Hypoglycemia

OVERALL_INSTRUCTIONS

Chief Complaint

Assessment of hypoglycemia.

Template

Dear Dr. [referring physician name], Thank you for referring [name], a [age] year old [gender], who was seen [in person/via telemedicine] on [date] for assessment of hypoglycemia. The patient was [seen alone/accompanied by family]. We spoke in [English/Mandarin]. Consent: I obtained consent from the patient for use of an AI scribe software. I explained that Empathia saves a copy of our conversation on their website for the purpose of generating a note, and that this software is FDA approved. History of presenting illness: [Brief description of when the patient's symptoms, when they were initially discovered, and initial testing done] Hypoglycemia: [timing, duration, blood glucose value, treatment, frequency] Prior bariatric surgery: [present or absent, type of surgery, date of surgery] Hypoglycemic medications: [present or absent] Critical illness during measurements: [present or absent] Adrenal insufficiency: [symptoms of adrenal insufficiency] Growth hormone deficiency: [symptoms of growth hormone deficiency] Past medical history: [medical_history] (List numerically with each having its own line) Medications: [drug_name] (List numerically with each having its own line) Allergies: [allergies] (List numerically with each having its own line) Social history: Exercise: [exercise] Meals: [meals] Work: [work] Extended coverage: [coverage] Alcohol: [alcohol] Cigarettes: [cigarettes] Drugs: [drugs] Family history: [Family history of hypoglycemia, insulinoma, adrenal disease, or diabetes] Exam: Weight: Height: Blood pressure: Heart rate: [general exam, weight, height, vitals, cardiac exam, pulmonary exam] Investigations: [investigations] (Organize lab values by date and list each lab value on its own line) Impression and Plan: [name] is a [age] year old [gender] with [symptoms and diagnosis]. [The differential includes reactive hypoglycemia, dumping syndrome, exogenous insulin use, sulfonylurea use, adrenal insufficiency, growth hormone deficiency, insulin auto-antibodies, IGF-2 mediated, insulinoma, non-insulinoma pancreatogenous hypoglycemia syndrome, and non-insulin mediated hypoglycemia.] I will proceed with further workup for the etiology, including [repeating bloodwork, including insulin, C-peptide, proinsulin, sulfonylurea screen, 72-hour fast, mixed meal test, AM cortisol, IGF-1, imaging for insulinoma (such as MRI, transabdominal or endoscopic ultrasound, or selective pancreatic arterial calcium stimulation with hepatic venous sampling), insulin antibodies]. [I have counselled the patient on management of acute and chronic hypoglycemia. Acute treatment of hypoglycemia is to ingest 15-20g of rapidly absorbed carbohydrates, checking CBG in 15 minutes, and repeating if necessary. If the hypoglycemia is severe, then use of glucagon would be necessary. Chronic management of hypoglycemia includes ingestion of frequent meals, eating complex carbohydrates rather than simple ones, use of a continuous glucose monitor, maintaining hypoglycemia awareness, and use of a MedicAlert bracelet]. Follow-up: I have arranged for follow-up in [time] Patient Counseling: Thank you for involving me in the care of this pleasant patient. Please do not hesitate to contact me with any questions or concerns. Dr. Leo Hu, MD, FRCPC Elida Medical Centre