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.
Before testing blood glucose, be sure you have read and understood our infection guide for blood glucose monitoring.
1. Tell client that you will measure their glucose (blood sugar).
“Blood sugar should be checked regularly for everyone with diabetes to make sure it is being well controlled. If blood sugar stays high for a long time, then damage to the eyes, kidneys or heart can occur.”
“Do you know how to check your blood sugar? Would you like me to demonstrate it for you?”
If client wants a demonstration, then: “I’m just going to go over each step with you and let you know everything that’s happening. Please stop me anytime if you have any questions.” (Then go through the steps and explain each step).
“Do you think you could try doing that yourself?”
“Why don’t you try it once on yourself while I’m here so I can help you if you have any problems or questions?”
2. Gather appropriate equipment (e.g. glucometer, lancet, test drips, and alcohol swabs).
3. Check that there is a sharps container nearby.
4. Tell client to wash his/her hands.
“First, let’s BOTH wash our hands.”
5. Wash your own hands or put on gloves.
6. Turn on glucometer.
7. Put test strip into glucometer.
8. Wait for glucometer to ask you to put drop of blood on strip.
9. Clean the area to be pricked (finger, or elsewhere) with alcohol swab.
10. Load the lancet into its holder.
11. Put the lancet against the area to be pricked, and push on the trigger.
12. Put just a drop of blood on the test strip.
13. Wait for the results.
14. Dispose of the lancet in a sharps container.
16. Record the results onto the Log sheet
17. Refer the client to the nurse right away if the blood sugar is LESS THAN 4 or MORE THAN 20.
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.