MOVING ON... WITH DIABETES ADOLESCENT KNOWLEDGE & SKILLS CHECKLIST (AGE 17-18 YRS) DIABETES EDUCATOR/TEAM USER GUIDE PURPOSE Provides adolescent self-assessment of learning needs prior to transition. Provides parent(s)/guardian(s) assessment of adolescent s learning needs prior to transition. Directs further education/skill development prior to transition INSTRUCTION Adolescent and parent(s)/guardian(s) to complete during the last year at the pediatric centre (age 17-18 yrs). Mail out prior to appointment or have completed while adolescent waiting to be seen. Review and assess actual knowledge and skill level of topic. Send copy to adult diabetes team with Transition package. Successful transition from pediatric to adult diabetes care requires the adolescent to have the knowledge, skills, and motivation to actively participate in diabetes self-management. The pediatric team members should continuously review and re-assess the knowledge and skill level of the adolescent through: Active discussion of how he/she has scored himself/herself on the checklist. Problem-solving (using their own data, situations, etc.). What the adolescent is actually doing on a day-to-day basis. It is important to verify that the adolescent is at the level he/she thinks, with regard to self-management skills, to indentify any gaps that need further education or skill development to assist with independence as he/she transitions to adult care.
MOVING ON... WITH DIABETES ADOLESCENT KNOWLEDGE & SKILLS CHECKLIST (TO BE COMPLETED BY THE ADOLESCENT AND BY THE PARENT) Use this checklist to help you evaluate your knowledge and skill level in managing your diabetes. It will help you to identify those areas where new information or a review is needed. If you have questions about any area, talk to your Diabetes Health Care Team. They are always available to help. Name: Age: Month/Year Completed: PART ONE DIABETES MANAGEMENT a) Blood Glucose Monitoring Using my blood glucose (BG) meter Taking care of my meter Comparing my meter reading with the lab result Recording my BG/uploading BG from meter Looking for patterns of high or low readings Taking appropriate action if glucose is high or low b) Insulin Management Identifying my insulin(s) name/type Stating the action/timing of my insulin(s) Using and rotating appropriate injection sites Using proper injection technique Using the following injection devices: Insulin Pen Syringes Pump Knowing what to do if my insulin pump stops working Adjusting my insulin/figuring out correction doses Uploading pump data to computer Safely disposing of my needles and sharps c) Nutrition Eating healthy meals/snacks Spacing my meals Controlling food portions Carbohydrate counting Adjusting insulin for the number of carbohydrate that I eat Making appropriate food choices when eating out (see other side)
d) Physical Activity/Exercise 2 Benefits of physical activity Effect of different types of exercise on my BG Adjusting insulin/food for extra activity Monitoring BG before, during, and after exercise and know what to do with results SHORT TERM COMPLICATIONS e) Hypoglycemia Identifying signs and symptoms of a low BG Identifying causes of a low BG Appropriately treating low BG What to carry with me to treat a low BG Why I need to wear a medic-alert ID or other identification What glucagon is used for/expiry date Dangers of driving with a low BG and how to avoid this What it means to have hypoglycemic unawareness f) Sick Day Management How often to check my BG when I am sick When to take my insulin when I am sick How to adjust my insulin and food when I am sick Why I should drink lots of water and glucose free drinks When and how to check for ketones What to do to prevent diabetic ketoacidosis (DKA) When to call my diabetes care team LONG TERM COMPLICATIONS g) Prevention and Screening Diabetes and Eye Disease (Retinopathy) for yearly eye exam (dilated pupils) Diabetes and Kidney Disease (Nephropathy) for urine testing for protein (every 6-12 months) Diabetes and Nerve Disease (Neuropathy) for yearly foot assessments Diabetes and Heart Disease and Stroke for regular blood pressure and cholesterol checks If there are things you are confused/unsure about, make a list below; talk to your Diabetes Care Team.
MOVING ON... WITH DIABETES ADOLESCENT KNOWLEDGE & SKILLS CHECKLIST (TO BE COMPLETED BY THE ADOLESCENT AND BY THE PARENT) Use this checklist to help you evaluate your knowledge and skill level in managing your diabetes. It will help you to identify those areas where new information or a review is needed. If you have questions about any area, talk to your Diabetes Health Care Team. They are always available to help. Name: Age: Month/Year Completed: PART TWO LIVING WITH DIABETES a) Lifestyle Sexual Health and Birth Control Planned Pregnancy Smoking and Diabetes Alcohol and Diabetes Drug Use and Diabetes Dating and Diabetes Travel and Diabetes Driving and Diabetes Diabetes and Eating Disorders Diabetes and Depression/Anxiety TAKING RESPONSIBILITY FOR MY HEALTH CARE b) Routine Follow-Up Making and Keeping Appointments Flu Vaccine and Other Immunizations Filling Prescriptions/Who Can Renew Prescriptions Ordering Diabetes Supplies Drug Plans and Tax Credits Insurances Contacting Other Health Care Professional/Resource People LIVING ON MY OWN c) Living On My Own Grocery Shopping Cooking/Meal Preparation University/College Life Apartment/Residence Living Finances and Budgeting Finding Reliable Diabetes Information/Resources Emergency Situation/Contact #s (see other side)
2 If there are things you are confused/unsure about, make a list below; talk to your Diabetes Care Team.