[patient] um , i have high blood sugar . yeah , osteoarthritis , arterial fibrillation , and reflux .
[doctor] hi , hannah . how are you ?
[patient] good , how are you ?
[doctor] i'm good . you ready to get started ?
[patient] yes , i am .
[doctor] so , hannah is a , uh , 52-year-old female here for evaluation of a high blood sugar . so , hannah , what ha- what happened ? i heard you were in the emergency room with a high blood sugar .
[patient] yes . so , i've been eating a ton of sweets recently . with the holidays it just feels like there is always something sweet available. whether i am at work and there are holiday gift baskets or clients bringing in treats or when i visit my family for the holidays and there is every baked good imaginable, there is always something sweet i can be eating. in the beginning i felt fine, but i have started to feel it after a couple of weeks, and this past week i just felt really light-headed and i could ... was seeing spots , really dizzy . so i went into the emergency room and they said i had a high blood sugar . um , so i wanted to come in and follow up with you to get that , um , get checked out .
[doctor] okay . all right . and how , how are you feeling now ? did they , did , did they treat you in the emergency room ? did they gi- they give you some iv fluids and things like that ?
[patient] yeah . they gave me some fluids and they told me just to try to really cut out eating any extra sweets and get back into my normal routine and diet, but i am still staying with my family, and my mom and grandmother are big bakers so i think it will be really hard to get into a routine there so i just want to make sure i am nipping this high blood sugar thing in the bud.
[doctor] okay . and i saw you went through a review of systems sheet with a nurse . i just want to ask you a few more questions from that standpoint . so you have had any fever or chills ?
[patient] no .
[doctor] any chest pain or shortness of breath ?
[patient] n- uh , no .
[doctor] abdominal pain ?
[patient] no .
[doctor] any burning when you urinate ?
[patient] no .
[doctor] any joint pain or muscle aches ?
[patient] no .
[doctor] okay .
[patient] i do have osteoarthritis though , so that , when i say , " no , " it's not , like , nothing out of the norm-
[doctor] okay .
[patient] . for me .
[doctor] perfect . um , and then , i know that you have this history of a-fib , atrial fibrillation . have you felt your heart racing at all , recently ?
[patient] only when i'm really anxious . i , i feel it , um , pumping a little bit . but other than that i have n't .
[doctor] okay . all right . and how are you doing with your reflux ?
[patient] i've been doing well . i've been taking the medication that you prescribed to me and that's been helping a lot .
[doctor] okay , yeah . i see here you're on the protonix , 40 milligrams , once a day .
[patient] yes .
[doctor] so that's , you're doing well with that ?
[patient] yep .
[doctor] okay . all right . so let's go ahead and do a quick physical exam . so , listening to you , um , look , or looking at you , you appear in no distress . your thyroid is a little enlarged , but non-tender . there's no carotid bruits , your heart is in irregular rate and rhythm , and your lungs are clear . your abdomen is nice and soft , and you have no edema in your lower extremities . let's go ahead and look at some of your test results .
[patient] okay .
[doctor] hey , dragon ? show me the blood sugar . hey , dragon ? show me the blood glucose . hey , dragon ? show me the hemoglobin a1c . okay , so i see here that both your blood sugar and your hemoglobin a1c are elevated . so your blood sugars have probably been running high for probably a few months . okay ? um , let's go ahead and look at some of your other results . hey , dragon ? show me the diabetes labs . yeah . okay . yeah , so , um , my impression of you at this time , um , for your high blood sugars , that you do have this diagnosis of diabetes . now , we're not sure if it's type i or type ii . even patients in , you know , in their mid-twenties can develop type i diabetes , so we're gon na go off and , we're gon na go ahead and , and send some labs to work that up . hey , dragon ? order a complete metabolic panel . and i'd like to start you on metformin , 500 milligrams , twice a day . that will help keep your blood sugars down .
[patient] okay .
[doctor] hey , dragon ? order metformin , 500 milligrams , twice a day . and then if some of the autoimmune labs that come back show that you have an autoimmune disorder , meaning that you would have type i diabetes , then we would have to go ahead and put you on insulin . but i'm gon na hold off until we have those results , okay ?
[patient] okay .
[doctor] but in the meantime , i really want you to avoid , uh , foods high in sugar . um , and the , the nurse will come in and she'll give you a glucometer and teach you how to do blood sugar testing . okay ?
[patient] okay .
[doctor] and then , from an atrial fibrillation standpoint , your heart , even though you're in atrial fibrillation right now , is in a good rate . and we'll just continue you on your metoprolol , 25 milligrams , twice a day . do you need a refill on that ?
[patient] yes , i do .
[doctor] hey , dragon ? order a refill on metoprolol , 25 milligrams , twice a day . and for your reflux , we'll just continue you on the protonix , okay ?
[patient] okay .
[doctor] do you have any questions , hannah ?
[patient] no , not at this time .
[doctor] okay , so the nurse will come in and she'll go over all that stuff with you .
[patient] okay .
[doctor] take care .
[patient] thank you .
[doctor] hey , dragon ? finalize the note .


Medical orders:
description: milligrams twice a day metoprolol 25
order_type: medication
reason: atrial fibrillation
description: complete metabolic panel
order_type: lab
reason: diabetes
description: metformin 500 milligrams twice a day
order_type: medication
reason: diabetes
description: insulin
order_type: medication
reason: if some of the autoimmune labs that come back show that you have an autoimmune disorder , meaning that you would have type i diabetes