[doctor] good afternoon , beverly . good to see you .
[patient] nice to see you too .
[doctor] so , i know my nurse told you a little bit about dax . um , now , if you do n't mind , i'd like to tell dax a little bit about you .
[patient] go for it .
[doctor] great . um , beverly's a 24 year old female patient , and i know you have a history of type 2 diabetes and high blood pressure . correct ?
[patient] yep .
[doctor] okay . so , you're here today for your yearly exam . have n't seen you in a year . how're you doing ?
[patient] i've been doing well . i began working in a bakery this summer which has been super fun. i have really been enjoying working there, but i find myself, since i am so close to so many delicious treats, snacking a lot during shifts and eating a lot more desserts than i normally would.
[doctor] okay , so , that brings me to your diabetes . so , how have your blood sugars been ?
[patient] uh , not so good .
[doctor] okay .
[patient] so , they've been up and down because of my diet , i think , because i've been taking my medication as prescribed . um , so , i have n't missed anything there , but my diet has been pretty bad lately .
[doctor] pretty bad lately ?
[patient] yeah .
[doctor] okay . and , that's really the only thing that's different is your diet , pretty much ?
[patient] yeah .
[doctor] and , that's because of the new job and all that ?
[patient] yeah. it has been really challenging to resist the temptation. 
[doctor] it's hard to ignore those desserts , are n't they ?
[patient] yeah .
[doctor] no willpower like me ?
[patient] no , no willpower .
[doctor] okay . all right . and , and then , um , i know you've had high blood pressure , hypertension . how is , how have your blood sugars been ? have you been checking them ?
[patient] so , my blood pressure's been good . um , despite my , um , my diabetes levels being up and down .
[doctor] okay .
[patient] so , that's been good .
[doctor] okay , so , your blood pressures have been normal . you've been sleeping well ?
[patient] yep , getting a full eight hours .
[doctor] no concerns about hurting yourself or anything like that ?
[patient] no .

[doctor] okay , good . okay , and i know my , um , nurse did a review of systems . other than what we've talked about so far , is there anything else that you needed to add ?
[patient] no .
[doctor] good . so , pretty much status quo except for those things that we've been working on , right ?
[patient] yep .
[doctor] okay , good . all right . well , let me do a quick physical exam , okay ?
[patient] okay .
[doctor] okay , squeeze my finger here . good . can you feel me touch out here ?
[patient] yep .
[doctor] okay . and , can you feel me touch you down here ?
[patient] yep .
[doctor] okay . no swelling . push your leg out . good . pull it back . mm-hmm . go . good . okay . so , on my exam , um , essentially , your exam is normal . your , um , heart is regular . you do have that grade 2 , um , systolic ejection fraction back ejection murmur that you , um , that we've heard in the past . okay ? so , um , we definitely know that's there . that's unchanged , okay ? um , your lungs are clear . um , your grips are equal . neurovascular's intact . you do n't have any carotid bruits in your neck , no thyromegaly . no edema . um , pulses are good , so essentially , your exam is , is essentially normal . let's take a look at some of your lab work , okay ?
[patient] okay .
[doctor] hey , dragon , show me the hemoglobin a1c . okay , so , blood sugars have been elevated . your hemoglobin a1c is elevated as well , so that tells me your blood sugars have been a little bit out of control . you're still taking the metformin , correct ?
[patient] yes , i am .
[doctor] okay , and you take that twice a day ?
[patient] yep .
[doctor] okay . um , uh , hey , dragon ? show me the vital signs . okay , good news here is your blood pressure's good . everything , um , there is fine . so , um , so , my assessment is , is , um , your first problem is diabetes . it's a little out of control . we'd like that hemoglobin a1c to be under seven , um , at least . you know , preferably , under six .
[patient] mm-hmm .
[doctor] so , um , uh , i'm not gon na change your medication . i think this is diet related , so i want you to try to cut down on the snacking and additional sweets , okay ?
[patient] yeah .
[doctor] and , i want you to check your blood sugars in the morning . i want you to call them in in about two weeks so we know what your first , um , fasting blood sugar was in the morning , and then , we'll come back and see you in about two months and see if everything has straightened out . if it has n't , then we'll talk about adding another medication , okay ?
[patient] okay .
[doctor] your second problem is your hypertension . that seems to be relatively stable . i want you to stay on your current medication . you're on li- lisinopril 10 mg once a day . just stay right on that medication . no changes at this point . seems to be doing well , okay ?
[patient] okay .

[doctor] good . anything else i can do for you today ?
[patient] no . that's it .
[doctor] good . come with me , we'll get you checked out .
[patient] thank you .
[doctor] hey , dragon ? finalize the note .

Medical orders:
description: come back and see you two months
order_type: followup
reason: diabetes little out of control