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Body Mass Index
BMI - This is the ratio of weight in kg over height in metre square.
WtKg
Ht (M)2
Males 25 and females 24 is the normal limits, and higher values indicate overweight.
Waist Hip Ratio
Girth should be measured without clothes, the waist is the maximum diameter between the
xiphisternum and umbilicus. Hip is the diameter at the level of the anterior iliac spine.
W/H Ratio
A W/H ratio more than 0.85 is a risk factor for cardiovascular disease.
Blood Pressure
Blood pressure should be taken in the supine position after five minute rest with 3 recordings, recorded with a minute in between each recording. Mean of the last two is to be recorded.
Normal value is : 140/90 mmHg
Percentile chart for age provides better assessment.
Foot Condition
Besides the skin and nail condition presence of any deformities, and trophic ulcers should be taken note of. Temperature should be recorded.
Foot pulses should be recorded, absence of pulse in any one foot indicates peripheral vascular disease. Brachial ankle index may also be recorded.
Neuropathy is assessed by testing for pin prick sensation, more precisely carried on by using filament testing, (less than 7 plus response, for 10 g filament test) and vibration (more precise test is by using Vibration 2 instrument) threshold less than 2.3 vibration units is significant.
Tendon reflexes should be recorded.
Visual Acuity
For this the Snellen chart should be held at 6 in with distance glasses or pin-hold. 6/12 is impaired. 6/36 is blind. This is done prior to pupil dilation
Tropicamide (mydriacil) eye drops are recommended for pupil dilation. There is recovery of pupil size in 2-3 hrs and hence no need for reversal with pilocarpine eye drops. Pupil should not be dilated if there is any suspicion of glaucoma.
Fundus examination is to be carried on by an expert,Fundus photography (to use ETDRS standards for interpretation) provides a good record for follow-up. If retinopathy is present, fundus examination be performed every 6-12 months or more often if indicated.
Autonomic Neuropathy
For Screening note
i. Heart rate variation to deep breathing (ECG record)
Normal Borderline Abnormal
>15 beats / min. 11-14 beats / min. 10 beats / min.
ii. Expiration /Inspiration ratio
Normal Borderline Abnormal
> 1.21 1.11 - 1.20 < 1.10
iii Orthostatic BP variation.
Normal Borderline Abnormal
< 10 mm/rig 11 - 29 mm/Hg < 30 mm/Hg
Laboratory parameters ecg
Standard 12 lead ECG must be recorded. Interpretation is by Minnesota coding.
Glycosylated Haemoglobin
Laboratory should standardise its own method. Mean + 2 SD is a good control
Albumin Excretion
It is recorded in two overnight samples and one done at the clinic. Overt nephropathy is present when albumin excretion rate of 200 ug/min is present in at least two of three samples. Best method is by immunoassay. On routine screening, Dipstick for albumin can be used. Serum creatinine 5 mg/dl indicates renal failure.
Lipoprotein Profile
This is done in the fasting state, the relevant constituents are cholesterol, triglycerides (use enzymatic methods, employing analyser) HDLc is by manganese precipitation method
Normal values are:
Cholesterol < 200 mg/dl
Triglycerides < 130 mg/dl
HDLc > 45 mg/dl
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