Trusted diabetes support at home that improves safety, strengthens daily routines, and reduces avoidable complications through structured monitoring, patient education, and tight physician coordination.
Recent hospital or SNF discharge with diabetes-related changes
New or adjusted insulin plan, injectable meds, or complex oral regimens
History of hypoglycemia or frequent high blood sugar episodes
Poor appetite, dehydration risk, or inconsistent meal patterns
Diabetic neuropathy, reduced sensation, or high-risk feet
Current foot blister, redness, callus breakdown, or early skin concerns
Provide timely physician updates with clear glucose and symptom trends
Request and confirm orders for diabetes plan adjustments when needed
Coordinate supplies and refills to prevent gaps in monitoring
Communicate with PCP/endocrinology as indicated for escalations
Align plan with discharge instructions and medication changes
Maintain consistent handoffs with referral partners and family
➜ Skilled nurse evaluation and diabetes risk baseline
➜ Medication reconciliation with focus on insulin, sulfonylureas, steroids, and interactions
➜ Confirm monitoring plan (glucose checks / CGM use if applicable)
➜ Identify supply needs and initiate right away
➜ Establish daily routine for meds, meals, and monitoring
➜ Teach-back with patient/caregiver for insulin safety and red flags
➜ Early physician touchpoint if readings are unstable or symptoms are present
➜ Review trends and refine routine for consistency
➜ Reinforce prevention plan (hydration + foot-safe habits)
➜ Update physician and confirm next-step plan
Whether this is for you or a loved one, we’ll guide you through eligibility, timing, and what to expect, one step at a time.