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. 2015 Mar 20;9(5):1138–1142. doi: 10.1177/1932296815576532

Table 1.

Checklist for Assessing MDI/Carbohydrate Counting (CHO) Knowledge and Skills.

GLUCOSE TARGETS
___ Can state his/her HbA1c target
___ Can state his/her fasting/preprandial glucose target
___ Can state his/her postprandial glucose target
KEY CONCEPTS/PRINCIPLES OF MDI
___ Can explain the concept and rationale for MDI therapy
___ Can explain the purpose of basal insulin
___ Can explain the purpose of mealtime bolus insulin
___ Can explain the purpose of correction bolus insulin
INSULIN-TO-CARBOHYDRATE RATIO (I:CHO)
___ Can explain the purpose of his/her I:CHO for calculating a mealtime bolus dose
___ Can state his/her I:CHO
___ Can explain the calculation of and process for using his/her I:CHO to calculate a mealtime bolus dose
___ Can explain how he/she adjusts his/her I:CHO
INSULIN SENSITIVITY FACTOR (ISF)
___ Can explain the purpose of his/her ISF/Correction Factor for correcting out-of-range BG
___ Can state his/her ISF/Correction Factor
___ Can explain the calculation of and process for using his/her ISF/Correction Factor to calculate a bolus dose prior to a meal
___ Can explain the calculation of and process for using his/her ISF/Correction Factor to calculate a bolus doses to correct high BG following a meal
___ Can explain how he/she adjusts his/her ISF/Correction Factor
SAFETY
___ Can list the potential causes of hypoglycemia
___ Can list and describe his/her symptoms of hypoglycemia
___ Can explain how to prevent hypoglycemia
___ Can explain how he/she should treat hypoglycemia if it occurs
___ Can list the potential causes of hyperglycemia
___ Can list and describe his/her symptoms of hyperglycemia
___ Can explain how to prevent hyperglycemia
___ Can explain how he/she should treat hyperglycemia if it occurs
___ Can list/explain his/her instructions for managing BG during illness
CARBOHYDRATE COUNTING
___ Can explain the concept and rationale for carbohydrate counting
___ Can explain the role of carbohydrates in providing energy and nutrition
___ Can identify the foods/food groups that contain carbohydrates
___ Can identify the food groups that do not contain carbohydrates
___ Can differentiate between simple carbohydrate foods and complex carbohydrate foods
___ Can describe a well-balanced meal—carbohydrates, protein, healthy fats
___ Can accurately estimate the number of carbohydrates in common foods
___ Can state the carbohydrate content of their chosen foods
___ Can explain what happens to BG when he/she underestimates number of carbohydrates to be eaten when calculating mealtime bolus dose
___ Can explain what happens to BG when he/she overestimates number of carbohydrates to be eaten when calculating mealtime bolus dose

Source: Adapted from assessment tools used in the ABACUS trial.3