PMHx
S/S
Chronic Disease Management
- Diagnosis:
- When was diabetes diagnosed?
- How (i.e. incidental laboratory finding vs. hospitalization for diabetic ketoacidosis)?
- GDM - Gestational Diabetes Hx?
- HbA1c?
- Glycemic Control
- How often are they performing self-monitoring of blood glucose? (glucometer)
- What are their blood glucose throughout the day?
- What are their blood glucose trends
- 4 times a day: fasting, lunch, dinner before bed
- Medications
- What DM medications are you taking?
- Are you taking them as prescribed?
- Complications
- Hypoglycemia ↓( ≤ 4)
- How often do they have hypoglycemia (blood glucose <4mmol/L)? Do they have
awareness of hypoglycemia (i.e. do they develop symptoms – Dizziness ,
Palpitation , Perspiration/Diaphoresis , Irritation, Confusion )?
- How do they treat episodes of mild hypoglycemia? Have they had episodes of
severe hypoglycemia and needed medical attention?
- Macrovascular
- Is there a known history of diabetes-related macrovascular complications
- Are they having any symptoms
- Microvascular
- Is there a known history of diabetes-related microvascular complications
- Are they having symptoms of microvascular disease currently?
- Retinopathy – E.g. Vision changes
- Have you had an eye exam? → Any optometrist closer to you
- Diabetic Neuropathy – E.g. Pain or numbness to the feet, early satiety/fullness or
bloating (i.e. gastroparesis), erectile dysfunction
- We are gonna check for it today, but we will come back later.
- Diabetic Nephropathy – Most will not have symptoms and this must be screened
for with lab testing (i.e. albumin:creatinine ratio, ACR)
- If they have known/chronic symptoms of macrovascular or microvascular complications, do they feel that their symptoms are changing?
- Lifestyle management
- Education – Has the patient had diabetes education? Do they feel confident?
FMHx