CC: Observe up post-sanatorium discharge.
SUBJECTIVE: Right here’s a 66-365 days-ragged sunless male with a PMH of HTN, IDDM2, and prostate most cancers s/p prostate radiation therapy. Surgical Hx: Prostate surgery and closing radiation Might well well well also simply 2022, FMHx: is essential for DM, HTN in his grandmother, Social Hx: denies alcohol and tobacco use, hypersensitivity indicators: NKDA. The patient gifts for a be conscious-up search the suggestion of with after being hospitalized for hyperglycemia. Effectively being center admission was from 9/5-10/2024 at SJH with a blood glucose stage of 800 mg/dl upon admission. He was no longer in diabetic ketoacidosis (DKA) and tested destructive for ketones. HBA1C was >14% per the sanatorium discharge summary. The patient admits to being non-compliant with insulin and oral glycemic medication. He endorses no longer the usage of insulin Novolin R and Lantus for the past eight months before sanatorium admission. For the duration of the evaluate, the patient advised indicators of polyphagia, polyuria, and polydipsia. He denies tingling and numbness in the decrease extremities, accidental weight reduction, cough, chest nervousness, SOB, dizziness, blurry vision, palpitation, or complications. Fingerstick blood glucose was 220 mg/dl in the situation of job, and he reported ingesting ragged-fashioned oatmeal without added sugar three hours prior.
OBJECTIVE:
Very essential Indicators: Ht(without shoes) 178 cm (5’10”). Wt. (dressed) 89.34 kg (197 lbs.) (BMI: 28.3 kg/m2) BP 132/96 mmHg (loyal arm seated); 135/90 mmHg (left arm, seated); with wide cuff. Coronary heart fee (HR) 96 bpm and licensed. Respiratory fee (RR) 18 bpm. Temperature (oral) 97. 6°F, Spo2: 98% Room air.
Eyes; Vision 20/20 in each eyes. Visible fields paunchy by difference. Conjunctive pink; sclera white. Pupils 4 mm constricting to 2 mm. PERRLA. EOMI. Disc margins provocative, without hemorrhage, exudate. No arteriolar narrowing or A-V nicking.
Ears: Ear canal decided bilaterally. TM decided bilaterally; bilaterally Ear loyal cone of mild. The cone of mild is at 5 o’clock in the excellent ear and 7 o’clock in the left ear. Rinne check: Obvious bilaterally (AC > BC). Weber midline: No lateralization. Mastoid task: No tenderness licensed bilaterally.
Nose Mucosa pink, septum midline. No sinus tenderness. No polyps, turbinates intact, no proof of bleeding.
Mouth: Oral mucosa pink. The dentition is true. Tongue midline. Tonsils 1+. Pharynx without exudates.
Neck: Neck Supple. Trachea midline. Thyroid isthmus palpable, lobes no longer felt.
Lymph Nodes: No cervical, axillary, or epitrochlear nodes.
Thorax and Lungs: Thorax Symmetric with loyal growth. Lungs resonant on percussion. Breath sounds vesicular with no added sounds. Diaphragms fall 4 cm bilaterally.
Cardiovascular: Traditional fee and rhythm, coronary heart fee 96 bpm. Crisp S1 and S2. On the sinister, S2 is louder than S1. On the apex, S1 is louder than S2. There are no murmurs or further sounds.
Abdomen: cushy, non-cushy + BS no guarding
Diagnostics:
Blood Glucose Monitoring:
· In-situation of job fingerstick blood glucose: 220 mg/dl.
Laboratory Assessments:
· HBA1C: >14% (from sanatorium discharge summary), indicating poorly controlled diabetes.
· Classic Metabolic Panel (BMP): To assess kidney feature, electrolyte levels, and glucose.
· Fasting Lipid Panel: To assess cholesterol levels and cardiovascular threat.
· Urine Microalbumin: To verify for early indicators of diabetic nephropathy.
Blood Stress Monitoring:
· Blood Stress readings in-situation of job 132/96 mmHg (loyal arm) and 135/90 mmHg (left arm).
Evaluation: 66-365 days-ragged male with poorly controlled IDDM2, non-compliance with insulin therapy, recent sanatorium admission for hyperglycemia, hypertension, and prostate most cancers (s/p radiation therapy). Hyperglycemia is most likely secondary to medication non-compliance.
Elevated HBA1C >14%, indicating severely uncontrolled diabetes.
Blood stress is a little elevated diastolic blood stress (DBP) >90.
Thought:
· Medications:
· Metformin HCL 500 mg tablet, take one tablet by mouth three occasions day-to-day
· Novolin 70-30, 100-unit insulin pen, inject six units subcutaneously three occasions day-to-day before every meal
· Lantus 100 units insulin pen, inject 24 units subcutaneously at bedtime
· Norvasc 10 mg tablet, take one tablet (10 mg) by oral route once day-to-day
· lisinopril 2.5 mg tablet, take one tablet (2.5 mg) by oral route once day-to-day
· Continues Glucose monitoring (CGM) Dexcom-G7 sensor/reader trade every ten days.
Education:
· Procedures: None today
· Education:
The hazards of uncontrolled diabetes, along side doable complications, were discussed. Educate on recognizing indicators of hyperglycemia and hypoglycemia.
The importance of a balanced diet and consistent carbohydrate consumption the usage of my plate meal planner to notion my diet.
Support increased physical job, much like 150 minutes of brisk walking three occasions weekly.
Emphasize the importance of medication adherence, along side licensed insulin use (Novolin R and Lantus).
Time table education intervals with a diabetes educator to toughen working out of insulin use, diet, and monitoring.
Support frequent home blood glucose monitoring (as a minimal three occasions per day). Earlier than breakfast, lunch, and two hours after dinner. The aim purpose of FS is between 120-130 mg/dl before breakfast and 160-180 mg/dl two hours after dinner.
Support home blood stress monitoring with the aim of
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