Building Competency in Diabetes Education THE ESSENTIALS

SELF-MANAGEMENT EDUCATION & SUPPORT: PROGRAM DEVELOPMENT| 11-107

specialist and for continued efforts to normalize BG levels; the need for a change in diet; or lactose intolerance. • They may also lead to vitamin or mineral deficiency or dehydration. • Frequent urinary tract infections may be an indication of hyperglycemia and the need to target BG control. • Nocturia: May indicate poor BG control overnight. • Test for random urinary albumin to creatinine ratio (ACR) (prepubertal children need not be screened) and for overall kidney function through an eGFR. If the ACR ratio is significantly elevated (>2.0 mg/mmol), it may indicate very early nephropathy that is potentially reversible with improved glycemia and hypertension control. Nephropathy is confirmed in those with microalbuminuria when two of three ACRs are positive, over 3 months (Canadian Diabetes Association 2018 clinical practice guidelines, Chronic Kidney Disease in Diabetes S201) (8).

• Diarrhea,

constipation, bloating. • Urinary tract infection. • Nocturia.

Renal function: • Creatinine, blood urea nitrogen and random urine ACR test results. • History of urinary tract infection.

ACR = albumin-to-creatinine ratio; eGFR = estimated glomerular filtration rate

Sensory perception This part of the assessment is concerned with the special senses: vision, hearing, sensation/neuropathy and pain.

Data collection should include:

Rationale for including this assessment area & application to SME:

• Frequency of visits to check vision and hearing. • Last visit to ophthalmologist and findings. • Episodes of blurred vision.

• Visual assessment and appropriate follow-up: Serious vision loss can be delayed or prevented. • Hearing assessment: Assess if hearing loss affects diabetes management and learning. • Awareness of need for specialist eye exams (difference between optician, optometrist and ophthalmologist). • Awareness of complications risk and status: Awareness of what eye diseases actually are; an explanation of cataracts, glaucoma and retinopathy may be needed. • Feelings/coping related to complications: Fear of blindness is often one of the greatest underlying and unspoken fears.