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Understanding diabetes workbook
3
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
5
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
6
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.
15
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
25
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
31
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