SN provided skilled dietary education related to diabetes management and a sugar-controlled diet. Baseline assessment: patient reports eating pastries and sweet breads most mornings and drinking regular soda with meals, and states she was “told to cut back on sugar, but not sure what that means.”

SN instructed patient on following a sugar-controlled diet to help maintain stable blood glucose levels. Teaching included limiting foods and beverages high in added sugars such as sweets, sugary drinks, baked goods, doughnuts, sweet rolls, and other refined carbohydrate foods. SN reviewed choosing complex carbohydrates (whole grains, beans, brown rice), increasing high-fiber foods, lean proteins, and non-starchy vegetables, and spacing meals and snacks evenly throughout the day to reduce blood glucose spikes.

Patient was educated on reading food labels for total carbohydrates, added sugars, and serving size, monitoring portion sizes, and avoiding skipping meals. SN reinforced the importance of regular blood glucose monitoring as ordered, keeping a log, and reporting symptoms of hypoglycemia (shakiness, sweating, confusion, dizziness) and hyperglycemia (increased thirst, frequent urination, blurred vision, fatigue) to the healthcare provider. Instructions given to follow provider-specific parameters for when to call the office and when to seek urgent or emergency care.

Patient was asked to:

• Name at least three foods high in sugar or refined carbohydrates to limit.
• Give examples of better choices for complex carbohydrates and non-starchy vegetables.
• Explain why regular meals and snacks are important.
• Describe two symptoms of low blood sugar and two symptoms of high blood sugar and what actions to take.

Patient correctly identified doughnuts, sweet rolls, and regular soda as foods to limit, and listed whole wheat bread, brown rice, and broccoli as healthier options. Patient verbalized that spacing meals helps “keep my sugar from going up and down too fast.” Patient was able to state two symptoms each of hypo- and hyperglycemia and when to notify the provider. Minimal cueing required.

Skilled nursing remains medically necessary to provide ongoing diabetes education, reinforce dietary changes, evaluate patient understanding using teach‑back, review blood glucose logs, and coordinate with the provider regarding glycemic control and any needed changes to the plan of care.