Anticipatory Guidance DSA (2Qs)

Question 1

glycemic targets in management (normals)

Answer 1

premeal plasma glucose (mg/dL) = <100

postprandial plasma glucose = <140

AIC = 4-6%

Question 2

recommendations for glucose monitoring in T2DM

Answer 2

check capillary glucose 1/day (fasting)

Question 3

how to use a glucometer:

Answer 3

1. wash hands w/ soap and water. Allow to dry completely. OR If you use alcohol, be sure the
   site is completely dry before sticking your finger.
2. Insert the lancet into the lancet device. Make sure the depth is set correctly (deep enough to
   obtain a sample) and the device has been cocked and is ready to use.
3. Verify the test strips are within their expiration period. Expired test strips can result in
   unreliable readings. Insert the strip into the monitor.
4. Stick the side of your finger (there are fewer nerve endings on the side, which may help
   decrease the pain associated with the test).
5. Allow the blood to wick into the strip without touching the strip.
6. Apply pressure with a cotton ball or gauze at the site of the stick to stop the bleeding.
7. Record the reading with the date and time. Take glucose readings to each appointment with
   your doctor.
8. Lancets should be disposed in a proper container, not put directly in the trash; can purchase hazard waste container from most drug stores; household generated sharps can be placed in regular trash in MO

Question 4

how often should diabetics get a foot exam and should check their own feet?

Answer 4

foot exam: annually

check feet: daily (identify open sores or risks for wounds)

Question 5

recommendations for foot care/own foot exam in diabetic pts

Answer 5

• always wear shoes and make sure they fit properly (so they dont reduce BF or increase wound development risk)
• keep feet warm and dry; if feet sweat–> foot powder + change socks frequently
• nails trimmed neatly + straight (horiz); angled nails can cause ingrown nails (pain + infection risk)
• look at all skin areas and bw toes (look for scaling or break-down of skin (maceration= sign of fungal infection)
• monitor for calluses + corns or signs of thickening (indicate footware too tight maybe)
• feet should be WARM to touch ; cool toes - problem w/ circulation
• hair over joints of toes = sign of good circulation; when circulation compromised, pts will lose hair and skin and be shinier/fragile appearing

Question 6

required components of diabetic foot exam

Answer 6

inspection (all surfaces)

pulses (dorsalis pedis or posterior tibial); if pulses not present, further assessment like more proximal pulses and anterior doppler of LE may be required

protective sensations (monofilament + vibration); make sure slight bend in monofilament

reflexes at ankle (achilles)

note: if cant feel more distal locations, continue moving more proximally until they voice sensation

Question 7

signs of hypoglycemia

Answer 7

weakness, sweating and palpitations

Question 8

other professionals in diabetic mgmt

Answer 8

podiatrist or wound care team- if wounds or complications; included in mgmt of pt

dietician or diabetic education- resource for detailed evaluation and dietary teaching

Question 9

where do foot exam findings go in the SOAP Note

Answer 9

objective portion

Question 10

where does record of home glucose readings go in the SOAP note

Answer 10

objective portion

Question 11

where does discussion about self-care get documented in SOAP note

Answer 11

Plan

also include patient education materials, name of document and site it came from