Chief co mplaints
YY Weight loss and weakness for … months.
YY Excessive thirst and frequent passage of urine for … months.
YY Burning sensation of the hands and feet for … weeks.
YY Dimness of vision for … months.
History
History of present illness: According to the statement of the patient, he was alright … months back.
Since then, he has been suffering from gradual loss of weight, about 12 kg, despite good appetite. It
is associated with extreme weakness and excessive thirst for which he used to take plenty of water
every day. He also complains of frequency of micturition, passage of large volume of urine and
waking up from sleep to void. For the last … weeks, he has been experiencing burning sensation,
heaviness, tingling and numbness of both hands and feet. His vision is progressively deteriorating
over the last … months. There is no history of loss of consciousness (diabetic ketoacidosis,
hypoglycemia), generalized swelling of body or legs (nephropathy), chest pain (IHD), dizziness or
giddiness (postural hypotension) or any skin abnormality (dermopathy, infection). He denies any
history of heat intolerance, tremor (thyrotoxicosis), bowel abnormality (malabsorption), cough,
hemoptysis or evening rise of temperature (TB).
History of past illness: There is no history of previous significant illness.
Family history: His father is diabetic for the last 25 years and his mother is hypertensive. He has
two brothers and one sister. All of them are in good health.
Socioeconomic history: Mention accordingly.
Drug and treatment history: He is now taking tablets. Glibenclamide, 2 tablets daily
General Examination
YY Ill looking and emaciated. (look for height, weight and BMI)
YY There is no anemia, jaundice, clubbing, koilonychia, leukonychia or edema
YY No thyromegaly or lymphadenopathy
YY There is no ulceration or skin abnormality
YY Pulse—96/min (look for peripheral pulses, may be feeble)
YY BP—130/80 mm Hg lying and 125/80 mm Hg standing
YY Temperature—98ºF
YY Respiratory rate—14/min.
systemic Examination
Nervous system
1. Higher psychic functions: Intact.
2. Cranial nerves: Intact.
3. Motor system:
Endocrinology
xx Muscle tone diminished in the lower limbs 609
xx Muscle power is diminished, grade 3/ 5 in the lower limbs
xx There is wasting of all the groups of muscle in the feet, legs and thighs.
xx Reflexes—
Jerks Biceps Triceps Supinator Knee Ankle Plantar
Right Diminished Diminished Diminished Diminished Absent Equivocal
Left Diminished Diminished Diminished Diminished Absent Equivocal
xx Superficial reflexes (abdominal reflex)—absent
xx Co-ordination—impaired in the lower limbs
xx Romberg’s sign—positive
xx Gait—normal
xx Involuntary movement—absent.
4. Sensory system:
xx Superficial sensation (pain, touch, temperature)—diminished in the foot up to mid leg and
hands (glove and stocking distribution)
xx Deep sensation (vibration, position sense)—absent in both the lower limbs.
5. Cerebellar test: Normal.
6. Autonomic function: Normal, as evidenced by normal pulse, no postural hypotension.
7. Fundoscopy: Few dot and blot hemorrhages in the 6 o’clock position, 2 disc diameter away from
the optic disc in the right eye. Few dot hemorrhages in 10 o’clock position, 1 disc diameter away
from the optic disc.