Type 1 Diabetes Follow-Up Note (CGM/Pump)

(Do not infer device settings or metrics without device download or clear patient confirmation. Prefer omission over placeholders except for safety-critical elements—hypoglycemia history, sick-day/ketosis readiness, and CGM data sufficiency—where an explicit "not reviewed" or "not available" statement is required.)

Date: [Date]

Patient: [Patient name / MRN]

Provider: [Provider name, credentials]

Encounter Type: [in-person / telehealth]

Visit Reason: T1D follow-up – CGM/pump review

Subjective

[Interval course since last visit] (Summarize overall trajectory and major events: ER visits, hospitalizations, DKA/ketosis episodes, severe hypoglycemia requiring assistance, glucagon use, device failures.)

• [Current CGM use] (Device type, wear consistency, adhesion issues, alarm tolerance, supply barriers.)
• [Current pump/AID use] (Model, mode utilization, infusion set rotation, occlusions or early set failures, supply barriers.)
• [Insulin regimen as actually used] (Basal/bolus approach; clarify differences from prescribed settings if any.)
• [Lifestyle factors] (Meal timing, exercise habits, shifts/travel, illness/stressors impacting glycemia.)

Hypoglycemia Review (required): [Frequency, timing, severity, lowest recent values, symptom awareness status, need for assistance, glucagon availability and who is trained to administer] (State explicitly if hypoglycemia awareness is impaired. If not reviewed, state "Hypoglycemia history: not reviewed this visit" with reason.)

Sick-Day/Ketosis Readiness: [Access to ketone testing supplies, familiarity with sick-day protocol, backup insulin plan if pump fails] (If not reviewed, state "Sick-day readiness: not reviewed this visit" with plan to address.)

Review of Systems

(Targeted to diabetes safety and complications; include only clinically relevant positives and pertinent negatives.)

• [Hypoglycemia symptoms and awareness]
• [Neuropathy symptoms]
• [Vision changes]
• [Foot concerns]

Objective

Vitals: [BP, HR, weight, BMI as relevant] (If patient-reported during telehealth, label as such.)

Exam: [Focused exam findings] (For telehealth, state "limited exam by video" and describe only observable findings.)

• [Infusion site and CGM site inspection] (Lipohypertrophy, irritation, infection, rotation adequacy.)
• [Foot exam] (If due; otherwise state deferred with reason.)
• [Other focused findings as relevant]

Labs: [Most recent A1C with date, renal function, urine albumin-creatinine ratio, other pertinent results] (If pending or overdue, state what was ordered.)

CGM and Pump/AID Data Review

Data Sufficiency: [Date range reviewed] | [Percent sensor wear time] (If wear <70% or <14 days, state "Insufficient CGM data" with reason and plan. Do not estimate metrics if insufficient.)

CGM Metrics (when sufficient data available):

• [Mean glucose / GMI]
• [Glucose variability (%CV)]
• [Time in range 70–180 mg/dL]
• [Time below range <70 mg/dL and <54 mg/dL]
• [Time above range >180 mg/dL and >250 mg/dL]

Pattern Interpretation: [Narrative patterns] (Address hypoglycemia patterns first with timing and suspected mechanism, then hyperglycemia patterns, then variability drivers. Link to suspected causes when supported by data.)

Pump/AID Summary: [Total daily dose, basal/bolus split, automated mode utilization, delivery issues, backup insulin plan confirmed] (If settings reviewed but unchanged, state "Settings reviewed; no changes today.")

Assessment

(Problem-oriented. Distinguish CGM-confirmed findings from patient-reported experience.)

• Type 1 diabetes – control status: [Overall control with reference to CGM metrics]
• Hypoglycemia risk and awareness: [Risk level, awareness status, recent events]
• Hyperglycemia/ketosis/DKA risk: [Risk in context of pump therapy]
• Device/supply issues: [CGM/pump functionality, access barriers]
• Complications/comorbidities: [Relevant conditions as applicable]

Plan

Insulin/Device Adjustments:

• [Setting changes in before→after format] (e.g., "Basal 12a–3a: 0.85 → 0.75 U/hr for overnight lows")
• [Glycemic targets prioritized] (e.g., minimize nocturnal hypoglycemia vs improve postprandial control)
• (If no changes, state rationale.)

Hypoglycemia Prevention Plan:

• [Recognition and treatment steps reviewed]
• [Alarm threshold adjustments if changed]
• [Glucagon prescription status and who is trained]
• [Safety counseling provided] (Driving, exercise, nighttime precautions.)

Sick-Day and Pump Failure Plan:

• [Ketone testing instructions during illness or persistent hyperglycemia]
• [When to call clinic vs go to ED]
• [Backup injection plan if pump fails with supplies confirmed]
• (If not reviewed this visit, do not assert it was covered.)

Education: [Topics covered, method used, patient understanding] (Avoid vague "counseled" statements.)

Follow-Up: [Interval, instruction to upload data before next visit, criteria for earlier contact]

Orders: [Labs, referrals, prescriptions]