Building Competency in Diabetes Education THE ESSENTIALS

11-106 | CHAPTER 11

• Changes in food or medication intake before, during and/or after exercise. Activity tolerance: • Pain with activity or shortness of breath. • Cardiovascular health, including cardiac stress test. • Pulmonary function/problems (shortness of breath and/or wheezing). • Presence of eye complications. Musculoskeletal and mobility assessment: • Adequacy of joint mobility, weight-bearing ability, problems with balance and sensory deficits. • Foot problems. • Assessment of complications related to neuropathy that may lead to injury during activity.

• Knowledge of hypoglycemia prevention: Inclusion of food snacks for unplanned or prolonged activity or reduction of insulin. • Exercise modification, if required; may necessitate limitations in activity type and intensity. • Cardiac stress test: Recommended for persons >35 years of age. Is the patient aware of risk and this recommendation? • Assessment of orthostatic hypotension, fixed pulse rate. • Post-menopausal state: Women with diabetes have even greater risk of coronary artery disease post-menopause. • Diseases that affect the safety of changes in activity without adequate assessment or education, such as hypertension, angina, history of infarction or congestive heart failure, cardiomyopathy, atherosclerosis and claudication.

• Safety issues. • Loss of sensation.

• Minor foot irritations caused by exercise. • Presence of deformity (e.g. Charcot’s foot). • Need for referral to podiatry or chiropody.

Elimination This part of the assessment addresses the pattern of bowel and urinary elimination, including frequency and amount.

Data collection should include:

Rationale for including this assessment area & application to SME:

Pattern of elimination:

• Problems with urinary or bowel elimination: These can seriously affect quality of life for the patient involved. They may indicate the presence of significant autonomic neuropathy; the need for referral to a diabetes