Wisconsin Diabetes Mellitus Essential Care Guidelines

Tools Section

The Tools Section of the Wisconsin Diabetes Mellitus Essential Care Guidelines provides useful resources for providers as well as consumers.  Information compiled here is intended to augment individual best practice guidelines by helping to inform and guide diabetes care.  These tools should be tailored using individual training, background, and clinical judgment and those using these tools are responsible for appropriate use.  (Supporting references for these tools are included at the end of each section in the Wisconsin Diabetes Mellitus Essential Care Guidelines.)

All Tools in Section

Entire Tools Section (Wisconsin Diabetes Mellitus Essential Care Guidelines 2012), 60 pages (PDF, 11.7 MB)

Tools by Section

General Recommendations for Care

• Prescription Template: Practice Prevention 1 page (PDF, 1.0 MB)
• Body Mass Index (BMI) Table for Adults 1 page (PDF, 1.0 MB)
• Growth Chart: Boys Body Mass Index-for-age Percentiles, 2 to 20 Years 1 page (PDF, 1.1 MB)
• Growth Chart: Girls Body Mass Index-for-age Percentiles, 2 to 20 Years 1 page (PDF, 1.1 MB)
• Growth Chart: Boys Weight-for-length Percentiles, Birth to 24 Months 1 page (PDF, 1.3 MB)
• Growth Chart: Girls Weight-for-length Percentiles, Birth to 24 Months 1 page (PDF, 1.2 MB)
• Waist Circumference Measurement and Risk Assessment 1 page (PDF, 1.1 MB)

Self-Management Education

• Diabetes Self-Management Behavior Goals with Graphics 1 page (PDF, 1.2 MB)
• Diabetes Self-Management Behavior Goals without Graphics 1 page (PDF, 1.1 MB)
• Follow-Up Instruction Form for a Person with Diabetes 1 page (PDF, 1.1 MB)
• Complementary Programs to Support Self-Management for People with Diabetes 1 page (PDF, 1.1 MB)
• Diabetes Self-Management Education Record 2 pages (PDF, 1.1 MB)
• Diabetes Flow Sheet/Chart Audit Tool 1 page (PDF, 1.0 MB)

Medical Nutrition Therapy

• Meal Planning with the Plate Method: Lunch/Dinner - English 1 page (PDF, 1.3 MB)
• Meal Planning with the Plate Method: Lunch/Dinner - Spanish 1 page (PDF, 1.3 MB)
• Seven Ways to Size Up Your Servings - English 1 page (PDF, 1.1 MB)
• Seven Ways to Size Up Your Servings - Spanish 1 page (PDF, 1.1 MB)
• How to Use a Food Label to Select Foods - English 1 page (PDF, 1.1 MB)
• How to Use a Food Label to Select Foods - Spanish 1 page (PDF, 1.1 MB)
• Understanding Sugar Alcohols 1 page (PDF, 1.1 MB)

Glycemic Control

• Type 2 Diabetes: Ambulatory Glycemic Control Pathway 1 page (PDF, 1.1 MB)
• Interventions/Treatment Pearls 1 page (PDF, 1.1 MB)
• Diabetes Mellitus Medications 2012 3 pages (PDF, 1.2 MB)
• Insulin Therapy 2012 1 page (PDF, 1.0 MB)
• Insulin Pearls 1 page (PDF, 1.1 MB)
• The Basal Insulin/Bolus Insulin Concept 1 page (PDF, 1.1 MB)
• Insulin Regimens 1 page (PDF, 1.1 MB)
• Diabetes Sick Days Plan 2 pages (PDF, 1.6 MB)
• Low Blood Glucose: Know the Symptoms 1 page (PDF, 1.4 MB)
• High Blood Glucose: Know the Symptoms 1 page (PDF, 1.3 MB)

Cardiovascular Care

• Tobacco Treatment Chart 1 page (PDF, 887 KB)
• Quit Tobacco Series: Plan to Quit 1 page (PDF, 946 KB)
• Quit Tobacco Series: What Happens When You Quit 1 page (PDF, 934 KB)

Kidney Care

• Screening and Initial Recommendations for Diabetic Kidney Disease Pathway 1 page (PDF, 1.0 MB)
• Chronic Kidney Disease: DVD Order Form 1 page (PDF, 952 KB)

Eye Care

• Dilated Retinal Eye Exam Communication Form 1 page (PDF, 883 KB)
• Eye DVD Order Form 1 page (PDF, 917 KB)

Neuropathies and Foot Care

• Diabetic Foot Ulceration 1 page (PDF, 901 KB)
• Diabetic Foot Infection 1 page (PDF, 901 KB)
• Charcot Foot 1 page (PDF, 901 KB)
• Annual Comprehensive Diabetes Foot Exam Form 1 page (PDF, 1.4 MB)
• Diabetic Foot Screen for Loss of Protective Sensation 1 page (PDF, 1.3 MB)
• Shoes and Socks Off Poster - English 1 page (PDF, 1.1 MB)
• Shoes and Socks Off Poster - Spanish 1 page (PDF, 1.1 MB)

Oral Care

• Medical-Dental: Team Referral Form 1 page (PDF, 922 KB)
• Diabetes: Screening Tools for Inspection of Gums and Teeth 1 page (PDF, 987 KB)

Emotional and Sexual Health Care

• Patient Health Questionnaire (PHQ-9) 1 page (PDF, 895 KB)
• PHQ-9 Quick Depression Assessment - Instructions for Use 1 page (PDF, 880 KB)

Preconception, Pregnancy, and Postpartum Care

• It's Never Too Early to Prevent Type 2 Diabetes 1 page (PDF, 1.4 MB)
• They Grow Up in the Blink of an Eye 1 page (PDF, 1.2 MB)

Assessing Risk and Prevention of Type 2 Diabetes

• Assessing Risk and Testing for Type 2 Diabetes Pathway 16 pages (PDF, 1.0 MB)
• American Diabetes Association Diabetes Risk Test 1 page (PDF, 905 KB)
• 50 Tips to Prevent Type 2 Diabetes 2 pages (PDF, 2.3 MB)

All Diabetes Prevention and Control Program resources are copyright-free. Please duplicate and distribute as many copies of these materials as you desire.

PDF: The free Adobe Reader^® software is needed to view and print portable document format (PDF) files. Learn more

Last Revised: March 07, 2013