Annual Physical Examination Plans for Diabetic Patients

by lkts1ji2kod on 2011-04-07 11:28:35

Many people set some annual plans for themselves, such as work plans, shopping plans, travel plans, and financial management plans. For a large number of diabetic patients, there must be another plan - the physical examination plan. Diabetes is a disease that affects all systems and tissues of the body, and if many abnormalities of this disease can be found in time, they can be treated and prevented. Therefore, making a comprehensive, regular, and targeted annual physical examination plan will help diabetic patients better stabilize their condition and stay away from risks.

Physical Examination Objectives

For diabetic patients, regular physical examinations are not only to understand the situation of blood glucose control, but should also focus on solving the following issues:

1. Understand the situation of blood glucose control.

2. The current status of diabetes, such as whether there are complications of diabetes (such as eye bottom, kidney, nerve lesions, etc.) and other problems (such as hypertension, abnormal blood lipids, etc.).

3. Whether the current treatment is in place, and whether the control of blood glucose, blood lipids, blood pressure, and weight meets the standard.

4. Whether the current treatment needs adjustment.

5. Develop a follow-up plan based on the examination results, that is, how long it takes to see a doctor.

6. Decide the content and time of the physical examination according to the specific situation of the individual.

Physical Examination Plan

Monthly Checkups

Fasting Blood Glucose (Normal Value: 4~7 mmol/L)

Significance: Understand the general state of blood glucose control. High fasting blood glucose mainly indicates poor basic insulin secretion capacity.

Postprandial Blood Glucose (Normal Value: 5~10 mmol/L)

Significance: High postprandial blood glucose often suggests poor reserve capacity of insulin secretion or insulin resistance.

Special Reminder: Normal fasting blood glucose does not necessarily mean normal postprandial blood glucose. Because eating is a load, some patients with certain insulin secretion capacity have good fasting blood glucose due to no food intake overnight. However, once they eat, the effect of insulin becomes insufficient, showing postprandial hyperglycemia. It's like a person walking on flat ground without feeling tired, but cannot walk under a load. Eating has a similar effect as carrying a load.

Therefore, each time diabetic patients visit a doctor, they need to check their blood glucose. They can check both fasting and postprandial blood glucose at the same time, or alternately check fasting or postprandial blood glucose. Patients receiving insulin therapy or those with unstable blood glucose should preferably have their own blood glucose measuring instrument and learn to measure their blood glucose at home. In principle, patients with stable blood glucose can reduce the frequency of monitoring, checking fasting and postprandial blood glucose once a week or even once a month. Patients with unstable blood glucose, accompanied by special conditions such as colds, fever, diarrhea, or receiving insulin therapy, should increase the frequency of monitoring blood glucose.

Blood Pressure (Normal Value: 24 Obese: >28

Significance: Although it is difficult to control weight, it is very important for diabetic patients. About half of Chinese type 2 diabetic patients belong to overweight or obese. Understanding one’s weight and whether it falls into normal, overweight, or obese categories can help develop appropriate dietary and exercise treatment plans. Severely obese individuals may require drug or surgical treatment. Measuring weight costs nothing, causes no pain, and requires little time; all that is needed is a bit of self-care awareness.

Special Reminder: There may be differences in weight in the morning, evening, before meals, and after meals. Therefore, it is best to measure weight under relatively fixed conditions, such as in the morning on an empty stomach and after urination. If a diabetic patient experiences a weight loss exceeding 5% within a short period, they should raise their alertness and find the cause.

Feet (Normal Condition: No deformity, no skin pressure ulcers, no infection)

Significance: Approximately more than half of diabetic patients have neuropathy. Neuropathy can lead to reduced sensation in both feet, or numbness, pain, etc., and can also cause foot muscle atrophy, leading to changes in foot pressure, and even skin ulcers in areas of high pressure. Foot examination is not complicated, mainly checking the pulse of the dorsalis pedis artery and posterior tibial artery, whether there is any deformity, skin ulcers or calluses, and whether the shoes fit properly.

Special Reminder: Diabetic patients with foot deformities, calluses (commonly known as corns), blisters, or ulcers should avoid treating them on their own and should seek treatment from local diabetes specialists or orthopedic doctors. Quite a number of foot ulcers originate from foot care (such as cutting toenails) or wearing inappropriate shoes.

Quarterly Checkups

Glycated Hemoglobin (HbA1c) (Normal Value: Below 7.0%, preferably below 6.5%)

Significance: Glycated hemoglobin represents the blood glucose level over the past two to three months, unaffected by temporary fluctuations. Generally speaking, glycated hemoglobin provides a more comprehensive reflection of blood glucose control. Currently, some large-scale international diabetes clinical studies use the rate of achieving glycated hemoglobin targets as the golden standard for evaluating blood glucose control.

Special Reminder: Glycated hemoglobin is generally checked once per quarter. Special cases may vary, such as patients requiring enhanced treatment may need more frequent checks.

Biannual Checkups

Lipid Profile

Cholesterol (TC) (Normal Value: 0.9 mmol/L)

Low-Density Lipoprotein Cholesterol (LDL-C) (Normal Value: <2.0 mmol/L)

Significance: Clinical practice shows that more than half of diabetic patients have lipid abnormalities. Patients with combined hypercholesterolemia, hypertriglyceridemia, or low high-density lipoprotein cholesterol have a higher risk of cardiovascular diseases. Therefore, correcting lipid disorders is an important part of diabetes treatment.

Special Reminder: If lipid levels are normal, checking one to two times annually is sufficient. If lipid levels are abnormal, it is necessary to increase the frequency of checks, testing 2-4 times a year, and adjusting treatment under the guidance of a doctor based on the category and degree of lipid abnormalities.

Urinary Albumin (Normal Value: <20 μg/min)

Significance: The presence of trace albumin in urine, such as urinary albumin exceeding 20 μg/min or urinary albumin exceeding 30 mg/g of urinary creatinine, indicates kidney damage. For diabetic patients with kidney damage, strengthening blood glucose and blood pressure control, and timely adjusting the treatment plan is very important.

Special Reminder: Urine specimen containers must be cleaned thoroughly, and it is best to collect urine in the morning. If it is the first examination and no obvious complications have been found, but abnormal proteinuria is detected, rechecking the urine is necessary. That is, do not diagnose proteinuria based on a single urine test result. Healthy individuals who have fever or intense exercise can also present with a small amount of urinary albumin. It is generally believed that if there are two instances of abnormal proteinuria within 3-6 months and other causes are excluded, then a diagnosis of diabetic nephropathy can be made.

Urine Routine (Normal Value: No cells, no ketone bodies, and no glycosuria or slight glycosuria after meals.)

Significance: Helps understand whether there is urinary tract infection. Urine routine tests are particularly important for female diabetic patients because some female patients may have asymptomatic urinary tract infections.

Special Reminder: If there are problems with urinary albumin and urine routine tests, further tests on serum creatinine and blood urea nitrogen are necessary. If these indicators are significantly elevated, it indicates that the kidney's ability to remove waste and toxic substances from the blood has decreased.

Electrocardiogram (ECG)

Significance: Cardiovascular complications are the leading cause of death in diabetic patients. Many patients may have cardiovascular complications without symptoms, meaning some diabetic patients may not know they have cardiovascular problems. In such cases, regular ECG examinations become even more necessary.

Special Reminder: Those who have had a myocardial infarction in the past; recently experienced frequent discomfort, tightness, or chest pain; or discovered irregular heartbeats or occasional pauses, should promptly undergo ECG tests. Some may even need 24-hour ECG monitoring or additional cardiac ultrasound tests.

Annual Checkups

Vision and Fundus Examination

Significance: Clinical data show that about one-third of diabetic patients have fundus problems. Poor blood glucose control or fluctuating blood glucose levels often lead to vision deterioration and blurred vision. A considerable number of patients, especially the elderly, suffer from cataracts, which can severely lead to blindness. Both cataracts and fundus diseases are treatable. The president of the Pakistan Diabetes Society mentioned that diabetic patients who regularly check their fundus once a year can prevent at least half of diabetic patients from going blind.

Special Reminder: Fundus examinations for diabetic patients must be conducted after pupil dilation (dropping special eye medication to enlarge the pupil).

Other annual checkups include chest X-rays, hematological tests (such as complete blood count, liver function, blood urea nitrogen, blood creatinine), liver and gallbladder ultrasound, and neurological examinations. Taking a chest X-ray to understand lung conditions is quite necessary, especially for long-term smoking diabetic patients, as they are prone to pulmonary tuberculosis. Chest X-rays can help identify lesions and enable timely treatment. Additionally, lung tumors are a relatively common disease among middle-aged and elderly individuals, and chest X-rays can aid in early detection. An annual hematological test, including white blood cell count, red blood cell count, platelet count, liver function, and renal function, helps understand the functions of various systems (such as hematopoietic system, liver, kidneys, etc.), and detect abnormalities in a timely manner. Diabetic patients, especially obese female patients, often have gallstones, which can be identified through liver and gallbladder ultrasound. Diabetic neuropathy can affect various systems throughout the body. Timely identification and further prevention and treatment have extremely positive significance for diabetic patients. The most commonly used neurological examination includes Achilles reflex, knee reflex, and sensory measurement using nylon threads or tuning forks.

Summary

Among the listed examination items, some reflect metabolic indicators, such as blood glucose and blood lipids, while others reflect complications, such as fundus, kidney, nerve, and cardiovascular examinations. In principle, the frequency of metabolic indicator tests is higher, while the frequency of complication indicator tests is lower.

In work arrangements, planning is very important. A good plan often achieves twice the result with half the effort. The same applies to physical examinations for diabetic patients. Knowing why to examine, what to examine, and when to examine allows you to make a plan, spend the least money, and achieve the best therapeutic effect. The physical examination schedule in this article considers the majority of patients, but special situations require special handling.

Keywords: Diabetes Plan, Diabetes Physical Examination