Home Health Training
Admin
10.2 Common Diagnoses

Diabetes

Blood glucose monitoring requirements, insulin teaching and safety, hypoglycemia, and the foot check nobody should skip.

Updated Sep 18, 2026

Most diabetic patients on our service are here because something changed — a new diagnosis, a new insulin regimen, an infection, a wound that will not heal, or an admission for hyper- or hypoglycemia. The skilled work is nearly always teaching, and the outcome depends on whether the monitoring is genuinely in place.

Blood glucose monitoring is required

Every diabetic patient has blood glucose monitoring in place. For patients on insulin, this is not optional.

At every visit, confirm all of it:

  • Monitoring is happening at the ordered frequency and timing
  • Readings are written down with date and time — a log, not memory
  • The meter works, the strips are in date, and there are enough lancets
  • Patient or caregiver can state their target range
  • Patient can state what a low feels like and exactly what to do about it
  • The technique is correct — watch them do it, do not ask whether they can

Review the readings for a pattern, not just today's number. Consistent morning highs, post-meal spikes, or 3am lows each point somewhere different, and that pattern is what the physician needs.

A patient on insulin with no working meter, expired strips, or no record of readings is a problem to solve that visit. It is not a note for next time.

Insulin

Check every visit

  • Correct dose drawn — watch them draw it
  • Correct insulin, when there is more than one in the house. Long-acting and rapid-acting mixed up is a life-threatening error and a common one.
  • Correct timing relative to meals
  • Site rotation — look at the sites; lipohypertrophy is easy to feel and easy to miss
  • Storage — in-use pens and vials at room temperature per the product, spares refrigerated, nothing frozen, nothing left in a hot car
  • Expiry, including how long the vial or pen has been open
  • Sharps disposal in an approved container

Teaching that holds

  • Return demonstration, not description. Chart that it was successful before discharge.
  • Use their own supplies, in their own kitchen, at their own light level
  • If vision or dexterity is a barrier, say so and solve it — pen devices, magnifiers, pre-drawn doses, or an OT referral
  • Teach a caregiver too wherever there is one

Hypoglycemia

The emergency that actually happens in the home.

Signs: shakiness, sweating, confusion, irritability, hunger, dizziness, palpitations, slurred speech, drowsiness. In an older adult it often presents as confusion alone, and gets mistaken for dementia.

Conscious and able to swallow — the 15/15 rule:

  1. 15 g fast-acting carbohydrate — 4 oz juice, 4 oz regular soda, glucose tablets
  2. Recheck in 15 minutes
  3. Repeat if still below target
  4. Then a complex carbohydrate with protein to hold it

Unconscious or unable to swallow: nothing by mouth, call 911, glucagon if available and ordered.

Afterwards, find the cause — a missed meal, a dose error, new exercise, alcohol, a changed medication — and notify the physician. A hypoglycemic episode with no cause identified will happen again.

Make sure fast-acting carbohydrate is kept where the patient will be, not in a cupboard across the house. See Emergencies in the Home.

Hyperglycemia and sick days

Teach the sick-day rules before they are needed:

  • Do not stop insulin because they are not eating — illness raises glucose
  • Check glucose more often
  • Keep taking fluids
  • Check ketones if that is part of their regimen
  • Call for persistent high readings, vomiting, or inability to keep fluids down

Signs of DKA or a hyperosmolar state — deep rapid breathing, fruity breath, severe dehydration, altered mental status — are a 911 call.

Feet, every visit

The check that gets skipped and should not be.

  • Inspect both feet, including between the toes and the soles — take the socks off
  • Skin integrity, colour, temperature
  • Any break in the skin, however small
  • Nails — and never cut them if there is neuropathy or vascular disease; that is podiatry
  • Footwear — what they actually wear indoors, which is often nothing
  • Protective sensation, per your assessment tools

Teach: daily self-inspection with a mirror if needed, never barefoot, check shoes before putting them on, lukewarm water only, moisturise but not between the toes, and report any break in the skin the same day.

A diabetic foot ulcer starts as something the patient did not notice. Note that it is not staged — see Wound Etiology and Pressure Injury Staging.

Medication and coordination

  • Reconcile at every visit; diabetic regimens change often
  • Watch for medications that mask hypoglycemia, and for steroids, which will send glucose up
  • Know who adjusts the insulin — PCP or endocrinology — and route changes to the right one
  • Get abnormal results to the ordering physician the day they arrive — see Labs, Specimens, and Results Follow-Up

When to call

  • Glucose below the ordered threshold, or any episode requiring treatment
  • Persistent readings above the ordered threshold
  • Any new break in the skin on the foot
  • Signs of infection anywhere
  • Vomiting, or inability to keep fluids down
  • New confusion