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Fatigue and weakness may be caused by muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Blurred vision results from the effect of the hyperosmolar state on the lens and vitreous humor.
Glucose and its metabolites cause osmotic swelling of the lens, altering its normal focal length.
Peripheral neuropathy presents as numbness and tingling in both hands and feet, in a glove-and-stocking pattern; it is bilateral, symmetric, and ascending.
It is important to inquire about the type and duration of the patient’s diabetes and about the care the patient is receiving for diabetes.
An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM.
The dorsalis pedis and posterior tibialis pulses should be palpated and their presence or absence noted.The possibility of foot disease should be addressed.Inquire as to whether the patient has a history of foot ulcers or amputations or whether any foot ulcers are present.Orthostatic vital signs may be useful in assessing volume status and in suggesting the presence of an autonomic neuropathy.Measurement of the pulse is important, in that relative tachycardia is a typical finding in autonomic neuropathy, often preceding the development of orthostatic hypotension.
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Symptoms at the time of the first clinical presentation can usually be traced back several days to several weeks.