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PAST MEDICAL HISTORY: Significant for type 1 diabetes, poorly controlled; retinopathy; peripheral neuropathy; ischemic heart disease; congestive heart failure; cardiomyopathy; depression; hyperlipidemia and hypertension.

REVIEW OF SYSTEMS: CONSTITUTIONAL: No fever or chills. ENT: No upper respiratory infection symptoms. RESPIRATORY: No difficulty breathing. CARDIOVASCULAR: No chest pain. GI: No nausea or vomiting. NEUROLOGIC: The patient has decreased sensation in the feet but denies any changes. SKIN and MUSCULOSKELETAL: As above.

PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature is 35.6, heart rate 84, respiratory rate 16, and blood pressure 119/49. She has 95% room air saturation.
GENERAL: She is alert and oriented. Her mentation is in her usual state at least for the last 3 or 4 times that I have encountered her in the inpatient setting.
HEENT: Most significant for dry mucous membranes.
HEART: Regular with no murmurs, rubs, or gallops.
LUNGS: Clear to auscultation bilaterally but with diminished excursions.
ABDOMEN: Obese but soft and nontender.
EXTREMITIES: Warm and perfused. She has no clubbing, cyanosis or erythema. Edema is difficult to assess because of the size of her legs.
SKIN: As above, otherwise negative for any acute changes.
NEUROLOGIC: Patient does have decreased sensation to the foot.
GU/RECTAL: Deferred.
PSYCHIATRIC: Normal affect.