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Fulfilling lives

Fulfilling lives. Delivering Clinical Excellence Toolbox Talk Diabetes. Be informed . Be aware . Let’s give excellent care!. Michael Redman Clinical Quality Manager June 2011.

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Fulfilling lives

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  1. Fulfilling lives Delivering Clinical Excellence Toolbox Talk Diabetes Be informed . Be aware . Let’s give excellent care! Michael Redman Clinical Quality Manager June 2011

  2. Diabetes:… chronically raised blood glucose concentration, caused by an absolute or relative lack of the hormone insulin or there is insufficient insulin or insulin action for the body’s needs” Type 1 Sudden Onset Severe symptoms Recent weight loss Usually lean Ketotic Type 2 Gradual Onset May be no symptoms Often no weight loss Usually obese Non ketotic

  3. WHAT IS DIABETES? “ … a condition in which there is a chronically raised blood glucose concentration. It is caused by an absolute or relative lack of the hormone insulin or there is insufficient insulin or insulin action for the body’s needs” (Williams, Pickup 2003) CATEGORIES OF DIABETES Type 1  Type 2  Other e.g. Gestational Type 1 Sudden Onset Severe symptoms Recent weight loss Usually lean Ketotic Type 2 Gradual Onset May be no symptoms Often no weight loss Usually obese Non ketotic

  4. How does insulin work? If no/ insufficient insulin is produced by the body ........ Understand how each treatment works as blood glucose monitoring will depend on this!

  5. WHAT IS INSULIN? • A hormone produced by the pancreas that allows glucose to enter the body’s cells where it is used for energy • Absence of Insulin means this glucose is not absorbed and complications develop • DIABETES – TREATMENTS • Oral Medication or insulin Injections • Oral Medication – Examples • Metformin, Glipizide, Glicazide, Pioglitazone • Insulin – Examples • Lantus, Novorapid, Actrapid, Insulatard • Understand how each treatment works as blood glucose monitoring will depend on this!

  6. Too little sugar ( or too much insulin) HYPOGLYCAEMIA

  7. Hypoglycaemia (too little sugar) • ( Less than 4mmol) • Sweating/Palpitation • Shaking/tremor/light headiness/ weakness • Hunger / Feeling Hot/ Anxious • Can lead to confusion, drowsiness, coma • Usually blood glucose less than 4. • Hypoglycaemia management • Rapid acting glucose such as Lucozade or Cola or any other sugary drink • Follow up with substantial snack or meal • Contact emergency services if not responding as further treatment may be necessary • Increase blood glucose monitoring based to assess effectiveness of treatment

  8. Too much sugar ( or not enough insulin) HYPERGLYCAEMIA

  9. Hyperglycaemia (too much sugar) • Blood glucose continually higher than normal for the individual • Excessive thirst • Excessive urine output • Rapid weight loss • Drowsiness and confusion • Breath smells of “pear drops” • May be less apparent than hypoglycaemia • This can cause long-term complications such as blindness if not treated • Seek medical advice and increase blood glucose monitoring as advised or appropriate. • Hyperglycaemia can lead to Ketoacidosis for Type 1. This is a life threatening condition which needs urgent treatment. Diagnosis of this is based on signs and symptoms as opposed to specific blood sugar readings.

  10. DIABETES – WHAT TO EAT  People with Diabetes can eat a well balanced diet and do not have to be restricted to a “diabetic” diet  Diabetic foods are costly, have a high carbohydrate content and produce a laxative effect  However – Check out individual resident preferences as they may have been living with this condition for several years. BLOOD GLUCOSE MONITORING  This is where blood is taken from a finger and then it is tested with a special machine to see how much sugar is in the blood at that time This type of testing needs to be done for a purpose and should not be done routinely or because it is a certain day of the week Testing will need to link with the how the Diabetes is being treated. There is little need to do this type of testing for someone who is not on any diabetes medication Testing will need to be increased if a resident with Diabetes is unwell Think about why you are testing and what you are going to do with the results! WHAT TO DO IF A RESIDENT WITH DIABETES IS UNWELL It is important that someone with diabetes continues to receive their prescribed medication  Discuss with the doctor or diabetes nurse specialist about what to do regarding the dosage of medication. Some dosages may need to be adjusted during the illness period  Increase blood glucose testing and fluid intake as advised or appropriate Do not make a decision yourself not to administer medication! Management of a diabetic

  11. S – Signs and Symptoms U – Understand the treatment effects G – Glucose monitoring for a reason A – able to eat healthily R – Record keeping accurately

  12. S – Signs and Symptoms U – Understand the treatment effects G – Glucose monitoring for a reason A – able to eat healthily R – Record keeping accurately

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