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Diabetes Education Class Referral

Please select up to one of each class type and complete the form to register.
Form may be submitted by the patient or their pcp.
Class descriptions and locations can be found below the form.

A PDF Version of this form is available here.

Class 1 & 2

No Current Classes

Class 3 & 4

No Current Classes

Pre-Diabetes

No Current Classes

Support Group

No Current Classes

Patient
XX/XX/XXXX
PCP
HbA1c

Please fax most recent lab results to 760-477-2924.

Educational Content

Class 1

Introductions
Questions/Topics Requested by Group
The Team Approach: Who's in Charge of Your Diabetes?
"Dispelling Diabetes Myths" Game and Prizes
Understanding Diabetes: An Overview
Monitoring Blood Sugar - Your Tool For Discovery
"Don't change a thing!" –Test, Experiment, and Learn at Home

Class 2

Gaining Insights from Last Week's Records
How Different Foods Affect Blood Sugar
Plate Model and "Carb Counting" for Blood Sugar Control
Reading Food Labels
Meal Planning Interactive Activities – Meal and Snack Ideas
Continue to Test, Experiment, and Learn at Home

Class 3

Gaining Insights from Last Week's Records
Reducing Risk of Complications: The "ABCs" of Diabetes/Standards of Care
Diabetes Medications-Group Activity
Benefits of Physical Activity and Stress Management: Developing a Plan
Continue to Test, Experiment and Learn at Home

Class 4

Gaining Insights from Last Week's Records
Jeopardy Game and Prizes: High and Low Blood Sugars, Sick Days
Foot Care and Foot Exams Per Request
Securing Ongoing Support
Setting Goals for the Future


Advanced Diabetes Supply (ADS)- Class Room
2544 Campbell Place, Suite 155
Carlsbad, CA 92009

Google Map

Patients Please Bring:
Support Person (Optional If Preferred)
Snack(s) (Optional If Preferred)
Meter/Logbook (If You Have One)