Designed front page to insert

Understanding diabetes workbook

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Contents

Guidance on how to complete this workbook 4

Aims and learning outcomes 5

Understanding diabetes

What is diabetes? 6

Common signs and symptoms 7

Types of diabetes 9

Causes of diabetes 11

Aims of treatment 11

Treatment 12

Dietary information 14

Complications of diabetes 17

Preventative measures 21

Is treatment working? 23

Role of carer 24

Dealing with emergencies 25

Diabetes national service framework 26

Care planning in diabetes 27

Further information 27

Exercises 29

Links to NVQ in Health and Social Care 31

References 32

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Guidance on how to complete this workbook

This booklet has been developed specifically for those members of

staff who will be working with service users who have been

diagnosed with diabetes; however it may also be used to increase

your general knowledge within this specific area.

If you require any advice or feel you need to discuss the content or

any of the workbook exercises, please speak to your line manager.

It is expected that this workbook will take approximately 2 hours to

complete.

The workbook includes information, and opportunities for

reflection. There are some exercises at the end of the workbook to

ensure learning has taken place. Upon completion of the

workbook, the confirmation page at the back must be signed by

you and your manager, and sent to the Learning and Development

Team, Adults Wellbeing and Health, County Hall, Durham.

- This sign can be seen throughout the workbook and indicates

important information for you to consider

- This sign can be seen throughout the workbook and indicates that you

need to consider ideas / provides an opportunity for reflection

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Aims and expected Learning Outcomes

The aim of this workbook is to provide:

An understanding of the term “diabetes”

A basic holistic understanding of some effects diabetes has upon daily activities

Learning outcomes: upon completion of this workbook you should:

Understand the term diabetes Recognise the common signs and symptoms of diabetes

Be aware of the different types of diabetes

Be aware of the aims of treatment

Recognise some complications associated with diabetes

Know and understand the limitations within your job role

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Understanding diabetes

What is Diabetes?

Diabetes Mellitus is a lifelong condition, characterised by the

body’s inability to control blood glucose levels within the

recognised normal range.

Although there is currently no definite cure for diabetes, there are

many treatment options available to safely manage the

condition.

Diabetes can occur at any age. When someone has diabetes, this

can increase the risk of developing other conditions, such as heart

disease. When it is effectively managed, people with diabetes can

lead an active, healthy life, and can reduce the risk of serious

complications and significantly improve the quality of a person’s

life.

According to the NHS Choices website over 2 million people in

England are living with diabetes; with many undiagnosed cases.

Diabetes UK report that since 1996 the number of people

diagnosed with diabetes has increased from 1.4 million to 2.9

million. By 2025 it is estimated that five million people will have

diabetes. It is estimated that most of these cases will be Type 2

diabetes, because of our ageing population and rapidly rising

numbers of overweight and obese people.

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In 2009, around five per cent of total NHS spending was used for

the care of people with diabetes. According to NHS Choices, a UK

study reported that the annual NHS cost of the direct treatment of

diabetes in the UK will increase from £9.8 billion in 2012, to £16.9

billion over the next 25 years. The predicted rise would equate to

the NHS spending 17% of its entire budget on the condition, up

from about the current 10%

Common signs and symptoms

The symptoms of all types of diabetes are very similar; however

type 1 diabetes usually develops very suddenly. General

symptoms for diabetes include;

Tiredness

As glucose is unable to move from the blood

stream into the cells of the muscle and brain,

energy supplies are in short supply resulting in

lethargy and tiredness

Frequent urination

As the blood passes through the kidneys, glucose is filtered out

into the urine (glycosuria). During this process a lot of fluid is also

filtered out of the body resulting in the person passing large

quantities of urine, which is known as Polyuria.

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Thirsty

High amounts of glucose in the urine can cause increased urine

output and lead to dehydration. This causes increased thirst and

water consumption.

Weight loss

In severe cases insulin deficiency eventually

leads to weight loss and muscle wastage.

Thrush

Urine which contains lots of glucose creates an environment for

bacteria to thrive, often resulting in thrush.

Blurred vision

Glucose can build up in the lens at the front of the eye altering its

shape which may result in blurred vision.

Slow healing wounds

Blood contains high levels of glucose therefore bacteria can breed

in flesh wounds making them slow to heal.

Frequent reoccurring infections

Glucose is attracted to protein and sticks to it. The white blood

cells that fight infections are made of protein and therefore if the

blood glucose levels are raised the glucose attaches itself to the

white blood cells and slows their action, making them less effective

at fighting infection.

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All of the above symptoms are signs that the body is not able to

balance its glucose levels. However it is also important to

remember that these symptoms may be due to other

conditions.

If a person you are caring for shows any of the above symptoms

that are listed it is important to encourage the individual to seek

professional medical guidance from a general practitioner

who may arrange for urine and blood tests to be carried out,

in order to provide a correct diagnosis.

Early diagnosis reduces the risk of developing complications. If left

undiagnosed, diabetes can lead to eye disease, kidney disease

and heart disease.

Consider what actions you would take if you noticed that a

service user you care for was showing a number of the above

symptoms

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

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Types of Diabetes

There are several different types of diabetes, for the purpose of this workbook we have concentrated on the commonest and most frequently seen. Type 1 Diabetes This occurs when the body is unable to produce any insulin at all. Insulin is a hormone released by the pancreas to help control levels of glucose in the blood. When no insulin is produced, this is due to the insulin producing cells of the pancreas being destroyed. Although it can occur at any age, this normally develops in people

under the age of 40

People with type 1 diabetes need

injections of insulin every day and

also need to eat a healthy diet.

Insulin is vital to maintain life and

has a major role in the management

of diabetes. Insulin can be given by

either a syringe, insulin pen or insulin pump. The most common

insulin regimens are two injections a day of mixed insulin or four

injections a day (three fast acting and one long acting insulin). This

does vary from person to person. If a service user with diabetes is

unable to self inject then a district nurse may do this. You should

never inject insulin for a service user.

Staff need to be extra vigilant when service users are using

needles, in order to avoid needle stick injuries.

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As well as using insulin injections this condition can be managed

with diet and physical activities. Remember, each person is

different, and you will need to refer to individual care plans for

guidance.

Type 2 Diabetes This occurs when the pancreas does not produce sufficient insulin

to control the blood glucose levels, or when the insulin that is

produced by the pancreas is not used properly. It is the most

common type of diabetes, and according to NHS Choices, it

accounts for around 90% of cases.

The symptoms of type 2 diabetes usually develop slowly and many

people live undiagnosed for several months or years without

knowing they have the condition. Unfortunately by the time they

are diagnosed many people have diabetic complications.

Some people wrongly describe type 2 diabetes as the mild form of

diabetes. This is not true. There is no such thing as mild diabetes.

People with type 2 diabetes may be treated with:

Diet and exercise Tablets Insulin injections Weight loss injections known as GLP1’s

Gestational Diabetes

Some pregnant women have high levels of glucose in their blood

because their bodies do not produce enough insulin to meet the

extra demands of pregnancy.

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Between 2% and 12% of pregnant women develop diabetes during

pregnancy. It usually disappears once

the baby is born.

Women with gestational diabetes are

more at risk of developing type 2

diabetes later in life.

According to NHS Choices website you are more likely to develop

type 2 diabetes if you have a relative with this condition, if you are

overweight or obese, if you take little physical exercise, or are over

the age of 40.

Why is it important to know what type of diabetes someone has? _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________

Causes of diabetes

There are a number of possible causes for diabetes including:

Drug related; particularly long term or high doses of steroids

Pancreatic disease, Inflammation, cancer and surgery

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Endocrine system disease, Cushing’s syndrome Auto immune disease Lifestyle factors

Aims of treatment

Once someone is diagnosed with diabetes it is important that they

receive sufficient support and information about the condition in

order to understand how it can be managed. Self management is

essential. This means that an individual takes control of what they

eat, having a healthy diet as well as physical activity.

The first aim should be to relieve the symptoms. As the glucose

level falls the symptoms will decrease.

It is important to try and achieve a near normal blood glucose

level. The target range should be 4-7 mmol/l before meals and

9mmol/l or less 2hours after meals; however some individuals’

blood glucose ranges will vary. This is meant to be a guide so that

you know what is ‘normal’. It is therefore essential that you refer to

individual care plans and where necessary keep accurate records

of blood glucose levels.

Where needed, the individual healthcare professional will

recommend times to check blood glucose levels in order to identify

at what points in the day the service users blood glucose levels are

rising and falling.

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In order to reduce the risk of short term complications, and avoid

high (hyperglycaemia) or low (hypoglycaemia) glucose levels in

the blood, carers need to be aware of the symptoms, treatment

and prevention of this condition.

Having control of diabetes can reduce the risk of diabetic

complications i.e. eyes (retinopathy), kidneys (nephropathy),

nerves (neuropathy) and heart/major organs (cardiovascular

disease).

It is important for people with diabetes to have regular check ups

to ensure the diabetes is under control. This should include regular

foot and eye checks. The service users Doctor/nurse will advise on

how regular these checks should be.

People with diabetes should aim to

achieve a near normal blood

pressure. Although the target range

for blood pressure is to be less than

140/80 individual ranges will vary.

It is also important to improve general

health and well-being. The importance

of following the suggested treatment plan, monitoring the diabetes

and following a healthy lifestyle can improve health and well being.

However the person with diabetes, and you as their carer, need

sufficient information to do this.

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Treatment

Treatment will vary between individuals, however it ultimately

depends upon getting the right balance of food, exercise and

treatment.

There are different treatments available and these will vary

between individuals.

Treatment for Type 1 diabetes

When someone has type 1 diabetes they will need regular insulin

injections, to keep their glucose levels normal. All people with Type

1 diabetes require treatment with insulin therapy. Insulin for this

group of individuals is their lifeline. Type 1 diabetes is a life

threatening condition without insulin therapy. Insulin therapy in

people with Type 1 diabetes must never be stopped.

Balancing insulin, diet and physical activity controls Type 1

diabetes.

The specific insulin used will vary from person to person and will

Food

Exercise

Treatment Blood glucose Levels

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depend on which insulin regimens are used. Insulin regimens use

short / rapid acting insulin to stimulate normal mealtime insulin

levels, and long acting insulin to provide a background

concentration of insulin.

If a person is treated with insulin, regular meals are especially

important. Food should be given within specified timescales of the

insulin injection (Refer to individual assessment plans for details of

timescales). If for any reason a meal is delayed check for signs

and symptoms of low blood glucose (hypoglycaemia).

Treatment options for Type 2 Diabetes The management of Type 2 Diabetes has several treatment

stages. If diagnosis has been delayed, the person with diabetes

may progress through the stages very quickly.

The aim of Type 2 Diabetes

management is to reduce the body’s

resistance to insulin and preserve the

insulin producing cells of the pancreas.

Diet and physical activity are important

factors in management of Type 2

Diabetes. Losing weight, if necessary

and increasing exercise/activity will make insulin work better as

this reduces insulin resistance.

The aim with this treatment option is to promote weight loss if over

weight, and to reduce insulin resistance, which is linked to obesity

and physical inactivity. The general recommendations in relation

to physical activity are to aim for 30 minutes per day 5 days per

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week. However any physical activity is better than none, as this

improves the body’s sensitivity to insulin.

There are several different types of glucose lowering medicines

used to treat type 2 diabetes. Medication to reduce the blood

glucose level may be required if adequate control cannot be

achieved or maintained with diet and exercise alone.

In some cases of type 2 diabetes, it may also be necessary to treat

the condition by insulin therapy (injection).

Insulin is required at the stage where failure of the insulin

producing cells become so severe that the individual is unable to

produce sufficient insulin.

Dietary information

What a person eats affects their diabetes. Choosing a healthy diet

helps to control blood glucose levels.

It is important that a person with diabetes eats a normal balanced

diet with a wide variety of different foods. The preferred diet

recommended in diabetes is one, is high in fibre rich, starchy foods

(such as cereals, fruit, potato, rice, pasta, beans, peas and

vegetables) and low in fat, salt and sugar.

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Regular meals of starchy foods help

to maintain a balanced blood

glucose level. For those

individuals on certain medication,

missing meals or snacks, or not

eating the starchy part of the meal may lead to too low blood

sugar.

It is suggested that people who need assistance to monitor their

food intake are given the appropriate help to do so. If this is

relevant to any of the service users you are supporting, you will

need to discuss this with your line manager.

If the starchy part of the meal or a snack is missed, an alternative

should be offered as soon as possible to prevent a hypoglycaemic

attack. If a person is having regular hypoglycaemic attacks a

Doctor and dietician should be contacted for further advice.

How to eat more fibre

Have more fruit based desserts and

snacks; e.g. crumbles made with

oat flakes

Encourage a whole grain and high

fibre breakfast cereal such as porridge or bran flakes, and

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wholegrain bread

It is recommended to have at least 6-8 medium cups of fluid in

order to prevent bowel problems; this could include water, tea,

coffee, and sugar free squash.

Solid foods, especially fruit and vegetables are another essential

source of fluid. It is also important to note that more fluid may be

needed when carrying out physical activity or during hot weather.

Adding sugar to food and drinks should be avoided. The aim is to

reduce foods high in sugar, this can be achieved by:

Use of artificial sweeteners instead of sugars

Diet or sugar free fizzy drinks

Low sugar or reduced sugar jams

Diet yoghurts instead of low fat yoghurts which are high in

sugar

It is also important to remember that some food such as fruit

contain natural sugars. Therefore it is important to monitor each

individual and their dietary requirements.

It is advised that people with diabetes eat less fried and fatty foods

Encourage fruit based desserts and snacks

Encourage low fat snacks

Use less butter or margarine

Eat fewer crisps, meat pies, pastries, biscuits and fried foods

Use skimmed or semi-skimmed milk in drinks, in cooking and

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on cereals.

Eat oily fish containing omega 3 at twice a week (not fried)

Reduce the amount of salt, for example do not use salt when

cooking and use salt sparingly on meals. It is also advisable not to

use ‘lo salt’ alternatives as they may contain additives.

It is recommended that any alcohol should be taken in moderation,

e.g. ½ pint of beer or lager, 1 glass of wine, 1 single measure of

spirit. Please refer to individual plans for further guidance, as this

will vary from person to person. Starchy food or a snack should be

eaten if an excessive amount of alcohol is drunk in order to

prevent hypoglycaemia in those on glucose lowering drugs (e.g. a

sandwich before bed). Remember each

individual is different, for some people alcohol

may not be suitable at all. Always refer to care

plans for details.

‘Diabetic foods’ are available; however there is

no need to use special ‘diabetic’ foods. Many foods sold as

suitable for people with diabetes are high in fat and some products

can cause diarrhoea.

Eating for a special occasion, e.g. a birthday is an opportunity to

choose something different. An occasional treat should not affect

diabetes control, if managed appropriately.

Diabetes U.K. recommends that all people with diabetes should

have access to a state registered dietician for specific individual

advice. The dietician can also offer advice to care staff and

catering staff.

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Complications of Diabetes

Early treatment and effective management will reduce the risk of

serious diabetes complications. Not all people will develop

complications.

Hypoglycaemia (Low blood glucose) is an acute situation (happens

quickly) if the person with diabetes has not had enough starchy

food, too much medication, unplanned exercise or excessive

alcohol.

Low blood sugar is often caused by:

Missed or late meals

Not enough food

Too much insulin or tablets

More activity than usual e.g. additional exercise

Too much alcohol

Hot weather

Some common symptoms, which a person may experience, are:

Shakes or tremor

Palpitations

Sweating

Hunger

Mood change

Poor co-ordination

Blurred vision

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Fast pulse

Recommended treatments for hypoglycaemia are given in 2 stages First stage (Fast acting):

glucose tablets x 3 or a small glass of Lucozade or Fizzy drink such as lemonade/coke or Fresh orange juice

Second stage, a starchy snack (Long acting):

2 plain biscuits or A piece of fruit i.e banana or A sandwich or Next meal if this is due

If no action is taken then the person may become confused, have

slurred speech, experience seizures and may even lapse into a

coma. If they become unconscious do not give anything by mouth

and ensure medical assistance is sought immediately.

To prevent a hypoglycaemic attack happening the person should

take regular meals, correct medication, eat extra starchy food,

participate in planned physical activity and moderate their alcohol

intake.

Hyperglycaemia (High blood glucose) occurs when the blood

glucose level rises above 11 mmols and is usually present when a

person is newly diagnosed with diabetes, poorly controlled or

unwell.

The signs and symptoms of hyperglycaemia and why they occur are:

Excessive thirst due to the body trying to dilute the high

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concentration of glucose in the blood Frequent passing of urine to eliminate un-required glucose

linked with thirst Tiredness, due to reduced amounts of insulin which allows

glucose to be turned into energy Weight loss due to fat being broken down to produce energy Infections such as frequent occurrence of thrush

Some of the causes of hyperglycaemia include:

Too much food (try to eat a balanced diet)

Not enough medication (ensure dosage correct)

Illness (seek medical help)

Not enough exercise (exercise in moderation)

Some of the long term complications of diabetes: Coronary Heart Disease is much more common among people

with diabetes and is the main cause of death (up to 50% in Type 2

diabetes). Tight diabetic control reduces the risk of Coronary

Heart Disease.

People with diabetes should be

encouraged to stop smoking.

Stroke is more frequent in people with

diabetes, and vascular dementia is also relatively common.

Neuropathy is damage to the small nerves in the feet and legs

caused by high glucose levels, which eventually leads to

numbness. Normally nerves pick up all kinds of stimuli, such as

pain, temperature and pressure. If the nerves become damaged,

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the person with diabetes may be unaware of these stimuli and

injuries can occur without their knowledge. The person with

neuropathy may complain of a variety of symptoms including pins

and needles, burning, coldness, numbness of varying degrees or

increased sensitivity in the feet so that even the weight of the

bedclothes on the feet is too much to bear. The symptoms are

usually worse at night and can sometimes be relieved by pacing

the floor. Symptoms of neuropathy may be present right from the

onset of the diabetes and may, in fact, be the first presenting

feature. Any person experiencing symptoms like these, but who is

not known to have diabetes should be checked for the condition.

Retinopathy occurs when degenerative changes take place in the

retinal blood vessels, leading to loss of vision. Retinopathy can be

treated by laser therapy. Diabetes is the leading cause of

blindness in the working population. All individuals with diabetes

should have their eyes examined for evidence of diabetic

retinopathy every year. This is not done as part of the routine eye

check at the opticians.

Nephropathy is disease of the kidney. Raised blood pressure

accelerates the development of nephropathy (test for protein in the

urine).

Renal disease is more common in individuals with Type 1 diabetes

with 20% - 40% of these developing some degree of renal failure.

Diabetic nephropathy accounts for 25% of the people who develop

end-stage renal failure each year.

Erectile dysfunction (Impotence) may have physical or

psychological causes or a mixture of the two. Diabetes can cause

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damage to the blood supply to the penis and to the nerves which

control an erection.

Ischaemia is another condition which may occur. It refers to poor

blood supply to the feet and legs. If the blood supply is not

sufficient, injuries will not heal, sores may develop and the person

is less likely to be able to fight infections.

The ischaemic foot will be pale and may have a waxy feel to the

skin. There will be little or no hair growth on the lower legs and

toes. The skin will be cold to the touch and the person may

complain of aching in the legs, even at rest. The symptoms, like

those of neuropathy, can be worse at night and the person will

often dangle the legs out of the bed to relieve the pain.

Infection is a further complication of neuropathy and ischaemia.

The presence of neuropathy allows the infection to take hold

before the person is aware of the problem due to their inability to

feel pain. If the person has ischaemia they are less likely to be

able to fight the infection because of the insufficient blood supply

and the infection will spread quickly.

Signs of infection in the foot are redness, heat, and inflammation

with or without discharge of pus. Don’t forget the ‘smell test’! An

infected wound has a distinct and unpleasant odour. Any areas like

this need URGENT medical attention.

A podiatrist plays an important role in caring for people with

diabetes. Every person with diabetes should see a State

Registered Podiatrist/Chiropodist once a year. As well as being

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able to provide treatment to nails, corns and callus, the podiatrist

will assess the feet and check for any signs of nerve damage or

poor blood supply. This will help to identify people most at risk

from developing problems later on, and enable the podiatrist to

work out a treatment plan for that person to prevent the risk of

complications.

Preventative Measures

There are a number of Government initiatives, which aim to

improve the general health and well being of people.

Five-a-day programme - introduced in order to increase the

consumption of fruit and vegetables.

Sport programmes - a number of initiatives are taking place

within leisure centres and local communities in order to

encourage people to become active

How do you think the five-a-day programme will help people

with diabetes?

__________________________________________________________________________________________________________

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_______________________________________________________________________________________________________________________________________________________________ Other preventative actions include:

Discouraging service users from walking around on bare

feet, even on carpeted areas.

The wearing of slippers should be avoided; the person

should be encouraged to wear a well fitting shoe. The shoe

should be long enough, broad enough and deep enough to

prevent pressure on the toes and borders of the foot. The

shoe should fasten with a high lace or strap to prevent the

foot moving around inside the shoe.

The use of hot water bottles and electric blankets should be

discouraged as these can cause severe burns if the feet are

numb or the blood supply is poor.

Any corns or areas of hard skin on the feet should be treated

regularly by a state registered podiatrist because if it

becomes too thick, the underlying tissue can be damaged

and ulcers can develop.

People who are mobile should be encouraged to take at

least a few steps on a regular basis to keep the circulation

going. People, who are able to be mobile with assistance,

should be encouraged to move/turn to prevent pressure

sores.

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Remember if you notice anything unusual on the feet;

report it immediately in order to encourage the person

to seek professional help.

Daily foot Care is essential. Encourage service users to wash

their feet in warm water every day. Be careful to check the

temperature of the water carefully with a thermometer. You must

refer to individual care plans for details of the required

temperature.

Guidelines for bath water temperature are 37ºC - 44ºC, and

shower is 37ºC – 41ºC, however this is specific to the individual.

You must follow the individual’s risk assessment

Encourage service users to dry well between the toes, being

careful not to pull the toes apart too much as this can cause

ulcers to develop

Check shoes and slippers for foreign bodies by shaking the

shoe to remove loose objects; check the soles of the shoes

and run your hand around the inside of the shoe to check the

inner sole and upper of the leather for rough areas.

Danger signs Remember that the earlier problems are identified, the more

successful the treatment is likely to be. The person or carer should

be encouraged to take a few moments to do these daily checks

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and this may be enough to prevent the person suffering serious

Complications.

Check for:

Swelling in the foot or part of the foot.

Colour change. This includes speckles of red/brown in hard

skin. This may be the first sign of an ulcer under the skin.

Also look for red/blue patches on the foot; any area that

looks unusually pale or dark; rashes or bruises should also

be reported.

Pain or throbbing in the foot. This may be due to infection,

poor blood supply or injury.

Sores, splits, cut on the skin or blisters. These are always

potential areas for bacteria to enter the foot and cause

infections.

Any area of discharge from the foot of pus, blood or fluid.

Corns calluses and nail problems should be attended to by

the podiatrist on a regular basis.

Is treatment working?

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Monitor your service user

Are they free from symptoms?

Are they content?

Are they losing weight?

Are there any skin changes?

Are they getting things mixed up

more?

All people on insulin should self monitor blood glucose levels. In

general terms we should aim for levels between 4 and 10 mmol/l

Less than 4 mmol/l = Low

4 - 10 mmol/l = Ideal

Over 10 mmol/l = High

To monitor blood glucose levels the service user should be

provided with a blood glucose meter. This is a device used to

analyse the amount of glucose from a small sample of blood,

normally obtained from a finger, which is placed on a disposable

testing strip, and then inserted into the meter.

There are several meters available, with different designs and

functions. For example some meters have a large display screen

which may be more suitable for people with poor eyesight. It is

important to select an appropriate meter which is easy to use. You

also need to ensure that the person using the blood glucose meter

knows how to use the device correctly, and that it is in full working

order.

A venous blood test is the most accurate method for measuring

blood glucose, and should be carried out every 3-6 months, or at

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least once per year. This test shows how well diabetes control has

been over a 3 month period. This will be carried out by a health

professional.

Role of the carer

Many people with diabetes will need some form of emotional and

psychological support to be able to tackle the challenges this

presents and to care for themselves effectively from day to day.

Each person with diabetes should be treated as an individual. This

is in-line with person centred planning. The service users wishes

should be considered and always respected. All information

regarding the person with diabetes must be confidential (unless

the health of the individual is at risk, then you must let the person

know that you need to inform your line manager). Carers are in an

ideal position to monitor the person with diabetes’ general health,

whilst enabling the person to carry out daily living activities.

Observe physical and mental state whilst, for example moving.

Remember, monitoring the service users general health and

well-being is essential. Carers must report their concerns to their

line manager immediately.

It is important that all carers must be aware of the limitations of

their role.

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Staff must adhere to Good Practice Guidelines/Health

and Safety Guidelines

Staff must not be tempted to carry out tasks for which

they have not been trained e.g. that of a podiatrist or

dietician.

It is dangerous to exceed capabilities

Dealing with Emergencies

Staff must be aware of the procedure to summon medical help in an emergency. Any suspicion that a person may be going either hypoglycaemic or hyperglycaemic must be treated as a medical emergency. Call 999 All service users will have risk assessments in place, some of these will indicate that glucose should be given orally in an emergency situation. Please ensure you have read, understood the instructions and then signed the appropriate documentation. Report quickly to your line manager if the person with diabetes is

ill, has an infection or their general condition changes. Medical

assistance should be obtained in the following cases:

Vomiting and unable to hold down fluids

Abdominal pain

Breath smells of acetone (pear drops)

Self monitoring shows “HI” reading

These are signs and symptoms of a medical emergency known as

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ketoacidosis

No matter how well people manage their diabetes, diabetic

emergencies can still occur. It is important that service users have

access to the right support and treatment in order to minimise the

chance of these emergencies happening. Severe acute

hypoglycaemia and diabetic ketoacidosis (DKA) are the most

common diabetic emergencies.

Diabetes national service framework

The 12 standards of the Diabetes National Service Framework

(NSF) cover all aspects of diabetic care and prevention.

The standards were published in 2001, setting out the first set of

national standards for the treatment of diabetes. See below for an

outline of each standard.

Standard one:

The NHS will develop, implement and monitor strategies to reduce

the risk of developing type two diabetes in the population as a

whole and to reduce the inequalities in the risk of developing type

two diabetes.

Standard two:

The NHS will develop, implement and monitor strategies to identify

people who do not know they have diabetes.

Standard three:

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All children, young people and adults with diabetes will receive a

service which encourages partnership in decision-making,

supports them in managing their diabetes and helps them to adopt

and maintain a healthy lifestyle. This will be reflected in an agreed

and shared care plan in an appropriate format and language.

Where appropriate, parents and carers should be fully engaged in

this process.

Standard four:

All adults with diabetes will receive high-quality care throughout

their lifetime, including support to optimise the control of their blood

glucose, blood pressure and other risk factors for developing the

complications of diabetes.

Standard five and six relate directly to children and young people.

Standard seven: The NHS will develop, implement and monitor

agreed protocols for rapid and effective treatment of diabetic

emergencies by appropriately trained healthcare professionals.

Protocols will include the management of acute complications and

procedures to minimise the risk of recurrence.

Standard eight: All children, young people and adults with

diabetes admitted to hospital, for whatever reason, will receive

effective care of their diabetes. Wherever possible, they will

continue to be involved in decisions concerning the management

of their diabetes.

Standard nine: The NHS will develop, implement and monitor

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policies that seek to empower and support women with

pre-existing diabetes and those who develop diabetes during

pregnancy to optimise the outcomes of their pregnancy.

Standard ten: All young people and adults with diabetes will

receive regular surveillance for the long-term complications of

diabetes.

Standard eleven: The NHS will develop, implement and monitor

agreed protocols and systems of care to ensure that all people

who develop long-term complications of diabetes receive timely,

appropriate and effective investigation and treatment to reduce

their risk of disability and premature death.

Standard twelve: All people with diabetes requiring multi agency

support will receive integrated health and social care.

Care Planning in diabetes

Care planning can be defined as a process offering service users

active involvement in agreeing how their diabetes will be managed.

It aims to assist those with diabetes to achieve optimum health

through a multi agency approach with health professionals. When

agreeing the care plan it is important that the service user and all

other people involved raise and discuss their respective concerns,

prioritise these, and explore options available to make informed

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decisions about ongoing care. Care planning should take place in

a relaxed environment with a flexible and responsive approach.

Care planning is one of the key interventions required to achieve

standard 3 of the diabetes National Service Framework.

The diabetes National Service Framework states:

“A care plan is at the heart of a partnership approach to care and a

central part of effective care management. The process of

agreeing a care plan offers people active involvement in deciding,

agreeing and owning how their diabetes will be managed.”

The White Paper, Our Health, Our care, Our say, sets a direction

for the whole health and social care system. The aim being that

services will be designed around the individual, rather than the

needs of the person being fit around the service already provided.

During the care planning process, the following areas may be

discussed:

Learning about diabetes

Managing diabetes

Living with diabetes

Other health and social issues

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Further information

Useful Contacts Local help line 01325 488606 (diabetes team)

Exercises

These questions are to be completed after you have read the workbook and finished the short questions throughout this workbook. 1. What is diabetes?

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2. How many ‘types’ of diabetes are there?

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3. What do you understand by the term “Type 1 diabetes”?

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4. What do you understand by the term “Type 2 diabetes”?

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5. What is your role when working with a service-user who has diabetes?

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6. Why is it important for someone with diabetes to have their

feet checked?

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7. Complete the sentences using the words below:

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____________ is used to monitor blood glucose levels ______________ can be defined as a process offering service users active involvement in agreeing how their diabetes will be managed

8. Gestational diabetes only affects women Please circle your response

True False

Links to NOS in Health and Social Care

This workbook can be linked to the following knowledge requirements for Level 2 and 3 in Health and Social Care. It cannot be used as evidence but will help to provide a basis for underpinning knowledge HSC25 - Knowledge: 2, 3, 7, 8, 9 HSC26 - Knowledge: 2, 6, 7, 11 HSC27 - Knowledge: 2, 5, 6, 7, 9, 11, 12 HSC213 - Knowledge: 7, 8, 9 HSC224 - Knowledge: 8, 9, 10 HSC328 - Knowledge: 4 HSC3112 - Knowledge: 2, 3, 21, 22

Care Planning Blood glucosemeter

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References Department of health and Diabetes UK care planning working group Department of Health National Service Framework for diabetes: delivery strategy Department of Health Five years on – delivering the diabetes National Service Framework Diabetes Mellitus presentation: Kenvyn Murray Diabetes facilitator / nurse practitioner Darlington PCT Diabetes UK Care planning in diabetes Report from the joint Department of Health and Diabetes UK care planning working group

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In order to ensure up to date information was provided for this workbook information was taken from the following websites: http://www.diabetes.org.uk/Professionals/Publications-reports-and-resources/Reports-statistics-and-case-studies/Reports/Diabetes-in-the-UK-2012/ http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs-cases-rising.aspx

http://openlearn.open.ac.uk www.dh.gov.uk/en/healthcare/diabetes/index.htm www.diabetes.org.uk www.medicinenet.com/diabetes_mellitus www.nhs.uk/pathways/diabetes

Understanding diabetes workbook