What Review of Systems (ROS) questions should be asked to a patient with hyperglycemia?

Review of Systems Questions for Patients with Hyperglycemia

A comprehensive review of systems for patients with hyperglycemia should focus on identifying classic symptoms of diabetes, potential complications, and causes of hyperglycemia to guide appropriate management.

Cardinal Symptoms of Hyperglycemia

• Polyuria: Ask about increased frequency and volume of urination, especially at night (nocturia)
• Polydipsia: Ask about excessive thirst or increased fluid intake
• Polyphagia: Ask about increased appetite despite weight loss
• Unexplained weight loss: Ask about recent unintentional weight changes 1

Acute Complications

Diabetic Ketoacidosis (DKA) Symptoms

• Nausea, vomiting, or abdominal pain
• Fruity breath odor (acetone)
• Rapid, deep breathing (Kussmaul respirations)
• Confusion or altered mental status
• Extreme fatigue or weakness 2

Hyperosmolar Hyperglycemic State (HHS) Symptoms

• Extreme thirst
• Dry mouth
• Confusion or altered mental status
• Visual changes
• Weakness or paralysis on one side of the body 2, 1

Chronic Complications

Cardiovascular System

• Chest pain or pressure
• Shortness of breath
• Irregular heartbeat
• Leg swelling
• Exercise intolerance 2, 3

Neurological System

• Numbness, tingling, or burning sensation in extremities (peripheral neuropathy)
• Pain in feet or hands
• Dizziness upon standing (orthostatic hypotension)
• Changes in bowel or bladder function
• Sexual dysfunction 2

Renal System

• Changes in urination pattern
• Foamy urine
• Swelling in feet, ankles, or around eyes
• Fatigue or weakness 2

Ophthalmologic System

• Blurred vision
• Floaters
• Vision loss
• Eye pain
• Recent changes in eyeglass prescription 2

Dermatologic System

• Slow-healing cuts or sores
• Frequent skin infections
• Itching (especially genital)
• Darkened skin patches (acanthosis nigricans)
• Skin tags 2

Oral/Dental

• Gum disease or frequent infections
• Loose teeth
• Dry mouth 2

Potential Causes of Hyperglycemia

Medication-Related

• Current steroid use (type, dose, duration)
• Recent changes in medications
• Adherence to prescribed diabetes medications
• Use of medications that may affect glucose levels 2

Immune Checkpoint Inhibitor Therapy

• Recent cancer treatment with immune checkpoint inhibitors
• Timing of treatment initiation
• Other immunotherapy treatments 2

Stress-Related

• Recent surgery or procedure
• Acute illness or infection
• Psychological stress
• Physical trauma 2

Lifestyle Factors

• Recent changes in diet
• Changes in physical activity
• Sleep patterns and quality
• Alcohol consumption 2

Social and Functional Assessment

• Ability to perform diabetes self-management
• Access to medications and supplies
• Food security
• Housing stability
• Transportation access
• Financial security
• Social support system 2

Family History

• Family history of diabetes in first-degree relatives
• Family history of autoimmune disorders 2

Screening for Comorbidities

• Symptoms of depression or anxiety
• Symptoms of sleep apnea (snoring, daytime sleepiness)
• Symptoms of thyroid disease (fatigue, cold/heat intolerance, weight changes)
• Symptoms of liver disease (jaundice, abdominal pain) 2

By systematically addressing these review of systems questions, clinicians can better identify the cause of hyperglycemia, assess for complications, and develop an appropriate management plan for patients with elevated blood glucose levels.