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Patient Protocols

Dear patient with diabetes mellitus,

We want to make your visit with Houston Thyroid as smooth as possible to allow as much time for a visit with your physician. We believe that reviewing the data on your devices and labs will change your management in a positive way. Please try to follow the below guidelines.

NEW PATIENTS: 
The physicians strongly prefer to review your previous records prior to your visit. If you have records with your previous blood testing or medication regimens or other doctor notes, please fax to our office 713.795.0855 at least 5 days in advance of your appointment or upload electronically here
If our clinic is managing your blood sugars with medication, then your should expect to have to visit with the doctor at least every 2-6 months depending on your blood sugar control. 

ALL PATIENTS: 
DEVICE DOWNLOADS
Glucometers
    • All patients who are on any insulin or sulfonylurea pills (such as glimepride or glipizide) must check blood sugars on a glucometer. 
    • Please Register for Diasend if you have not already done this. You should upload your meter readings from your home computer 2-3 days prior to arrival to your visit to increase time spent with the doctor at your visit
    • Otherwise you must bring the meter to the visit for download if not already done via Disend
Insulin Pumps  (Medtronnic, T-Slim, Omnipod, etc)
Dexcom Continuous Glucose Monitors
    • If you have a Dexcom G4 you should upload your data to Diasend and share with our clinic
    • If you have a Dexcom G5 or higher then please please download the clarity app on your smartphone clarity.dexcom.com  You will need to give the share code to the office staff when you arrive so we can download your data


PRECLINIC LABS
Almost all visits with the doctor will involve reviewing laboratory data so please complete labs 10 days prior to your schedule visit.  It is very rare that lab work is not needed in advance of an appointment.

EYE EXAMINATIONS
All patients with diabetes must have a diabetes eye exam once yearly. You should be able to utilize your medical insurance for such an examination. Please have the eye doctor fax their results to our office at 713.795.0855 so that we can review the results. 



GENERAL EXPECTATIONS FROM OUR CLINIC:
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It is important for patients to recognize that long-term hyperglycemia can cause significant damage to blood vessels, leading to diabetes complications such as nerve damage, blindness and kidney failure, as well as increased risk of a heart attack or stroke. The many symptoms of diabetes mellitus are categorized as short-term and long-term side-effects to the body from having uncontrolled blood sugars. The long-term side-effects are called microvascular (small blood vessel) and macrovascular (large blood vessel) complications. The microvascular diseases that are directly related to the degree and duration of blood sugar elevation include retinopathy (leads to blindness), nephropathy (leads to kidney failure), and neuropathy (leads to amputations, gastroparesis).
Patients with diabetes mellitus also have a much increased risk of macrovascular diseases such as of blockages of coronary arteries, heart attacks, peripheral vascular disease, and stroke.
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We ask you to follow some basic rules in our clinic:
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- Eye evaluation. We require you see an ophthalmologist (not optometrist) once per year to evaluate for diabetes changes in your eyes called retinopathy. Bring their report to us or instruct their office to have it faxed to us 713.795.0855. It is your responsibility to have this done to prevent blindness.
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- Foot care is important. Meeting with a podiatrist at least once per year is suggested if you already have numbness/ tingling in your feet which are signs of diabetic neuropathy. If you have cuts, bruises, or ulcers on your feet you must inform us about it as soon as possible to prevent amputations. Avoid smoking, walking barefoot, the use of heating pads or hot water bottles, and stepping into a bath without checking the temperature. The toenails should be trimmed to the shape of the toe and filed to remove sharp edges. The feet should be inspected daily, looking between and underneath the toes and at pressure areas for skin breaks, blisters, swelling, or redness. You may need to use a mirror or, if vision is impaired, have someone else perform the examination. You should wear shoes and socks at all times. Shoes should fit properly and not be too tight, and the socks should be cotton, loose fitting, and changed every day. All patients with diabetes need to pay special attention to the fit and style of their shoes and should avoid pointed-toe and open-toe shoes, high heels, thongs and sandals. Patients who have misshapen feet or have had a previous foot ulcer may benefit from the use of special customized shoes. The feet should be washed daily in lukewarm water. Mild soap should be used and the feet should be dried by gentle patting. A moisturizing cream or lotion should then be applied
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- Checking sugars: If we have asked you to check your blood sugars, always bring your glucometer with you to each visit
- Goals: blood pressure should be less than 130/80. LDL cholesterol should be less than 100 mg/dl Hemoglobin A1c should be less than 7% in most patients
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-If you are taking the medication metformin (glucophage, glumetza): stop this medicine 3 days before any planned CT scan imaging testing. Please let the ordering physician know you are on this medication. Also if you have worsening diarrhea, vomitting,or severe muscle aches while on the medication please contact us and stop the medication as this could be a sign of lactic acidosis a rare but fatal side effect. If your kidney function, liver, or heart function has worsened for any reason, you must contact us as well.
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-When to check blood sugars with a glucometer: -every day if you are on any insulin or sulfonylurea medication (glipizide, glyburide, amayl, glimepride), -if you have signs of hypoglycemia (dizziness, nausea, tremor, fast heart rates, double vision, blurred vision, sudden severe hunger), - if you develop any other illness such as the flu or a cold your blood sugars will rise so check twice per day, -if you are started on any kind of inhaled, topical, or oral steroid medication your sugars will rise so check twice per day, -if you are about to start driving or operate heavy machinery
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-Emergency warnings- go to the emergency room call us on the way if you have:
1) blood sugar is greater than 300 repeatedly for more than 2 days 2) frequent blood sugars less than 60 (especially when associated with confusion) 3) nausea with vomiting therefore unable to take pills or not taking insulin 4) chest pains 5) If you are admitted to St Lukes Hospital in the Medical Center, please call our office directly so we can try to see you in the hospital
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-If you are on any type of insulin, then you must check you blood sugars daily, and you must bring your glucometer to each visit. Patients on insulin should check blood sugars 4 times per day- just before breakfast, before lunch, and before dinner and at bedtme for at least the 7 days prior to next visit. We will download glucometer at next visit.
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-Warning when driving a vehicle or heavy machinery:
Many diabetes medications can cause low blood sugar reactions which include symptoms of dizziness, nausea, sweating, fast heart rates, confusion, or even coma. Therefore, anytime before you begin to drive a vehicle we recommend you check your blood sugar with a glucometer before starting the car and keep a snack in your vehicle at all times. If your blood sugar is less than 70 or has been dropping quickly we recommend that you do not drive.
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-Use of alcohol can interact with all diabetes medications and drinking is not recommended for any diabetes mellitus patient who is taking any anti-diabetes medication.
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HOW TO DISPOSE OF NEEDLES AND SYRINGES
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Storage of Used Needles
Store at home
If you have a medical facility that accepts sharps from the community for disposal, either purchase a sharps disposal container from a pharmacy or ask your specialty pharmacy to provide you with a sharps container (these are typically readily available if you receive your medication through the mail).
If disposal sites open to the public are not available in your area, DO NOT use a sharps container. Instead, USE an empty laundry detergent bottle with a screw-on lid. 
Do not store used sharps in glass bottles, soda bottles, milk jugs, aluminum cans, or coffee cans.
If you are bringing used sharps to a clinic or hospital collection site or using a mail-back program, follow their requirements, which may include use of a pre-purchased sharps container.
Always keep storage containers for used sharps out of the reach of children.
Disposal of Used Needles
Never place containers with used needles or syringes in a recycling bin.
Never place loose sharps in the garbage.
Do not place sharps in containers with a BIOHAZARD label on the outside of the container in the household garbage. Biohazard material is typically not allowed in household trash. Sharps containers with a Biohazard label are usually treated as medical waste. To find out if your state allows sharps containers in the household trash contact your state waste department for specific regulations on household medical waste.
Clinics and Hospital Collection Sites
Some medical waste facilities such as, clinics, physician offices, EMT stations and hospitals have collection programs for needles, lancets, and syringes for use by their patients at home. If your healthcare provider has a collection program, learn about and follow their instructions for sharps storage and disposal.
DO NOT bring used needles and syringes to your clinic or hospital if they do not accept them.
Disposal Options Available to Texas Residents
Texas state regulators do not provide written recommendations to syringe users for disposing of sharps. However, individuals who use syringes at home are responsible for ensuring that their used syringes are stored in a way that does not cause a health hazards. To safely dispose of used sharps in the state of Texas, you may use one of the options listed below to dispose of used needles, lancets, and syringes.
I. Mail-back Programs
Mail-back disposal programs allow home sharps users to mail used sharps to licensed disposal facilities as a safe disposal option. Such programs charge a fee for this service. Check with your health care provider or pharmacist, or search the yellow pages or Internet using key words sharps mail-back.
II. Needle Destruction Devices
Devices or containers with mechanisms that bend, break, incinerate (destroy by high heat), or shear needles are called sharps needle destruction devices.
A destruction device that incinerates needles and lancets can be used at home to destroy needles immediately after use. These small, portable devices use a few seconds of high heat to melt needles and reduce them to BB-size balls. Previously used only in healthcare facilities, these devices are now available in smaller, less expensive models for home use.
Once the needle or lancet is destroyed by heat in a destruction device, the remaining syringe and melted metal can be safely disposed of in the garbage (not the recycling container).
A needle cutter that automatically stores the cut needles is also useful while away from home when a disposal container is not available. The remains of the syringe after the needle has been clipped can be placed in either a household container or a sharps container (if there is a site available to drop off the sharps container). When the needle clipper is full, simply place it in the storage container (household or sharps container) and dispose of properly.
III. Legal, but Less Safe
In Texas, it is currently legal to put used sharps that are in a laundry detergent bottle with a lid into the garbage.
However, this is highly discouraged because of the injury and health risks it places on garbage hauler and processing facility workers. It is best to use one of the options previously listed for safe management and disposal of used sharps.
NEVER PLACE LOOSE NEEDLES AND SYRINGES IN THE TRASH!
Label container Do Not Recycle.
Put sharps in point-first.
Containers more than half-full should be disposed of.
Store sharps in closed container with the cap screwed on.
Although placing household generated sharps in the regular trash may be allowable under state rule, some municipalities prohibit this disposal method. Please check with the local authority to determine if this practice is acceptable in your community. You should contact your county or city waste manager, public health official, sanitary department, or environmental health department.
For more information on safe needle disposal contact the Texas Natural Resources Conservation Commission at www.tceq.state.tx.us or (512) 239-1000.
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