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Diabetes Patient Education Material Provided in Patients Primary Language:
Assessment and Planning

First visit and ongoing:
Assess for other disciplines: PT, OT, Speech, SW, HHA. If needed:

  • Obtain approval from D.O.N
  • Speak with MD, obtain verbal orders; write and send Interim orders.
  • Request in managed care report

Reassess d/c plan at every visit
If further visits needed – at least 1 week prior to planned d/c date:

  • Obtain approval from D.O.N
  • Speak with MD, obtain verbal orders, write and send Interim orders.
  • Write managed care report 1 week prior to any change


  1. Assess and reconcile all medication. Instruct in purpose, route, frequency, side effects.
  2. Assess knowledge of ABC’s: A-HbA1C, B- Blood Pressure, C- Cholesterol
  3. Assess for effects of diabetes and instruct in S/S hyper/hypoglycemia, peripheral neuropathy and circulation, and skin breakdown including proper foot care with regular inspection of feet.
  4. Evaluate knowledge of S/S of hypoglycemia and hyperglycemia and actions to take.
  5. Evaluate blood glucose results in daily log or history and investigate reasons for fluctuations.
  6. Evaluate compliance with proper glucose testing technique.
  7. Evaluate compliance with proper insulin preparation and administration.
  8. Evaluate compliance; Instruct family/friends on actions to take for hypoglycemic and hyperlipidemia
  9. Instruct on effects of poor control: retinopathy, neuropathy, ASHD hypertension, hyperglycemia, hyperlipidemia and renal disease.
  10. Evaluate knowledge of importance of yearly eye, dental, and podiatry exams.
  11. Instruct on prescribed diet, portion control and carbohydrate planning.
  12. Instruct on importance of Medi-Alert identification and procedure to obtain.


  1. Knowledge of reasons to take medications as ordered with understanding of route, frequency, purpose and side effects, as appropriate. (V)
  2. Proper technique and timing for blood glucose monitoring (D)
  3. Blood glucose levels within normal range for patient. (D)
  4. Correct procedure for cleaning and calibrating glucose meter. (V)
  5. Ability to prepare and administer insulin using proper technique. (D)
  6. Ability to interpret BS results and take appropriate actions. (D)
  7. Three (3) potential effects of poor diabetic control. (V)
  8. Three (3) S/S of hyperglycemia and appropriate actions to take. (V)
  9. Three (3) S/S of hypoglycemia and appropriate actions to take. (V)
  10. Knowledge of prescribed diet, portion control, and carbohydrate planning. (V)
  11. Self care needed to prevent complications secondary to disease. (V)
  12. Importance of annual eye, dental, and podiatry exams. (V)
  13. Compliance with appropriate measures of diabetic foot care. (D)
  14. Appropriate actions to take to manage diabetes when ill. (V)