What questions should I ask a patient with diabetes to gather a comprehensive history and understand their diagnosis, treatment, and current health status?

Essential Questions for Diabetic Patient Assessment

When evaluating an unknown diabetic patient, systematically gather information across six critical domains: diabetes classification and duration, current treatment regimen, glycemic control patterns, complications screening, medication adherence barriers, and psychosocial factors. 1

Diabetes Type and Disease Characteristics

Determine the specific diabetes type first, as this fundamentally changes management approach:

• Ask directly: "What type of diabetes do you have—Type 1, Type 2, or another form?" 2
• Inquire about age at diagnosis and presenting symptoms (polyuria, polydipsia, weight loss, DKA) to help classify unclear cases 2
• For Type 1 patients, ask about history of diabetic ketoacidosis episodes 2
• Document diabetes duration in years, as this correlates with complication risk 2
• Ask about family history of diabetes in first-degree relatives (parents, siblings) 2
• For women, inquire about gestational diabetes history 2

Current Treatment Regimen

Document all diabetes medications with specific details:

• List all current diabetes medications: insulin types, oral agents, GLP-1 agonists, SGLT2 inhibitors 1
• For insulin users: Ask specific types (basal/bolus), doses, timing, and injection sites 1
• Inquire about insulin pump use or continuous glucose monitor (CGM) technology 1
• Ask about medication adherence: "Do you ever skip doses or ration medications due to cost?" 1
• Document any medication side effects or intolerances experienced 1

Glycemic Control and Monitoring Patterns

Assess current glucose control through multiple parameters:

• Request recent blood glucose monitoring results and patterns of readings 1
• Ask about frequency and severity of hypoglycemic episodes: "How often do you experience low blood sugars? What symptoms do you get?" 1, 3
• Inquire about timing of hypoglycemia (nocturnal, fasting, post-prandial) 3
• Ask about most recent HbA1c value and when it was checked 1
• For CGM users, review downloaded data and time-in-range metrics 1
• Document any recent diabetes-related hospitalizations or emergency visits 1

Microvascular Complications Screening

Systematically screen for end-organ damage:

• Eyes: "When was your last eye exam? Any vision changes or difficulty with night vision?" 1
• Kidneys: "Have you noticed changes in urination frequency or foamy urine? Any leg swelling?" 1
• Nerves: "Do you have numbness, tingling, or burning sensations in your feet or hands?" 1
• Feet: "Any foot wounds, ulcers, or infections? Do you check your feet daily?" 4, 5
• Ask about sexual dysfunction, as this may indicate autonomic neuropathy 1
• Inquire about gastroparesis symptoms (early satiety, nausea, bloating) 1
• Ask about orthostatic dizziness when standing, suggesting autonomic neuropathy 1

Macrovascular and Cardiovascular Risk

Assess cardiovascular complications and risk factors:

• Ask about chest pain, shortness of breath, or exertional limitations 1
• Inquire about leg pain with walking (claudication) suggesting peripheral arterial disease 1
• Document history of hypertension and current blood pressure control 2, 1
• Ask about hyperlipidemia and statin use 2
• Document smoking history and current tobacco use 2, 4
• Inquire about previous cardiovascular events (MI, stroke, revascularization) 1

Lifestyle and Self-Management

Evaluate daily diabetes management behaviors:

• Ask about typical eating patterns and familiarity with carbohydrate counting 1
• Inquire about physical activity: "How many days per week do you exercise? What type and duration?" 1
• Document weight history and recent weight changes 1
• Ask about alcohol consumption patterns 1
• Screen for sleep problems and symptoms of obstructive sleep apnea 1
• Inquire about vaccination status (influenza, pneumococcal) 2, 1

Psychosocial Assessment

Screen for mental health and diabetes distress—this is frequently neglected but critically impacts outcomes:

• Ask directly: "How are you coping emotionally with diabetes? Do you feel overwhelmed?" 1
• Screen for depression: "Over the past two weeks, have you felt down, depressed, or hopeless?" 1
• Assess diabetes distress: "Do you feel burned out by the constant demands of diabetes?" 1
• Inquire about fear of hypoglycemia affecting daily activities 1
• Ask about cognitive difficulties, especially in older adults 1
• Document social support systems and who helps with diabetes management 2
• Assess financial barriers to medications, supplies, or healthy food 2

Common Pitfalls to Avoid

Three critical errors occur repeatedly in diabetes assessments:

• Neglecting foot examination: Always perform comprehensive foot inspection including monofilament testing, as this prevents amputations 1, 4
• Skipping psychosocial screening: Depression and diabetes distress profoundly impact self-management and must be addressed 1
• Forgetting vaccination history: Diabetic patients require specific immunizations that are often overlooked 2, 1