GETTING THE MOST OUT OF YOUR CLINIC APPOINTMENT

Transcription

1 GETTING THE MOST OUT OF YOUR CLINIC APPOINTMENT In preparation for your visit to the Diabetes Clinic, we have created this checklist which will help you get the most out of your clinic appointment. Have lab work done at least 2 days before the visit. You can save time by booking an appointment online with Calgary Lab Services. If a glucose meter check has been ordered, to ensure an accurate lab to meter comparison: be sure your child has not had any carbohydrate or sugar containing foods to eat or drink for at least 2 hours before doing the test. wash the hands with soap and water and dry thoroughly before poking the finger. your child s meter is meant to be used with blood from the fingertip. (The lab technician should not offer you blood that has been obtained from the vein.) the meter test should be done right after the blood sample has been taken from the vein. if you are testing more than one meter, make sure you have a method of identifying each one. (For example: home and school meter or old and new meter.) Bring an up-to-date log book to your appointment. If you are using a meter with software, download the meter and bring a printout of recent blood sugar readings. Remember to review the blood sugars, high lighting numbers that are above and below target. Bring a list of questions including those related to insulin dose adjustments. Insulin pump users: Keep a paper record of blood sugar results for 1 to 2 weeks before your appointment. Download the pump and print reports and bring them with you. For information on what reports to print, please see Pump Software Reports ACHDC Non Pump Package 136 ACHDC 129 Your Clinic Appointment Aug 17, 2015

2 Addressograph here PATIENT CLINIC QUESTIONNAIRE (NON-PUMP) Date: Who is completing this form today? What would you like to discuss today? Family Doctor s name: Pediatrician s name: Eye doctor s name: Is he/she an optometrist? Yes No Don t Know What grade is your child in? Any allergies? If so, please describe: List all current activities in which your child participates: List all non diabetes medication, including, prescribed medications, multivitamins, herbal supplements. Medication Name/Dose and Frequency List your child s insulin dose. Meal Insulin: type/dose/insulin carb ratio if using Breakfast Describe your system for correcting high blood sugar Lunch Dinner time What are your carb goals, or carb range (if using ratios) at meals and snacks? Breakfast a.m. snack Lunch p.m. snack Supper time Insulin Always Often Sometimes Never Does your child give his/her own insulin? Is insulin given before meals? Which sites are you using? Arms Legs Buttocks Tummy Are there any lumps at your sites? No Don t Know Yes ACHDC 115 Clinic Questionnaire NP Page 1 Aug 8, 2015

3 Who is most responsible for: Shared Parent Child Nobody Preparing food? calculating carb at meals/snacks? calculating insulin dose for carb eaten? calculating correction dose for high blood sugars? What tools do you use to calculate carb content of foods? Food labels Measuring Cups Binder from diabetes clinic Other: Scales Eyeball Carb-counting books/software/apps Since your child s last diabetes clinic visit, has she/he had: No Yes a low blood sugar with confusion, loss of consciousness or seizure? any low blood sugars during sleep at night? more than 3 low blood sugars per week? any visit(s) to the hospital? high blood sugars with ketones? any illnesses (cold, flu, etc.)? to pee during the night? When would you test for ketones? During Illness When blood sugar is greater than 14 Never Yes No Don t Know Do you have up-to-date ketone testing strips? Do you have up-to-date Glucagon Kit? Do you need a prescription renewal? Always Often Sometimes Never Does your child wear a medic alert? Does your child recognize low blood sugars? Do you or your child carry low treatments? List your child s symptoms of low blood sugars. How do you treat low blood sugar? (Be specific) Does your child have: No Somewhat Yes issues with insulin injections or finger pokes? a fear of low blood sugars? concerns about body weight and/or appearance? anxiety or depression? Are there family events/issues that are impacting diabetes management? No Yes: If yes, describe: Reviewed by: ACHDC 115 Clinic Questionnaire NP Page 2 Aug 8, 2015

4 USEFUL PUMP SOFTWARE REPORTS Once you download your pump, there are many pump reports available. It can be overwhelming to know which ones to print and how to interpret them. In preparation for clinic visit, please print the following and bring to your clinic appointment. Medtronic: Carelink Reports 1. Quick Review Summary 2. Device Settings 3. Logbook Diary (last 2 weeks) 4. Trends Summary 5. Sensor Daily Overlay (if using continuous glucose monitoring) Animas & Omnipod: Diasend Reports 1. Glucose Standard Day 2. Diasend Logbook (last 2 weeks) 3. Insulin Week by Week 4. Bolus Adherence 5. Pump Settings 6. Comparison 7. Compilation ACHDC 120 Pump Software April 2015

5 Alberta Children s Hospital Diabetes Clinic 2888 Shaganappi Trail, NW Calgary, AB T3B 6A8 Fax: Dear Parent, In order to assist the Dietitian in evaluating your child s intake and to be more effective during your clinic visit, we request you provide a three day food diary indicating ACTUAL FOOD INTAKE. Prior to each Diabetes Clinic appointment, please complete the attached food diary form (see reverse side). To complete the form, please follow these instructions and the example below. 1. Record usual time of meal, carbohydrate goals, insulin/carb ratio (if used) and usual insulin dose in left-hand column. 2. Record blood glucose test results (BG) in upper left-hand boxes. 3. *Record food intake for 3 days. Specify types and amounts (weight or volume) and the carbohydrate count of all foods eaten. To record ACTUAL food intake: Indicate the amount and kind of food eaten in weight or cups using imperial or metric measurements, e.g. 50g (weight) Kellogg s Rice Krispies. Indicate preparation method, e.g. 1/2 cup boiled potatoes. Indicate butter fat content of dairy products, e.g. 1/2 cup 2% milk. If eating out - indicate restaurant and food eaten (be as specific as possible!), e.g. 1/8th of 10" thin crust Boston Pizza - pineapple, ham and cheese. Provide the recipe (including all ingredients and the yield) of homemade dishes such as casseroles or baking. 4. Record activity and multivitamins/herbal supplements taken at the bottom the page. Completing the attached food diary: The better prepared we are for your appointment, the more you will benefit from our time spent together. Please return the completed food diary before your clinic visit. If you are unable to return the log to us, please bring it in with you for your appointment. If you the food diary: In order to comply with Alberta Health Services privacy regulations, we are unable to accept any electronic ( ed) document containing a patient s name. Given this restriction, we are able to accept documents ed with an appointment date. Please type your appointment date in the to your Dietitian (see addresses below). If you mail, fax or deliver the food diary: Make sure your child s name and date of your upcoming visit is filled in. Our mailing address and fax number is shown in the top right corner of this page. You can drop off the printed diary to the reception desk at the Clinic. If you have questions, please call. Thank you for your cooperation. Kelly Grebenc-Rukavina RD, CDE Deanna Langille RD, CDE Lesley McCoy RD, CDE Julia Mercer RD, CDE Clinical Dietitian Clinical Dietitian Clinical Dietitian Clinical Dietitian Kelly.Grebenc@albert ahealthservices.ca Deanna.Langille@alb ertahealthservices.ca Lesley.McCoy@albert ahealthservices.ca Julia.Mercer@alberta healthservices.ca ACHDC 117 Food Diary Instruct July 11, 2015

6 Food Diary for: Appointment Date: (Please see instructions on how to complete this food diary.) Breakfast Time: Carb Goals DATE: Carb DATE: Carb DATE: Carb BG: BG: BG: Usual Insulin Time: Carb goals Lunch: Time: BG: BG: BG: Carb Goals Usual Insulin Time: Carb goals SUPPER Time: BG: BG: BG: Carb Goals Usual Insulin Time: Carb goals Usual Insulin BG: BG: BG: Activity: Type Time Multivitamins/Herbal supplements: ACHDC 117 Food diary Log July 11, 2015

7 INSTRUCTIONS FOR BASAL-BOLUS/PUMP BLOOD GLUCOSE LOG See the attached sample below to help you with accurate recording of blood glucose, carbohydrate and insulin doses. = blood glucose = carbohydrate Bolus+ = rapid insulin for food + correction (if needed) Basal Insulin = amount of Lantus or Levemir or pump basal profile settings When Recording: Time Record the time that a blood glucose check was done, insulin taken or carbohydrate eaten. Note: any actions occurring after midnight (24 hours) should be recorded on the actual day. Record the amount and time that was eaten Bolus You do not need to record the name or your rapid-acting insulin, only the dose. Record the name and time that a bolus was given even if you do not do a blood glucose check. See example: Tuesday at 3:30. If the blood sugar is above target, add the correction dose to the food insulin. See example Wednesday at 8 a.m., 2 units was given for a breakfast of 30 grams of extra to correct the blood sugar of 18.4 mmol/l. Basal Insulin You do not need to record basal insulin every day, unless you make changes to the dose. Record the usual time of day that Lantus or Levemir is given. Comments Record special occasions, activity or illness in this section. ACHDC 121 Blood Glucose Log Instruct May 2, 2015

8 Blood Glucose Log for Insulin Carb Ratio: Breakfast Lunch Dinner time Mon Time Tue Time Wed Time Thu Time Fri Time Sat Time Date Night Breakfast Lunch Supper Sun Time ACHDC 114 Blood Glucose Log July 13, 2015