The diabetes safety checklist contains questions to ask patients and actions to take (ideally at the beginning of each appointment). Any safety topic could trump the patient’s primary agenda item or reason for referral. Please refer to your program’s policies and procedures for relevant and current procedures.
Reviewing a safety checklist helps patient safety and educator comfort. We've all had clients that ask, "Can I tell you one more thing?" just before leaving, and learn it is a safety concern that should have been dealt with at the start of the appointment. It also assists with rapport building as it expresses that educators care about their patients' safety needs.
Assessing safety items helps with:
- Identification of safety concerns that patients may not volunteer
- Time-management of priorities in the appointment
- Patient education on self-triage for safety at home
Diabetes Safety Checklist Topics
Related Pages:
- Hypo and Hyperglycemia Troubleshooting
- Hypoglycemia (more detail) - in development
- Diabetic Ketoacidosis (DKA) - in development
- Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - in development
Psychosocial Emergency
Psychosocial: What to ask | Psychosocial: What to do |
What, if anything, is getting in the way of you taking care of your health? For some people it is finances, stress or depression - or review PHQ. | Call Calgary Distress Centre 403-266-4357 if client verbalizes intent to act on suicidal thoughts. |
Hypoglycemia
Hypoglycemia: What to ask | Hypo: What to do |
Insulin dose error with too much rapid insulin:
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You can ask the patient to call PADIS (1-800-332-1414 Alberta) immediately; they will work through this with the patient or the educator can follow their program's protocol for insulin dose errors which may include:
See your program's full policy or refer the patient to PADIS (Poisin and Drug Information Centre 1-800-332-1414 for Alberta) |
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What symptoms do you have if your blood sugar is < 4.0 mmol/L? | If hypo-unaware review:
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Have you had a low you could not treat by yourself? | Discuss use of glucagon in clients with type 1 diabetes and review glucagon handout. Investigate frequency, causes and preventative measures and assess for hypoglycemia unawareness. Chart “severe” hypoglycemia only if client was unable to treat episode by him/herself. |
How do you treat your low blood sugars? |
Review Hypoglycemia symptoms / treatment handout. If CGM indicates extended period of hypoglycemia requiring repeat treatments, advise test fingerstick blood glucose. Repeated treatments may not be needed and may result in hyperglycemia. Some educators recommended fingerstick verification for all low CGM readings to rule out false lows. |
Hypo: if on CGM:
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Hyperglycemia (DKA, HHNS)
DKA/Hyper: What to ask | DKA/Hyper: What to do |
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DKA can result in death. Review appropriate handouts:
ADVISE EMERGENCY SERVICES IF: DKA suspected: nausea, vomiting, abdominal pain, rapid deep labored breathing, confusion and dehydration (dry mouth, cracked lips, decreased skin turgor, dark urine). Contacting physician as required. HHNS suspected: type 2 diabetes with blood sugars > 25.0 mmol/L and is physically unwell, dehydrated, hypotensive and confused with an altered state of consciousness as HHNS may be considered (hyperosmolar hyperglycemic non-ketotic state). This is extremely rare. |
Are you on an SGLT-2 inhibitor? | Regardless of blood glucose level, send to emergency if on SGLT-2 inhibitor with symptoms of DKA (nausea, vomiting, abdominal pain, rapid deep labored breathing, confusion, dehydration e.g. dry mouth and cracked lips, decreased skin turgor, dark urine). |
If on Insulin Pump:
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Review and provide:
Summary of DKA prevention in pump therapy:
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Hyper: If on CGM:
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Pregnancy
Pregnancy Planning: What to ask | Pregnancy Planning: What to do |
Are you planning pregnancy? | Refer to diabetes in pregnancy clinic for preconception care. Review importance of preconception glycemic control to reduce risk of fetal malformation or loss. Discuss with MD regarding any medications contraindicated in pregnancy that may need discontinuing. Advise daily folic acid for at least three months prior conception |
Are you using birth control? Ask all women of child bearing years. |
Do not assume the patient is using reliable birth control. Discuss importance of contraception: hyperglycemia in early pregnancy increases risk of stillbirth and fetal malformation and can worsen diabetes complications in the mother. Discuss role of metformin and insulin sensitizers in increasing fertility. Emphasize importance of adequate contraception. |
Pregnancy: What to ask | Pregnancy: What to do |
Are you pregnant or could you be pregnanct? Ask all women of child bearing years. |
Do not assume the patient will tell you she is pregnant. Ask about last menstrual period. If pregnant, refer the patient to a Diabetes in Pregnancy Clinic. If pregnant, discuss with the MD an order to discontinue the following: (Refer to Diabetes Centre Calgary DIP document "Guidelines for discontinuing medications during pregnancy and preconception" or your program's procedures)
Advise start 1 mg folic acid daily. |
Blood Pressure in Pregnancy:
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Check BP according to Diabetes Centre Calgary protocol
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Hypoglycemia in pregnancy:
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If decreasing insulin requirements in 3rd trimester are not explained by usual causes and/or decreased fetal movement, suspect placental insufficiency. Refer to Diabetes Centre Calgary DIP Policy on ‘Decreasing insulin requirements'. |
Hyperglycemia in pregnancy:
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Obstetrical concerns:
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Signs of Vascular Events
Vascular Safety: What to ask | Vascular Safety: What to do |
Have you had trouble speaking; understanding; seeing; walking; sudden numbness; sudden weakness of face, arm or leg; dizziness; loss of balance; sudden severe unexplained headaches or any other unusual symptoms especially when blood sugars were not less than 4 mmol/L? |
Assist client in seeking emergency care if symptoms currently present. If no current symptoms, advise client discuss with MD. Communicate with MD. Discuss risk of stroke and MI and advise to seek urgent care if symptoms return. (Investigate if hypoglycemia is the cause of any symptoms.) |
Foot Wounds
Foot Wounds: What to ask | Foot Wounds: What to do |
Do you have wounds or cuts to your feet or legs? |
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Related Safety Concerns
Related Concerns: What to ask | Related Concerns: What to do |
Are triglycerides (TG) 6 mmol/L or greater? | If TG 15.0 mmol/L or greater advise urgent referral to endocrinologist. For TG > 6 counsel regarding risk for pancreatitis. Advise client seek emergency care if develops symptoms of pancreatitis (abdominal pain or nausea that is worse after eating, swollen or tender belly). Counsel to avoid alcohol, fatty foods and large carbohydrate portions including juice and regular pop. Refer to a dietitian. . |
Blood pressure: Is systolic blood pressure 200 or greater? Is diastolic blood pressure 130 or greater? | Discuss plan with referring physician or family doctor, or send to urgent care/emergency. |