1 Diabetic care follow up 2018 Date ......../....../20..... Personal data
Name ......................................................... Age............... Sex ............... residence ............................... occupation................. Special habits.............................................
Diabetes mellitus information
Social history
Medications history
Screening
Type.............. Duration............... Treatment regimen ..............................................
Eating pattern and Wight
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Sleep behavior and physical activity
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Medication-taking behavior
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Medication intolerance or side Effects
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Complementary and alternative medicine use
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Hypoglycemia Timing..................... awarenees............ frequency................ ...... causes....... .................................................................................................................. Pregnancy planing Contraceptive need
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Preconception planing
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2. Vital signs Height............................................................................................................ Weight........................................................................................................... BMI................................................................................................................. GROWTH DEVELOPMENT ..................................................................................................................
Physical Examination
B.P ................................................................................................................. .................................................................................................................. .................................................................................................................. Temp............ RR............. HR............................................................................................................................ ....
General exa ................................................................................................................................. .... ................................................................................................................................. .. ................................................................................................................................. .. ................................................................................................................................. ................................................................................................................................. ...
Thyroid gland ................................................................................................................................. .. ................................................................................................................................. ..
Skin exam ................................................................................................................................. ..
Insulin sites ................................................................................................................................. .. ..................................................................................................................
Foot exam Inspection.............................................................................................................. ................................................................................................................................. ........ ................................................................................................................................. ..
Vessels.................................................................................................................... ... ................................................................................................................................. ..
Neurological exam ................................................................................................................................. .. ................................................................................................................................. ..
3
4 A1c KFT
S.creatinin Urea spot UACR
Laboratory evaluation
eGFR Lipid profile
Total C LDL HDL TG
LFT
AST ALT
In T1D.M
TSH
If metformin
VIT B12
Electrolytes
Ca K Na S.phosphorus
Date
SMBGT Breakfast Before
2 PP
Lunch Before
2 PP
Bedtime Dinner Before
2 PP
Date
SMBGT
Bedtime
5
Goal setting
A1c HTN
Assessment and Plan
CV risk assessment
ASCVD age
Yes
No
Evaluate and treat risk factors for CKD progression*
Evaluate and treat CKD complications**
<40 > 40 CKD STAGING
stage of CKD
*risk factors for CKD PROGRESSION ARE the elevated B.P , glycemia and albuminuria. ** CKD COMPLICATIONS ARE the following: Complication
medical and laboratory evaluation
Elevated B.P
B.P and weight
volume overload
Hx , physical examination and weight
electrolyte abnormalities
Serum eletrolyte
Metabolic acidosis
Serum electrolyte
Anemia
Hb and iron if indicated
Metabolic bone disease
Ca, Ph, PTH, vitamin 25 (OH) D
6
Lifestyle management Pharmacologic treatment Drug Management Plan
Dose
Frequency
Duration
side effect
Complications 1-Microvascular : Complica tions DRP
Approach .......................................................................................................................................... .......................................................................................................................................... ...................................................................................................................................
NP .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... .......................................................................................................................................... ..........................................................................................................................
DNP
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Diabetic foot
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