CKD Dietitian Diabetes Educator PRM - Page 1 of 3 - Metro South Health

Dietitian - Diabetes Educator consultation

Diabetes Assessment

Consent/ID checked: Yes

Registered with NDSS: Yes

Dm diagnosed <1 year Dm diagnosed: 1-5 years Dm diagnosed: 5-10 years Dm diagnosed: >10 years

CKD stage 1 CKD stage 2 CKD stage 3 CKD stage 4 CKD stage 5

Cardiac history includes HTN Hypercholesterolaemia Heart Failure AF CVA

Screened in the past 12-months by Optometrist Podiatrist Dentist

CDMP - No CDMP - Yes

The patient is SBGM at home The patient is not SBGM at home

Glucometer

The metre is <1year old The metre is 1-2 years old The metre is >2 years old they rarely test before a meal they regularly test before a meal rarely test 2hrs after a meal regularly test 2hrs after a meal and rarely wash hands with soap and water before testing and regularly wash hands with soap and water before testing

Meds impacting BGLs:

The patient is prescribed insulin The patient is not prescribed insulin

Insulin device and regimen:

Injection site on arm Injection site on leg Injection site on stomach Injection site on combination arm, leg Injection site on combination arm, stomach Injection site on combination stomach, leg was reviewed and condition appears good condition appears poor lipohypertophy is present at the RUQ LUQ RLQ LLQ lipohypertrophy was not present

Takes insulin regularly takes insulin at prescribed times correctly stores stored insulin correctly stores insulin in use insulin in-date and used within 30-days mixes mixed insulin changes needle regularly completes air shot does pinch/hold for 10 seconds

Individual BGL target range

HbA1c (%)

10% within target range 20% within target range 30% within target range 40% within target range 50% within target range 60% within target range 70% within target range 80% within target range 90% within target range 100% within target range

10% above target range 20% above target range 30% above target range 40% above target range 50% above target range 60% above target range 70% above target range 80% above target range 90% above target range 100% above target range

10% below target range 20% below target range 30% below target range 40% below target range 50% below target range 60% below target range 70% below target range 80% below target range 90% below target range 100% below target range

Hypo’s occur rarely at least daily at least weekly at least monthly and management is poor and management is adequate they usually occur in the morning they usually occur in the afternoon they usually occur in the evening they usually occur overnight and the patient is symptomatic with hypo’s and the patient is asymptomatic with hypo’s

The patient demonstrates adequate knowledge of driving responsibilities adequate knowledge of ketone testing adequate knowledge of sick day management

Nutrition Assessment

Weight (kg)

BMI (kg/m^2)

Ideal body weight (kg)

Weight history

Comparative standards

Biochemistry of note:

Ability to ID CHO foods is poor Ability to ID CHO foods is moderate Ability to ID CHO foods is adequate CHO intake is evenly distributed and is consistent daily CHO intake is evenly distributed and is variable daily CHO intake is unevenly distributed and is consistent daily CHO intake is unevenly distributed and is variable daily low GI foods rarely consumed low GI foods consumed at some meals low GI foods consumed at most meals low GI foods consumed at all meals knowledge of low GI foods is poor knowledge of low GI foods is adequate

It is estimated the patient consumes <50g CHO/day It is estimated the patient consumes 50-100g CHO/day It is estimated the patient consumes >100g CHO/day and <40g protein/day. and 40-80g protein/day. and >80g protein/day.

Minimal added salt intake is evident Moderate added salt intake is evident Excessive added salt intake is evident and knowledge of high sodium foods is poor. and knowledge of high sodium foods is adequate.

The number of standard alcohol drinks per week is 0 1 2 3 4 5 6 7 8 9 10+

PAID scale score is <40 PAID scale score is =>40 (severe diabetes distress)

Self- reported readiness for dietary change (0-10) 1 - Not at all ready 2 3 4 5 6 7 8 9 10 - High readiness

Self- reported confidence for making dietary changes (0-10) 1 - Not at all confident 2 3 4 5 6 7 8 9 10 - High confidence

Self-reported importance for dietary change (0-10) 1 - Not at all important 2 3 4 5 6 7 8 9 10 - High importance

Diagnosis: New Diagnosis: Active Diagnosis: Resolved Diagnosis: Discontinued Inadequate CHO intake Excessive CHO intake Inconsistent CHO intake Inappropriate types of CHO Inadequate physical activity Self-monitoring deficit Altered glucose values Food and nutrition related knowledge deficit Excessive protein intake Excessive sodium intake Nil nutrition issues at this time

related to food and nutrition knowledge deficit unsupported beliefs about food and nutrition lack of or limited access to healthy food choices unwillingness or disinterest to change diet food and nutrition adherence limitations psychological impact of condition impacting intake as evidenced by diet indicates excessive intake CHO intake exceeds amount recommended verbalises inaccurate or incomplete knowledge insulin management not following prescribed regimen BMI classification overweight/obese high % BGL's outside target range low confidence in making dietary changes low readiness for dietary changes considers importance of dietary change to be low

Diet prescribed reduced energy controlled protein (1g/kg IBW) no added sodium (80-100mmol/day) reduced CHO

Recommended CHO distribution

Education provided on CHO sources and portions low GI choices protein sources and portions added sodium sources and lower salt alternatives SBGM hypoglycaemia management insulin administration and storage ketone testing sick day management driving responsibilities

Dietitian review in DDE review in 2-weeks 4-weeks 6-weeks 8-weeks 12-weeks No review required

Referral to IDA service at Logan renal service with DDE dietitian only clinic at Logan renal service private dietitian in the community through CDMP phone health coaching service

To evaluate SBGM and insulin adherence glycaemia management weight (aiming for 5% LOW within 6-months) dietary intake; comparing to baseline recall and application of education readiness/motivation to change PAID scale score

Case conference discussion