When patients with diabetes require home health care, it presents a unique opportunity for home health professionals to assess the patient’s self-management routine. Using the cornerstones of diabetes management (meal planning, exercise, medication and blood glucose monitoring), we can establish a plan of care to evaluate the current care, recommend modifications, teach new skills and update the patient’s knowledge and skills.

One of the most important steps in managing diabetes is following a daily meal plan. This healthy meal plan can keep blood sugars in target range, help reduce weight if needed and improve heart health for the patient. Begin with a history of what times the patient eats and what they really eat (including the good, the bad and the ugly). From this information we can begin formulating the meal plan. Having the patient show you that they have measuring cups and tools to measure their portions makes teaching portions easier. Patients can be taught to avoid the “Jethro" bowl for more appropriate, smaller-sized bowls and plates. Teaching label reading has more impact when you use the loaf of bread from the kitchen table, canned goods from their cabinet or that piece of fruit from the bowl on the countertop. Many surprise discoveries provide teachable moments – such as showing the patient the sodium content on their soup or package of Ramen noodles that has been pushing their sodium limit over the edge. Other details may surface such as the lack of certain foods or over abundance of inappropriate foods. When approached in nonjudgmental fashion, patients more readily share their true food habits and behaviors.

Testing blood sugars is one of the most valuable tools that patients and providers have in their arsenal to attain glycemic control. Proper testing requires both a functional meter and a patient or caregiver trained to perform the test. Watching the patient actually perform the test can often reveal any problems. It also allows health professionals to help the patient develop the techniques to successfully perform the test. Teaching patients target blood sugars and what to do with values out of target can prevent unnecessary problems. Patients need to know the appropriate actions for blood sugars under target (hypoglycemia) and identify sources of quick acting carbohydrates that are readily available in their home. Prevention of these problems can be a focus for teaching. Taking medications appropriately and avoiding skipped or delayed meals often prevents the problem. By helping patients and their caregivers prevent problems or respond appropriately to diabetes emergencies, catastrophes can be prevented. Even patients who are unable to record blood sugars can perform the test. With the correct date and time set on a patient’s meter, the staff can access the memory on their blood sugar record and communicate these values to the patient’s physician.

Medication management is also an important part of diabetes care. Careful review of what medications the patient is actually taking, at what times and with what regularity is essential. If the patient has stopped taking a medication because of “problems” such as excessive gas or diarrhea, this can be addressed with their physician. Many times, checking prefilled medication boxes filled by the patient or caregiver can reveal dramatic inaccuracies such as duplications. Actually observing how the patient measures and injects their insulin or other diabetes injectable medications can ensure better outcomes. If the patient is unable to see the exact dosage, low vision resources can be mobilized.

Foot care and footwear are also critical elements in the plan of care for most patients with diabetes. On home visits, the staff will see what footwear is actually used daily. Are patients wearing their special diabetic therapeutic shoes or going barefoot or in flip-flops? Having the patient demonstrate how they perform their daily foot inspection may reveal that the patient cannot actually visualize all surfaces of their feet or cannot apply any special lotion or even see their own feet. If these problems exist, special equipment or training may be helpful.

Diabetes management of the patient receiving home care can reveal many interesting and surprising problems and solutions. Teaching in this setting can be one of the best educational opportunities a home health professional will ever encounter. The result will be improved diabetic care, control and compliance.