1. Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Caring for people with diabetes Understanding diabetes, supporting the individual and planning care Module 3.2.2

2. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Presentation purpose Target audience Grade 2 nurses, aged care workers and personal care assistants Aim To provide best practice care for people with diabetes. Objectives Provide an overview of diabetes and how it affects the body. Discuss what information people with diabetes require in order to understand their condition and appropriate education strategies to provide this information. Discuss best practice care for people with diabetes. Discuss role of carers in promoting best practice care. Discuss guidelines in relation to care planning for diabetes.

3. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes Diabetes means that blood glucose in the body (often called blood sugar) is too high Glucose comes from the food we eat Glucose is transported by the blood stream to all the cells in the body. G G G G G G G G G Muscle Bloodstream

4. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes Insulin helps the glucose from food get into your cells. Insulin is a chemical (a hormone) made in a part of the body called the pancreas. PANCREAS G G G G insulin Muscle

5. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Overview of diabetes If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into cells. Glucose stays in the blood. Blood glucose levels get too high, causing diabetes. G G G G G G G G Bloodstream Muscle

6. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Common types of diabetes Type 1Type 2 Age of onsetUsually <40 yearsUsually >40 years Body weightLeanUsually obese Prone to ketoacidosis YesNo MedicationInsulin essentialTablets and /or insulin Onset of symptoms AcuteGradual (may be asymptomatic)

7. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Complications of diabetes Diabetes can cause increased risk of:  Heart Problems  Stroke  Eye sight problems  Kidney problems  Foot problems

8. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment goals Symptom free Prevent short term complications Prevent long term complications Quality of life = Lifestyle focus

9. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Cornerstones of treatment Insulin/tablets Physical activity Diet

10. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Healthy eating To help control blood glucose, blood fats and adequate body weight Healthy Eating  Regular carbohydrate  High in fibre  Low in fat (particularly saturated fat)  Low in added sugar  Adequate energy /protein/fluids/vits and mins

11. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Exercise / activity 30 minutes moderate intensity most days preferably all Helps to:  Increased insulin sensitivity  Decreased insulin requirements  Weight reduction  Lipid control  Blood pressure control

12. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Insulin and tablets Type 2 diabetes treatment may be  Healthy eating  Healthy eating + tablets (several different types of tablets may be on combination of tablets  Healthy eating + tablets + insulin  Healthy eating and insulin Type 1 diabetes always require insulin  May have long acting 1-2 times a day  Short and long acting 1-4 times a day  Continuous – insulin pump

13. Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Hypoglycaemia

14. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 What you need to know! Blood glucose level that is considered low Signs and symptoms Causes Plan of action to treat Strategies to prevent hypoglycaemia

15. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Definition of hypoglycaemia Blood glucose level below 3.5 mmol/L in people with diabetes who are treated with insulin or oral hypoglycaemic agents

16. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Symptoms excessive hunger headache profuse sweating feeling dizzy/shaking pins and needles around mouth

17. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Cognitive impairment Symptoms of cognitive impairment Lack of concentration Altered vision Peculiar behaviour Loss of consciousness

18. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Nocturnal hypoglycemia Symptoms may include:  Sweating  Vivid dreaming  Restlessness  Incontinence  Waking with a headache  High or low fasting levels

19. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Act quickly

20. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment Treat hypoglycaemia with quickly absorbed glucose (15 gm carbohydrate in total) eg.  100 ml Lucozade  150 ml lemonade  5 Jelly beans  4 Jelly babies  3 heaped teaspoons of sugar  3 glucose tablets

21. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment If symptoms have not resolved in 5-10 minutes treatment needs to be repeated. Followed up initial treatment with carbohydrate which is more slowly absorbed eg. Sandwich or fruit

22. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Never Never give food to an unconscious person

23. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment if unconscious Position in the left lateral position and withhold any food or fluids. Seek further medical help. If glucagon is available it can be administered subcutaneously, intramuscularly or intravenously.

24. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Causes of Hypoglycemia Insufficient food or delayed meal or snack Excess of insulin and some oral hypogycemic agents insulin Alcohol consumed without food or excess alcohol Extra physical activity or exercise

25. Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Hyperglycaemia

26. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 What you need to know! What is hyperglycaemia Causes Describe the main principles of the treatment Diabetic Ketoacidosis Hyperosmolar non ketotic coma

27. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Hyperglycaemia Persistent BGL over 10 mmol/L Signs and symptoms of hyperglycaemia  Polyuria  Polydipsia  Blurred vision  Weight loss  Infections, thrush  Tired

28. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Causes of Hyperglycaemia Increased weight Incorrect foods or amount of foods Forgetting or insufficient medication lack of physical activity Stress Certain medications Illness /infections

29. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Treatment Relieve symptoms Increase monitoring Identify cause treat accordingly Observe for signs of concurrent illness or infection

30. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Managing Type 2 if illness present BGLs  Monitor 2-4 hourly, record BGLs Drink 1 glass of fluid per hour  If on diet or metformin water or diet lemonade  If on sulfonylureas/insulin - diet or regular lemonade depending on BGL Contact Dr  If becoming drowsy, vomiting or dehydrated  If BGLs over 15mmol for 24 hours

31. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Fluids  Drink 1 glass of fluid per hour. Sweetened if BGL below 15mmol - unsweetened if above 15mmmol Insulin  Never omit even if not eating BGLs  Test 2-4 hrly, may require extra short acting insulin Ketones  Test for ketones if ill, BGL > 15 for 24 hours, or if vomiting Contact Dr  If becoming drowsy or dehydrated  If vomiting or ketones present Managing Type 1 if illness present