Ralphie’s Results
You have been asked to see Ralphie before he sees the practice nurse. You look at the last entry in his notes which was written by your clinical partner when they saw him earlier in the week.
The story
Cholesterol 6 mmol/l, TC/HDL ratio 5 and HbA1c 64%.
Informed Ralphie he has diabetes and that his cholesterol is high.
We discussed this meant he is eating too much sugar and needs to cut down. He is a builder and has a fry up for breakfast and lots of cake and chocolate bars as snacks. He also adds 3 sugars to his cups of tea.
Ralphie could not see where he might cut down in view of the physical nature of his job. Also his wife makes his packed lunch and dinners. I suggested we could put him straight on medication to control his sugar. I advised him to book in with the practice nurse as she can demonstrate how to use insulin and decide on a starting dose.
Ralphie also has a very active job so there was no room for increasing his activity.
He understands that it was always going to happen; he is high risk for diabetes because his dad and sister developed diabetes when they got older.
We discussed his cholesterol result needs repeating with a fasting sample. If it is still high I discussed he will need treatment with a statin to reduce it, aiming for a cholesterol level below 4. He wanted to know why this was important and I explained that he could have a heart attack or stroke. He was worried about how likely that was to happen but I wasn’t sure. The nurse would be able to help.
Ralphie has been told he is also at risk of complications of his diabetes that might affect his kidneys, his hearing or he could even lose a leg! I have explained that he can attend screening to try and prevent this.