Clients should be monitored regularly for changes in blood pressure, weight and foot problems. If problems are identified earlier, the doctor and/or nurse can be alerted sooner, and problems can be dealt with sooner before they get worse.
Measuring weight is important because it helps determine whether or not a client is overweight or obese. Obesity can lead to diabetes, and reducing obesity can help improve diabetes. However, you need to know the height as well as the weight to determine if someone is obese. Someone who is 160lbs and 5 feet is obese, but someone of the same weight and 6 feet is not; the extra weight is due to more muscle and bone, not fat.
Height is used to calculate the Body Mass Index (BMI) according to a special formula. “Ideal” is from 18 to 25; “overweight” is from 25 to 29; and “obese” is 30 or higher. (You don’t need to know this formula; you just have to enter weight and height in the registry, and BMI will be automatically calculated.)
Checking the feet is important because people with diabetes lose their sensation and may not notice small cuts or tears in the skin. These problems can quickly get worse if not identified early and treated. Complications of cuts or ulcers include infections, which if not treated early enough can lead to severe infections, and even amputation.
The CHW’s role is to do physical assessments on clients deemed at “high-risk”, those who have very poor control of their diabetes and require more support. See section I below on how these clients will be identified. CHWs will use the CHW Diabetes Clinical Assessment Log sheet paper form to record visit information.
1. Tell client you will be examining their feet.
“Sometimes people with diabetes can develop problems with their feet, like infections. I would like to check your feet now. Please remove your shoes and socks.”
2. Have client sit down.
3. Remove the client’s shoes and socks to fully expose the feet.
“Have you noticed any NEW cuts, open sores, or ulcers? Any NEW numbness or tingling? I will now check them myself as sometimes diabetes makes it hard to feel sensation in your feet.”
4. Look and the top, bottom, and in between the toes of BOTH FEET.
5. LOOK for:
b. Open sores, or ulcers, where the top of the skin is scraped off.
c. Areas of redness which persists even if you push on it.
6. Ask about numbness and tingling in the feet.
7. Record any findings from step #5 in the Logsheet.
8. If there are any NEW abnormal foot problems (cuts, ulcers, redness, numbness), please notify someone right away – either the nurse or doctor.
Download or use this online CHW sample form to practice the contents of this module.
Please note that these training modules are to be used for the purposes of CHW training in diabetes management. CHWConnect does not provide medical advice or specific diagnostic or treatment information.