Diabetes CJ

Diabetes Follow-up (250 K030):

Wt: • kg Ht: • cm WC: • «BMI:» BP: •  HR: • 
Monofilament R:•/10 L:•/10 missed

Logbook:« no, forgot»« no, does not check sugars regularly»
«-FBS: •
-Lunch: •
-Dinner: •
-QHS: •
»«
-Hyperglycemia: highest in last • month(s) = • (explanation:)
-Hypoglycemia: lowest in last • month(s) = • (explanation:)
-Hypoglycemic symptoms occur at a threshold of: •
-Frequency of BG <4.0: 
-Severe low?  «no»»

Lifestyle:
-Smoking: •
-EtOH: •
-Diet: •
-Exercise: •

Complications:
-Macrovascular:« No chest pain, TIA/strokes, claudication.» 
-Erectile dysfunction: •
-Gastroparesis: •
-Peripheral neuropathy: •
-Ulcers: •

Current DM meds: Reviewed and updated medications in chart, denies s/e

Physical exam:« NAD, looks well».« Obese.»« No acanthosis nigricans.»
-HN: «Thyroid not enlarged, no nodules palpated, no lymphadenopathy»
-CVS: «NHS, no murmurs»
-Resp: «GAEB, no c/w»
-Fundi: «Grossly normal» 
-Foot exam: «No »PPP, monofilament R:•/10 L:•/10 missed, «no foot lesions», calluses/toenails: •

A+P: «DMI»«DMII», «well»«poorly»«not» controlled

1. Glycemic control 


2. Microvascular complications
Retinopathy:« No»« YES»
Neuropathy:« No»« YES»
Nephropathy:« No»« YES»

Latest Ophthalmology Consult = «never done»
Latest Optometry Consult = «never done»
Latest Podiatry Consult = «never done»
Latest A1c (q3m):
Latest Cr (q6m):
Latest ACR (q12m):
Latest ECG (q24m):

3. Macrovascular complications -« ABSENT»« YES:« CAD»« MI»« Stroke»« TIA»« PVD»»

ASA:« Yes.»« No, not indicated for primary prevention.»
ACE/ARB:« Yes.»« No, not indicated as BP at target and no nephropathy.»
Statin:« Yes.»« No, not indicated as <40 years and no macro- or microvascular complications.»

4. Immunizations: 

Influenza:
Pneumovax:
Zostavax:

5. Other counselling discussed:

«-Smoking: •» 
«-EtOH: •»
«-Exercise: advised 30 mins per day or 150 mins per week of moderate intensity aerobic exercise»
«-Diet: we reviewed all of the lifestyle options to achieve optimal glycemic control, including diet (ex. Mediterranean diet, portion control, fibre, etc), exercise (eventual goal of >30 minutes of moderate exercise most days of the week), and 
«-Weight loss: advised a target 5-10% of current body weight over 6 months»
«-Medications: - we also reviewed all of the medication options available including metformin, sulfonylureas, acarbose, DPP4 inhibitors, GLP analogues, SGLT2 inhibitors, and long-acting and rapid insulin
«-Sick day medications: Reviewed SADMANs medications to hold while unwell»
«-Driving: reviewed need to check sugar 1 hour prior to driving, "less than five, don't drive," and "less than four, don't drive for 1 hour"»
«-Hypoglycemia: reviewed need to carry glucose, how to treat a low (15g CHO q15 minutes until BG>4.0, take snack containing carbohydrate AND protein if not proximate to a meal)»