketoacidosis or hypoglycemic
31 ;; reactions.
32 ;;
33 ;; 4. Restricted diet.
34 ;;
35 ;; 5. Weight loss or gain since last exam.
36 ;;
37 ;; 6. Describe any restriction of activities on account of the
38 ;; diabetes (e.g., avoiding strenuous activity to prevent
39 ;; hypoglycemic reactions).
40 ;;
41 ;; 7. Treatment - oral hypoglycemic, insulin (frequency of injections).
42 ;;
43 ;; 8. Frequency of visits to diabetic care provider.
44 ;;
45 ;; 9. Other symptoms, such as anal pruritus, loss of strength.
46 ;;
47 ;; 10. Visual problems.
48 ;; Refer to examination worksheet: Eye examination, if
49 ;; indicated.
50 ;;
51 ;; 11. Vascular (including hypertension, if appropriate) or cardiac
52 ;; symptoms.
53 ;; Refer to examination worksheet(s): Hypertension, Heart,
54 ;; Arteries, Veins, and Misc., etc., if indicated.
55 ;;
56 ;; 12. Neurologic symptoms.
57 ;; Refer to examination worksheets(s): Peripheral Nerves, etc.,
58 ;; if indicated.
59 ;;
60 ;; 13. Bladder or bowel functional impairments.
61 ;; Refer to examination worksheets(s): Genitourinary, Rectum
62 ;; and Anus exam, etc., if indicated.
63 ;;
64 ;;C. Physical Examination (Objective Findings):
65 ;;
66 ;;Assess for chronic complications of diabetes mellitus. Complete
67 ;;appropriate additional worksheets.
68 ;;
69 ;; 1. Cardiovascular examination to include blood pressure and status
70 ;; of peripheral arteries, presence of peripheral edema.
71 ;;
72 ;; 2. Neurologic examination.
73 ;;
74 ;; 3. Eye examination.
75 ;;
76 ;; 4. Skin examination.
77 ;;
78 ;; 5. Examination of extremities, including feet.
79 ;;
80 ;;D. Diagnostic and Clinical Tests:
81 ;;
82 ;;Provide:
83 ;;
84 ;; 1. Fasting blood sugars, or other laboratory evaluation if
85 ;; necessary to establish the diagnosis.
86 ;;
87 ;; 2. Blood sugars.
88 ;;
89 ;; 3. Evaluation for kidney function including: urinalysis with urine
90 ;; for microalbumenuria; blood urea nitrogen (BUN) and creatinine
91 ;; (Cr).
92 ;;
93 ;; 4. Include results of all diagnostic and clinical tests conducted
94 ;; in the examination report.
95 ;;
96 ;;E. Diagnosis:
97 ;;
98 ;; 1. State whether the veteran has diabetes mellitus. Indicate type.
99 ;;
100 ;; 2. Specifically list each identified complication of the veteran's
101 ;; diabetes. Indicate these conditions as complications of the
102 ;; veteran's diabetes. If the veteran has peripheral edema,
103 ;; indicate whether it is a consequence of diabetic kidney disease
104 ;; or other non-diabetic related etiology.
105 ;;
106 ;; 3. For each identified complication of the veteran's diabetes,
107 ;; provide a brief rationale for your conclusion. You may base
108 ;; your rationale on such things as the duration of the veteran's
109 ;; diabetes, whether the veteran's diabetes has been poorly
110 ;; controlled, the onset of the condition that you deem to be a
111 ;; complication of the veteran's diabetes in relation to the onset
112 ;; of the veteran's diabetes, the severity of the complication, or
113 ;; anything else you consider relevant.
114 ;;
115 ;; 4. Where the veteran has visual impairment, cardiovascular disease
116 ;; (including hypertension), kidney disease, neurologic disease,
117 ;; amputations, or any other disabilities which, in your opinion,
118 ;; are not complications of the veteran's diabetes, please state so
119 ;; and provide a supporting rationale as to the basis for your
120 ;; conclusion.
121 ;;
122 ;; 5. Where the veteran has a condition that is worsened or increased
123 ;; by the veteran's diabetes but is not a diabetic complication,
124 ;; discuss the relationship between the condition and the veteran's
125 ;; diabetes. In particular, discuss what the degree of disability
126 ;; is of the condition over and above the degree of disability that
127 ;; existed prior to aggravation/worsening by the diabetes. Provide
128 ;; your rationale. Indicate if this is not possible to do without
129 ;; resorting to speculation.
130 ;;
131 ;;
132 ;;Signature: Date:
133 ;;END
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