Diabetes Risk Assessment (QMS-F053) DIABETES RISK ASSESSMENT (QMS-F053) Contact Document Ref: QMS-F053 (Diabetes Risk Assessment) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Safe (Mitigating Risk) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Diagnostic Baseline & ManagementDiabetes Diagnosis Type- Select -Type 1 Diabetes (Autoimmune / Insulin-dependent)Type 2 Diabetes (Metabolic)Pre-diabetes / BorderlineSteroid-induced DiabetesPrimary Method of Management- Select -Diet Controlled OnlyOral Medication (e.g., Metformin)Insulin Injections (Pre-filled pens)Insulin PumpName of Lead Diabetic Nurse / GP ContactSECTION 2 - Blood Glucose MonitoringHow are blood glucose levels monitored?- Select -Service User self-tests independentlyDistrict Nurse attends to testCare Worker assists/prompts (Requires formal competency sign-off)Continuous Glucose Monitor (CGM) sensor in placeNo routine monitoring required by GPTarget Blood Glucose Range (if known)Mandatory Scope of Practice Rule- Select -I confirm that Mutima Care staff will NOT calculate or adjust insulin doses based on blood glucose readings. Dosages must be pre-set by a medical professional or the service user.SECTION 3 - Hypoglycaemia (Low Blood Sugar) Emergency ProtocolKnown individual symptoms of Hypoglycaemia (Select all observed/reported): Sweating / Clamminess Trembling / Shaking Sudden confusion or behavioural change Pallor (Pale skin) Slurred speech Extreme tiredness / LethargyEmergency 'Hypo' Treatment Available in the Property- Select -Glucogel / DextrogelFast-acting sugary drink (e.g., pure fruit juice, non-diet cola)Glucose Tablets (e.g., Dextro Energy)Jelly babies / SweetsNone currently available (URGENT ACTION REQUIRED BEFORE CARE STARTS)Step-by-Step Emergency 'Hypo' ProtocolSECTION 4 - Secondary Complications & Foot CareSecondary Diabetic Complications Present: Diabetic Neuropathy (Loss of sensation in feet/legs) Diabetic Retinopathy (Vision impairment) Poor wound healing / History of leg ulcers Frequent infections (e.g., Thrush, UTIs) None identifiedDoes the service user require daily diabetic foot checks by Care Workers?- Select -Yes (Check for redness, broken skin, or swelling during personal care)NoMandatory Foot Care Rule- Select -I explicitly confirm that care workers are strictly forbidden from cutting the fingernails or toenails of this diabetic service user. This must be done by a registered Chiropodist/Podiatrist.SECTION 5 - Preventative Action Plan & Sign-offSpecific Instructions for Care WorkersAssessor NameDate of AssessmentSave Diabetes Assessment
