138
VOLUME 10 NUMBER 4 • NOVEMBER 2013
EDUCATOR’S FOCUS
SA JOURNAL OF DIABETES & VASCULAR DISEASE
presence of HIV and CD
4
count and details of HAART, current or past
medications and allergies, and the presence of any cardiovascular dis-
eases or complications.
The height, weight, body mass index, waist circumference, and blood
pressure and pulse both sitting and lying down, and fasting or random
blood glucose tests are done on the day of examination. The presence
or absence of carotid or abdominal bruits is noted. A urine dipstix ex-
amination is done on the day of the visit to detect albuminuria, ketones,
nitrites and any other abnormality. Visual acuity and fundal examinations
are arranged.
Examination of the cardiovascular and respiratory system, feet, periph-
eral pulses, nerves, skin, injection sites and thyroid is undertaken at every
visit. Sexual health should be enquired about as it may be related to wider
vascular diseases. Dental hygiene and health should be recorded and at-
tended to. An ECG is done to exclude any ischaemia or other abnormality.
All blood tests are recorded at the six-monthly visit. Any abnormality
is acted upon, e.g. potassium, creatinine, urea, lipids, vitamin B
12
, HbA
1c,
FBC, TSH and liver function. Appointments with the ophthalmologist,
dietician, podiatrist and cardiologist are confirmed or arranged.
All current medications are listed as a record for the information of
other health professionals the patient may consult, for example the pri-
vate doctor, or the district hospital or clinic nurse. The plan of action, or
management decisions, or changes to the treatment is recorded. The
next appointment date is recorded. A copy of the record is retained in the
patient file and a copy handed to the patient for the use of other profes-
sionals he/she may consult.
The above is all contained in the diabetes service record, which is cur-
rently in use at the Edendale Diabetes Clinic (Fig. 1). This is presented as
a guide and example to achieve optimal diabetes care.
In addition to the above diabetes record, the diabetes diary, and some-
times an Accu-Chek 360 View Smartpix print out, various risk-assessment
tools are available and should be used to guide on-going management,
such as the cardiovascular, type 2 diabetes and chronic kidney disease
risk-assessment tool to assess combined risk.
18,19
Acknowledgements
I acknowledge the contributions made by Dr Faz Mahomed and Dr Rekha
Mohan from Greys Hospital, Pietermaritzburg.
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Fig. 1.
Diabetes service record.
