Basic guidelines for diabetes care

BASIC GUIDELINES for DIABETES CARE
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PHYSICAL AND EMOTIONAL ASSESSMENT

Blood Pressure, Weight - Every visit. Blood pressure target goal 200 Clinical nephropathy Adapted from Diabetes Care, 26(Suppl. 1):S95, 2003

Spot collection (A/C ratio) (µg/mg creatinine) < 30 30-299 > 300

Page 2 of 2. This product is part of the Basic Guidelines for Diabetes Care Packet and may be reproducedwith the citation: “Developed by the Diabetes Coalition of California and the California Diabetes Prevention and Control Program, 2003-04.” For further information: www.caldiabetes.org or (916) 552-9888.

FOOT CARE for PEOPLE with DIABETES
DETAILED FOOT EXAM
(at least yearly)
NEUROLOGICAL ABNORMALITIES NORMAL SENSATION/ PULSES VASCULAR ABNORMALITIES

Neuropathy
• Symptoms - burning - pain -numbness • Signs - atrophic skin - callus formation - dystrophic nails - bone deformities - muscle wasting - decreased sensation - absent reflexes • Evaluation - monofilament - vibration - reflexes • Management - pain control - reduce pressure points - refer to foot specialist

Preventive Care
• Daily foot exam - skin care - nail care • Proper footwear
REINFORCE

Vascular Disease
•Symptoms - intermittent claudication - pain at rest • Signs - absent pulse - dependent rubor - elevation pallor - loss of hair - atrophic skin - cyanosis • Evaluation: refer for - arterial ultrasound - angiogram • Management - medication - exercise - refer to vascular specialist

• Visual inspection each diabetes visit • Identify bone deformities • Smoking cessation • Assess/optimize - glycemic control- blood pressure control - cardiovascular risk Preventive care should be life-long and reinforced at least yearly.

Neuropathy and Peripheral Vascular Disease
• High risk for: plantar ulcers, infection, gangrene, and amputation. • Essential care: access to prompt and appropriate urgent care. • Specialty team care: diabetes educator, primary physician, endocrinologist, podiatrist, infectiousdisease expert, vascular specialist, surgeon, radiologist.

Page 1 of 1. This product is part of the Basic Guidelines for Diabetes Care Packet and may be reproduced with the citation: “Developed by the Diabetes Coalition of California and the California Diabetes Prevention and Control Program, 2003-04.” For further information: www.caldiabetes.org or (916) 552-9888.

REINFORCE

HIGH RISKNeuropathy & Vascular Disease
HIGH RISK

DIABETES FOOT EXAM
Patient Name: ____________________________________________________________

_________
Last First MI

DOB: ____________________________________________Medical Record #: ______________________________

1. DETAILED FOOT EXAM: Initially and then yearly
Date: Indicate presence (+) or absence (-) in the space below: Dorsalis pedisPosterior Ulcer (note Bony deformity/ pulse tibial pulse size if present) Callus Right Left
Indicate presence (+) or absence (-) of sensation in 5 areas using 10gm monofilament

Loss of hair/ Atropic skin

Notes:

____________________________________________ ____________________________________________ ____________________________________________ ________________________________________________________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________
Education/education materials given Provider Signature: _______________________

VISUAL INSPECTION ONLY: at every diabetes care visit 2. Date:___________
Normal Abnormal;specify_____________________________________________________

___________ Education/education materials given No referral Referral to ____________________________________________________________

_ Provider Signature: 3. Date:___________ Normal Abnormal; specify_____________________________________________________

__________ Education/education materials given No referral Referral...