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Inspection: SKIN: Hairless and atrophic because of small vessel disease and ischaemia. Ulcers: On toes or pressure areas! (Combination of macro and micro vascular disease and peripheral neuropathy) Infection: Superficial infections are common, e.g. boils, cellulitis and fungal infections (tinea pedis) (due to ischaemia and high tissue glucose providing ideal environment for bacterial growth). Pigmented scars / diabetic dermopathy, small rounded plaques with raised borders lying in a linear fashion over the shins. Necrobiosis lipoidica diabeticorum: Rare, striking localized skin atrophy with lipid deposits over shins. Starting as flat red or yellow plaques which later ulcerate. Very hard to treat. Gangrene: Advanced macro vascular problems (Pulseless foot) or peripheral neuropathy problem (painless foot). It can also be due to micro vascular changes where pulses are still palpable! The tissue becomes necrotic with black skin either dry or moist! Injection sites: Usually on thighs Charcots joint: Due to loss of sensation (Proprioception) the knee joint is exposed to frequent injuries which the patient does not even notice, leading to joint deformity. Palpation: Injection sites: Possibly atrophy or hypertrophy (Diabetic amyotrophy) in the area of the thigh if patients have injected for years. Pulses Temperature Capillary return Neurological Examination: Peripheral neuropathy: distal, symmetric loss of sensation (stocking paraesthesia) with numbness and tingling and reduced sensation of light touch, pain and vibration. Position sense reduced. Abnormal two point discrimination. Mononeuropathy: acute mononeuropathy most commonly affects the femoral or sciatic nerve following an occlusion of vessels supplying the nerve. Reflexes: reduced deep reflexes Plus ABI and Burgers test.