I'm Carol Jones, I'm 50 years old, and I'm from Stewartville, Minnesota. I'm here to see my doctor today because my diabetes is still out of control. At my last appointment, we made some changes in my medication and I still need some help. So I'm hoping today we'll figure out where we go next. >> I'm a care coordination nurse in the care team. I partner with Mrs. Jones and her physician in the management of type two diabetes. I help Mrs. Jones assess her plan of care, and provide a touch point of communication to her between visits. >> I'm Mrs. Jones physician and I'm seeing her for her three month follow up visit to help her manager her type two diabetes mellitus. Good morning. >> Good morning. I met with Mrs. Jones to see how she is doing. She has been very busy lately with work and at home. She hasn't had a chance to implement some of the diet chances she had hoped to. She still has the goals of snacking less often and eating regular meals. I will continue to update her and communicate with her online as to any changes that are in her care plan today. >> Okay, thanks for the update. This really helps me know what the important issues are for this visit. >> After clinic today, I'd also like to update you on some of the other diabetic patients I've been working with, including their care plans and brainstorm ideas for some of the barriers that they been communicating with me. >> Okay, that sounds good, let's setup a time to visit later. Good morning, nice to see you. How are things going? >> Not to bad. I've been checking my blood sugar every other day like you asked at the last appointment for me to do, but they are still in the hundred and eighty range. And I also wanted to mention, I don't think I'm going to be able to check it every other day. >> What have some of the difficulties been for you? >> Well, the test strips are really expensive and my health insurance company doesn't cover it, also it takes time >> And quite honestly, at the end of the day, I'm very, very tired. Also, I don't know if you know this, but in th evenings, I'm talking care of my grandson, and he is so full of energy I'm exhausted, and sometimes I just forget. >> Yes, I heard from our nurse that you've been very busy at home and at work. I think we can make some changes to how often you check your blood glucose values. I previously suggested more frequently so that we could get an idea of your diabetes control but now, I think it's fine to decrease the number of test to twice weekly. And there are also some glucose strips that you can use which work just as well as the ones that you are using now, but they cost a lot less. And we can get that information from the Clinical Assistants at the end of the visit. >> That would be very helpful if I can get the cheaper glucose strips. You know what? I do believe that I could check my blood sugars. Twice a week, I think that would be good. That's a lot off my plate, thank you. >> Okay, let's look at your glucose readings that the nursing team downloaded from your glucometer when you first checked in. Yes, I can see that your blood glucose levels in the morning are above your goal range of 140. At your last visit, we talked about increasing your medication dose if your glucose was above goal range. >> I remember at our last visit, you did say that if the range didn't come down, that I would probably have to increase my medicine. So I think that that's a good idea. I would like to see those levels lower, so I promise I'm still planning to make those changes to my diet that we talked about it's just that I need work to slow down a little bit. >> Okay, let's increase your dose of medication from two tablets with your evening meal to three tablets with your evening meal. And I'd like to see what effect that has on your glucose levels. So, I'll ask one of our Nursing Team colleagues to contact you through the Patient Online Portal, and I see that you're signed up for an account. Okay, now let's have a look at your medical record. So, I can see that you're due for your eye exam in three months. Your blood pressure is looking great, you're up-to-date on your immunizations, but your cholesterol is still above goal. >> I remembered last time you did talk about the cholesterol, I've been thinking that a lot about it. And I would like to see those levels go lower particularly since my dad died at 55 from a heart attack. But I am not really sure about adding another medication to the list. >> We talked about it, your last visit, how important it is to decrease your cholesterol to try and prevent you having a heart attack or a stroke. So is it okay if we discuss trying to decide whether taking a medication would be good for you? >> Sure. I think that would be good. I really can't ignore it much longer. >> Making a decision about whether to take a medication can be hard. So I like to use this tool to help us decide what would be the most helpful for you. The information here can help because it tells you what you would gain if you took a cholesterol lowering medication and it also tells you what some of the risks would be if you took the medication. And it also tells you what could happen if you decide not to take the medication. So shall we go through this together? >> Sure.
