Diabetes Clinic - Community Nurse Note

**Diabetes Clinic Review** **Diabetes Diagnosis** - Type 2 Diabetes, diagnosed on 12 June 2018, based on fasting plasma glucose of 14.2 mmol/L. **Medications** - Metformin 1000mg twice daily, taken regularly with no reported side effects. - Gliclazide 80mg once daily, patient reports occasional mild hypoglycaemic episodes. **History** - Previous hospitalisation for diabetic ketoacidosis in August 2020. No other significant comorbidities. **Consent for HbA1c** - Consent obtained for HbA1c test. Patient understands the test and its purpose. **Foot Assessment and Care (for Type 2 Diabetes)** - Pedal pulses palpable bilaterally. Sensation intact to light touch. No skin breakdown or ulceration noted. Patient educated on daily foot inspection and proper footwear. **Questions about Complications of Diabetes** - Patient enquired about the risk of diabetic neuropathy and retinopathy. **Eye Care** - Last eye examination was 6 months ago, with no evidence of diabetic retinopathy. Next examination scheduled for 12 months. **Kidney Care** - eGFR 65 ml/min/1.73m2. Urine albumin-creatinine ratio (UACR) within normal limits. Discussed importance of blood pressure control for kidney health. **CVD Care** - Blood pressure 135/85 mmHg. LDL cholesterol 3.5 mmol/L. Patient advised on the importance of regular exercise and a healthy diet. No pharmacological interventions required at this time. **Managing Hypoglycaemia** - Patient reports experiencing mild hypoglycaemic episodes approximately once a month. Discussed strategies for managing hypoglycaemia, including adjusting medication dosages and carrying glucose tablets. **Sick Day Care** - Provided advice on sick day management, including monitoring blood glucose levels more frequently and adjusting insulin dosage as needed. Advised to seek medical attention if experiencing persistent vomiting or high blood glucose levels. **HbA1c Result** - HbA1c result: 7.8% (62 mmol/mol). Discussed the result and the need for improved glycaemic control. **Recommendations** - Referral to a dietician for further dietary advice. Review medications at next appointment. Follow up HbA1c in 3 months. Date: 1 November 2024