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Quiz

As you perform the heart and lung exam, ask the patient about any chest pain. Also ask about any change in exercise tolerance. Check pulses as part of the cardiac exam.

As you examine the abdomen, if you have not already done so, ascertain whether the patient is having any new digestive problems. The neuropathy that accompanies diabetes leads to gastroparesis.

Make sure to examine the sites of insulin injection. Specifically, you are looking for lipodystrophy, a disorder of the subcutaneous tissue that occurs when patients reuse needles and/or do not rotate injection sites. Lipodystrophy is normal fat. It often can be seen better when the patient is sitting or standing up. It does not feel different from other fat but stands out from the contour of the abdomen or place where the insulin is being given (arm, leg, buttock) like a ball. It should be suspected if you ask where they are giving their shots and they only point to one or two sites. You want to look at the sites to see if they look different from the surrounding areas.