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Blood Glucose Monitoring by District Nurses

For those patients who are unable to monitor their own blood glucose levels, weekly blood glucose profiles are recommended i.e. pre-breakfast, pre-lunch and pre-teatime blood glucose levels recorded using medisense blood glucose meter.

As stated earlier clear parameters should be set out in a care plan for each individual. The care plan should include what action should be taken if blood glucose levels are below or above the set parameters.

Other patient may be treated with oral hypoglycaemics. The action of some of these medications can cause hypoglycaemic episodes. (Metformin is the most likely NOT to cause hypoglycaemic episodes.) Therefore it would be necessary to carry out blood glucose profiles on these patients also.

Patients who are housebound whether they have diet, tablet or insulin controlled diabetes will need regular reviews. Individual care plans can specify how often depending upon evidence of risk factors and complications.

Foot Assessments

1. The diabetic foot risk assessment guidelines should be used to categorise "risk" and determine frequency of foot assessments (usually one per year).
2. A 10mg monofilament should be used for the neurological assessment.
3. The diabetic foot screening tool can be used to document the assessment and then be filed into the patient held record or used as a referral form.

Risk Stratification for Diabetic Foot Disease

1. Low Risk Patients (refer to community chiropody only for chiropodial problems)
   • No clinical signs of peripheral vascular disease or neuropathy
   • Display none of the features listed below
2. Moderate Risk Patients (refer for regular community chiropody )
   • Clinical evidence of neuropathy [10g monofilment]
   • Absence of foot pulses
   • Presence of foot deformity
   • Visual impairment
   • Physical disability
3. High Risk Patients (refer to specialist diabetes chiropody service E.G. Foot Clinic, Diabetes Clinic, Community Chiropody)
   • Clinical evidence of neuropathy [10g monofilament] with callus
   • Presence of foot deformity with callus
   • Present or previous history of ulceration
   • Peripheral vascular disease - absent pedal pulses with history of intermittent claudication or rest pain or in combination with neuropathy
   • Previous amputation
   • Previous Charcot's Arthropathy

For patients With any of the following

• Non-healing ulcers
• Active Charcot's Arthropathy
• Deep infection
• Suspected Osteomyelitis

Arrange for URGENT REVIEW by a Specialist Chiropodist or member of the Hospital Diabetes Team A Combined Diabetes Foot Clinic is held weekly in the Diabetes Centre at Ninewells Hospital. This has input from a Diabetologist, State Registered Podiatrists and the Vascular Surgery team

Contact: Brian McMurray

Tel 01382 660111 ext. 33509

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