Tayside Diabetes MCN Handbook

Caring for People with Diabetes in Long Term Care, Care Homes and in Their Own Home.

 

 

                                            

Situation

People with diabetes who are housebound or in residential home care settings, including long-stay hospital wards deserve the same quality of diabetes care as those who are able to self manage their condition.  Blood glucose control is an important part of this process to prevent acute and long term complications of diabetes.

 

Background

Self management of diabetes cannot always be achieved due to physical and/or psychological conditions. Care, including treatment, screening and monitoring must be ‘individualised’.  There can be no fixed rules applicable in all situations.  A high level of clinical judgement must be used by the multi-professional healthcare team who are looking after each individual.

 

The aim of glucose control for the older adult with diabetes is:

  • To prevent ‘osmotic’ symptoms due to hyperglycaemia, e.g. thirst, polyuria, thrush, recurrent infections. Hyperglycaemia can exacerbate other medical conditions and contribute to changes in mood and behaviour.
  • To prevent the acute complications of hypoglycaemia, and the hyperglycaemic states of diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS) in clinical situations where any of these are risks.
  • In certain cases, prevent long-term vascular complications in people whose quality of life will be adversely affected by the development of such complications.

 

For frail individuals blood glucose targets will vary according to the health status, presence of co-morbidities, and life expectancy.

 

The ‘Good Clinical Practice guidelines for Care Home Residents with Diabetes’ provides comprehensive information.

 

Assessment

 

Formal diabetes check up

Tayside Diabetes Managed Clinical Network guidance for the follow up of patients with established diabetes can be accessed through this link.

  • HbA1c measurement: a minimum of every six months and for some three-monthly HbA1c testing may be of some clinical utility in monitoring metabolic control.
  • The Diabetes UK ‘15 Healthcare Essentials Checklist’ should be used to assist individualised priorities in diabetes care
  • Individualised nutritional assessment and medication review
  • Foot screening and eye screening

 

Near patient testing

  • The frequency and need for monitoring should be agreed according to individual clinical need
  • Tight blood glucose targets should be avoided in frail or very elderly patients
  • Blood glucose target levels should be reviewed and changed in response to any changes to clinical condition.
  • Hypoglycaemia (blood glucose < 4mmol/L) is a risk in people treated with insulin and/or sulphonylurea hypoglycaemic drugs e.g. gliclazide, glipizide, glimerpiride, glibenclamide

 

 Blood glucose monitoring should be undertaken in people who are:

  • treated with insulin
  • at risk of hypoglycaemia
  • unwell, for example infection, changes in mood/levels of confusion
  • experiencing osmotic symptoms – thirst, polyuria
  • treated with steroids for example prednisolone or dexamethasone due to the risk of problematic hyperglycaemia

 

Ketone monitoring should be undertaken in all patients with diabetes during illness and more frequently in those who have Type 1 diabetes.

 

Recommendation

The following recommendations should be prerequisite for caring for a person with diabetes

  • Appropriately trained staff* (see below)                                                                                      
  • Quality controlled blood glucose meter available for near patient testing                                    
  • Ketone meter or urine strips for detection of ketones in the blood or urine during illness            
  • Hypo’ box suitably stocked with treatment for hypoglycaemia and management information  
  • Individualised diabetes management plan                                                                                    
  • Individualised record of diabetes treatment                                                                                  
  • Record of blood glucose results (for patients as above)                                                              
  • Individualised nutrition plan                                                                                                           
  • Insulin syringes                                                                                                                              
  • Sharps disposal                                                                                                                             
  • Foot screening and foot care                                                                                                        
  • Contact details for Diabetes Team for advice     

                                                                          

*Staff education and support

The Diabetes Managed Clinical Network provides educational Forum meetings in various locations across Tayside.

 

The Tayside Managed Clinical Network website has information and guidance for healthcare professionals and people with diabetes. All healthcare professionals can access the Handbook (staffnet>clinical systems>diabetes SCI-DC>handbook) for diabetes care guidelines.

 

Professional education links are also available such as:

Safe Use of Insulin

e-learning module that is designed to improve knowledge and confidence in the safer use of insulin for healthcare professionals

 

Hypoglycaemia

e-learning module that is designed to improve knowledge and confidence in the safe and effective management of hypoglycaemia

 

Trend UK set out to competency information for nursing staff involved in diabetes care and recommendations for safe insulin administration and injection technique

 

Telephone contact details for Diabetes Specialist Nurse Team

Mon – Fri 09.00 - 17.00 (24 hour answering machine)

  • Ninewells tel. 01382 496431, ext 36431 or bleep 3291
  • Perth Royal Infirmary tel. 01738 473476
  • Abbey Health Centre, Arbroath tel. 01241 447811

 

Uncontrolled when printed.  Last Update April 2013