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 that you will be reviewing the logbook and glucometer.
2. Ask the client to see their logbook and glucometer.
“If you brought your sugars logbook, may I review it with you?”
3. Review the logbook and glucometer if available.
4. If no logbook, or no results in logbook/glucometer, explore reasons.
If: Client has no logbook, and no results in glucometer are available: “It looks like you haven’t been checking your blood sugars regularly. Can I ask you if there is anything that is preventing you from checking it? Is there anything we can help you with?”
“Would you like a demonstration or refresher on how to take your blood sugar?”
5. If client has some results, but not as frequently as recommended, explore reasons.
Client has some results in logbook or glucometer, but not as frequently as recommended: “Thanks for capturing some of the results on your client log. That’s very helpful. Do you think you could check blood sugar more often now? Is there anything we can help with?”
6. If problems with equipment (broken, missing), record in the registry.
7. Record 5-10 most recent pre and post meal blood sugars.
8. Record frequency of blood sugar measurements on the Log sheet:
a. No testing
b. Testing 1-2 times a week
c. Testing 3-6 times day
d. Testing every day or more
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.