Building Competency in Diabetes Education THE ESSENTIALS

11-108 | CHAPTER 11

• Tests for changes in sensation.

• Changes in sensation represent potential risk; use 10-g monofilament for foot assessment. • Knowledge and daily self-management practices related to foot care. • Use of podiatrist/chiropodist/foot clinic services. • Sexual disturbances: These are commonly reported by both men and women with diabetes and may be associated with cardiovascular disease and/or neuropathy. This needs to be sensitively and explicitly investigated because this may be difficult for the patient to discuss.

• Foot exam. • Hand exam.

• Change

in/satisfaction with sexual functioning.

Sleep and rest This part of the assessment evaluates the individual’s concerns about sleep quality and quantity.

Data collection should include:

Rationale for including this assessment area & application to SME:

Normal sleep/wake cycle, insomnia, shift work.

• Potential diabetes-related causes of sleep disturbance: Nocturnal hypoglycemia and/or neuropathic pain. Waking feeling very unrested or in a heavy sweat may be related to nocturnal hypoglycemia. A 3:00 to 4:00 AM assessment of BG level may be useful, as would continuous glucose monitoring technology. • Shift work: The patient may need a more flexible therapy plan.

Sexuality and reproduction This part of the assessment addresses the individual’s satisfaction with his or her sexual relationship and may lead to an appropriate referral for any problems identified. Concerns raised about reproduction or satisfaction with sexuality may have multiple causes and may require the involvement of specialists for diagnosis and treatment.

Data collection should include:

Rationale for including this assessment area & application to SME: • Potential diabetes-related causes of dysfunction in both men and women (e.g. impotence, loss of vaginal lubrication, decreased libido, etc.).

• Sexual concerns in males and females (see also impotence with neuropathy);