Diabetes Examination - Diabetes Annual Review and Foot Examination - Dr Gill

yes yes yes yes come on please kind of take a seat for me thank you right uh my name's dr gill um before we go any further could i please confirm your name and date of birth yeah my name is abby tucked in the 7th of december 96. thank you so we're here today to do your annual diabetes review um so to start off just tell me how you're doing at the moment um it's been a bit better than the last review so i've been up and moving a bit more i think i've lost a bit of weight um so i think we're doing okay okay so have you seen uh your blood results yet no not yet okay well we've got those here we'll we'll go through the other bits that we need to do and then we'll have a look at these shortly but i think you'll be very pleased with the results we've got okay so you've said that um you've been sort of being a little bit more active and trying to lose the weight how has your diabetes been generally of late um i think it's been okay i've i don't feel dizzy at all um i've been watching a lot more christmas you just want to sit down and eat whatever's next to you so no i've been watching a lot more of that um i haven't got the foot tingles so that's been i think excellent so clearly we've you know we've been able to build on some of the things we discussed last time now i've asked before but we do need to check these things with current do you smoke at all i know good okay now obviously a diabetic review doesn't look at you purely as you know a diabetic person when you know we want to look at you as a person that happens to have diabetes so how are you generally are there any things that are bothering you at the moment no it's just general back to work and back to normality stress but we're good okay now obviously we've had covert and things like that have you been able to get both of your vaccines uh yes i've had life now sibo and it's that time of the year again in terms of flu vaccines have you either had or booked for your vaccine yet i haven't seen any advertisement yet but when it comes i'll book it super okay well we're certainly uh taking those at the moment so have a chat with the ladies at the desk once we're finished and we can solve that for you today um now you mentioned uh that you've been doing really well losing weight is that something that you've done yourself or have you been you know talking with one of the dietitians something like that i did have a talk with them but it's been mainly me watching my calorie counting things like that okay super so the dietitian was that something that you organized or did that come from us previously uh that came from here okay so you've had and they've gone through all the structured sort of diabetes step-wise approaches to diet and losing weight excellent now the next thing we need to look at is just how you're monitoring the home do you check your blood sugars at all yes okay and how are they at the moment uh they're generally okay i've had a few spikes but that was just when i was was being a bit ditzy and not recording it but that's fine okay okay but as long as we've got a good control over those now that's the main thing and do you do your blood pressure at home uh yes the machine's just broke though so i need to get a new one okay we'll be doing your blood pressure in a moment what numbers have you been seeing at home think it's been slightly on the high side i've been trying to get it down but i can't get it lower than maybe 140 over 100. okay so that's still quite high for yourself now i know previously you weren't very pro letting us put on one of the medications for the blood pressure i think it's important that we reiterate that those medications also protect your kidneys now we are going to check your blood pressure here in a moment but i think even if we started a really low dose it will be a good idea to start this medication called ramipril has your mind changed on that at the moment yeah i've been trying to do it my own but it looks like i do need a bit of help okay excellent now we'll start this um as really low dose 1.25 milligrams now this is a medication from a diabetic perspective will also protect your kidneys but it can make people's kidneys work harder when they first start them so what we'll need to do is repeat your bloods in two weeks time after you've had the medication for a week and we'll make sure your kidneys are all right with that okay does that sound reasonable okay so let's check the blood pressure and things anyway but i think we need to have that medication because it's a useful with regard to diabetes regardless okay and um have you brought the sample of urine requested uh yeah we put that on the table let me just put these gloves on and what i'll do is i'll go and start this processing over by the sink and we'll also take you over and we'll see how we're doing with your weight doing your height and weight okay so if you come with me please and then step on scout super okay that's grand and if we just move over to um get your height so if you come step backwards for me okay and down and step away please okay so 166 centimeters right let's go back so we've definitely got some sugar in there but there's no protein there's no blood and there's nothing else for us to worry about so that's reassuring but we definitely need to sort out that sugar for you okay so that's your height and weight and sorted let's just get you to lie on the bed for me and we'll check your blood pressure okay and if you just relax back for me okay so what we're going to do we're going to use the manual blood pressure cuff okay we'll run this twice once without the stethoscope and once with okay before we start do you have any problems with your arm at all good okay so just make sure that we've got the right size in there for you do you have any problems with your shoulder at the moment okay so let's put that on here super and just relax then so you said yours is 140 so i have to get a bit higher than that okay so that looked like it's about 142 okay we'll do the same again but now with the stethoscope next okay so it's actually a little bit more 144 over eight it's a bit a bit a bit large but uh we'll certainly deal with that shortly now let's have a look at your feet and we'll see if we can see any issues there okay so just relax for me and we're going to just check what your capillary refill is one two one two okay so that responds nicely now just put your trousers up slightly please okay we're going to check the pulses okay so that's the posterior tibial that's behind your ankle that's all good and we'll check over the front the dorsal speed that's good i'm gonna have a look at your heel so i can't see any signs of ulcerations there's no calluses at all that's good we'll check again on the opposite side again no obvious issues we'll check between the toes make sure there's no signs of bleeding or anything like that okay so we've got a a neuro tip here okay so this is just a simple filament so please um close your eyes and say yes when you film we touch it with it okay so you're closer eyes yes yes yes yes yes yes yes yes yes yes check on the base of your feet yes yes yes super we've got excellent sensation there to your feet so i appreciate the pins and needles that you've commented on but everything looks to be good there so let's go let's go back over the side and carry on our conversation okay all right so if you want to take a seat again so everything there was looking very good i appreciate that the comment you've made about pins and needles to the feet but all of your sensation they seemed absolutely excellent so what we'll do we'll do the referral to the diabetic structured help group and we'll see what other optimizations we can find with regard to your diet we've got the metformin now you're taking so far one gram so half half a gram twice a day we're going to increase that up a little bit we'll do half a gram but we're going to do that four times in a day please make sure you take it with food and that way you should get the best benefit from it and hopefully the least side effects now do you have any side effects when you start a metformin the first time around can't seem to remember sometimes as we go to the higher doses people can get a bit of an upset stomach but if that happens this probably happened last time it should resolve after two weeks okay we'll start the cytoglyptin okay so you shouldn't really have any side effects of note with that but if you get any severe tummy pain i need to know about this okay if we just touch base in two weeks time and see how you're doing with those medications and i'll put a blood form at the desk for you to repeat these bloods in three months time hopefully with the diet the increased exercise and help from the structure group will be able to get that um diabetic number under the magical 48. i think we can get there okay have you got any other questions for us today um no super well thank you very much if there's any problems then do give us a call and the one thing i just need to double check with yourself before we go any further so because the metformin and the cytoglyptin you'll be having just refresh my memory what are the sick day rules with regard to the medications so if i am feeling ill including if i'm being sick or i have diarrhea i need to stop my medication so i know my metformin is one i need to stop um and uh need to refresh my mind about glycoside um but i know i need to stop these on the days that i feel ill and then when i start to feel better then i can restart them uh make sure that i'm drinking enough that i'm not becoming dehydrated and i'm checking my blood sugars a lot more terrific so in terms of those medications because they're not all ones that we would necessarily give you an easy way to remember them is the sad man drugs so we'd want to stop something called an slgt2 inhibitor you don't have those we'd need to stop the angiotensin-converting enzymes so ace inhibitors so that will be the new medication that we've just given you the ramipril we'd also need to stop any diuretics thankfully that's not an issue for yourself you've said metformin quite rightly so a different medication an arb again not one for you to worry about and our n for nsaids so if you're feeling unwell for yourself make sure you're avoiding ibuprofen anything like that because that can make your kidneys work harder the other thing that i think will be worthwhile going forwards is just keeping a quick check on your blood pressure particularly whilst we're starting the ace inhibitor okay so um we're going to hopefully get your blood pressure on average under 135 over 85 but as you said you've tried a few things at home cutting down salts and trying to get a healthy diet that can help but hopefully we'll get a benefit from the ace inhibitor as well okay so any other questions to myself about that no i don't think so right we'll leave it at that thank you very much for your time and we'll have a chat in three months thank you yes yes yes yes yes yes