The main aim of management of diabetes is to prevent complication due to diabetes and treat complications appropriately if already occurred. The objective of appropriate management of diabetes can be met by a set of complex self-management skills of the diabetes patient and a structured approach by health care providers. Diabetes and its complications produce a wide range of symptoms and signs. Some of the symptoms are secondary to acute hyperglycemia and may occur at any stage of the disease, whereas some are related to chronic complications and begin to appear during the second decade of disease (hyperglycemia).

Approximately 50% of type-2 diabetes patients have some complication at the time of diagnosis of the disease. The history and physical examination should be done to assess symptoms or signs of acute hyperglycemia and also screened for the detection of chronic complications and conditions at the time of diagnosis of diabetes.

History Taking in Diabetes:

A complete history should be taken and special emphasis given to diabetes relevant aspects such as body weight (weight should be taken and BMI calculated), family history of diabetes and its complications, exercise, smoking, risk factors for cardiovascular disease and alcohol use/abuse.

The diabetes symptoms should be looked for which include, polyuria, polydipsia, polyphagia, weight loss, fatigue, weakness, blurring of vision, delayed or slow healing of even minor injury/trauma, frequent superficial infections such as vaginitis, fungal infections of skin etc.

If patient is a diagnosed case of diabetes, the history taking should also include on prior diabetes care including the type of prior treatment, prior glycosylated hemoglobin (A1C) levels, the results of self-monitored blood glucose, presence of diabetes-specific complications (retinopathy, nephropathy, diabetic foot etc.), exercise, and nutrition, assessment of the patient's knowledge about diabetes, frequency of hypoglycemia (if any) etc. Diabetes related comorbidities such as cardiovascular disease, hypertension, dyslipidemia etc. should also be sought.

Physical Examination in Diabetes:

A complete physical examination should be done, with special emphasis on diabetes relevant aspects such as body weight and BMI (body mass index), examination of retina, orthostatic blood pressure, foot examination, peripheral pulses, and insulin injection sites (in diagnosed cases of diabetes who is receiving insulin). A blood pressure of more than 130/80 mmHg is considered hypertension diabetics, in compare to 140/90 mmHg in normal individuals.

Careful examination foot should be done for evidence of peripheral neuropathy (vibration sensation tested with128-MHz tuning fork at the base of the great toe and/or the ability to sense touch with a monofilament size 5.07, 10-g monofilament, and/or pinprick sensation are used to detect diabetic neuropathy), calluses, superficial fungal infections (including in nails), ankle reflexes, and foot deformities (such as hammer or claw toes and Charcot foot), which will be helpful to identify sites of potential skin ulceration, a common problem in long standing diabetes, known as “diabetic foot”. The teeth and gums should also be examined in diabetes as periodontal disease is frequently encountered in diabetes.

Classify Diabetes for better management:

If diabetes is diagnosed in an individual, it is important to classify the diabetes as the treatment of different types of diabetes may be different. Diabetes can generally be classified based on clinical criteria. For example, individuals with type-1 diabetes generally have the following characteristics: (1) onset prior to 30 years of age; (2) a lean body; (3) insulin is essential for initial therapy; (4) propensity to develop ketoacidosis; and (5) an increased risk of autoimmune disorders such as pernicious anemia, celiac disease, autoimmune thyroid disease, adrenal insufficiency, and vitiligo.

Individuals with type-2 diabetes have the following features: (1) onset of disease after the age of 30; (2) are usually obese (80% are obese), although elderly patients may be lean; (3) generally do not require insulin therapy initially; and (4) associated conditions are insulin resistance, hypertension, cardiovascular disease, dyslipidemia, PCOS (polycystic ovarian syndrome) etc.

Although most individuals diagnosed with type-2 diabetes are older, the age at which type2 diabetes is diagnosed is declining. Sometimes it may be difficult to classify the type of diabetes, such as individuals who deviate from the clinical profile of type 1 as well as type-2 diabetes, and also others with associated abnormalities such as deafness, pancreatic exocrine disease, and other endocrine disorders, should be classified accordingly.

Laboratory assessment of Diabetes:

The lab assessment is generally done to determine whether the patient meets the diagnostic criteria for diabetes, as given by World Health Organization and accepted worldwide. Next is to find out the degree of glycemic control by estimation of A1C. Diabetes associated conditions such as microalbuminuria, dyslipidemia, thyroid dysfunction should be assed next.

Laboratory assessment can also be used to establish the category of diabetes in case it can not be done clearly with clinical features.