Diabetes is a world health issue with 4.9 million people in the UK diagnosed and a further 850,000 who may have type 2 diabetes and not know it. By 2030, it could be the 7th leading causes of deaths according to the WHO.
Once diagnosed, patients typically only spend 3 hrs per year with a health professional. 8757 hours they manage their diabetes themselves. So, how can we make the best use of that time and to help patients manage their diabetes in a way that’s meaningful for them and their health goals?
Following a #NurChat discussion on the topic of beating diabetes and World Health Day 2016, here are some of the essential things every student nurse should know about diabetes and supporting patients.
What is diabetes?
Diabetes occurs when either the pancreas produces no insulin or the insulin that is present is insufficient or not working correctly.
The most well-known forms of diabetes are type 1 (T1) and type 2 (T2), however there are others:
Gestational diabetes
Maturity onset diabetes of the young (MODY)
Neonatal diabetes
Wolfram Syndrome
Alström Syndrome
About 10% of adults with diabetes have T1, and 90% have T2.
Patients with diabetes will usually need insulin and / or medication combined with a healthy lifestyle and exercise routine. In some cases, healthy lifestyle choices and exercise can be enough to manage the condition, but as it progresses this may be less effective without medication.
What are the potential complications from diabetes?
Short or long term complications as a result of diabetes are varied and personal to the individual. Everything from short term low blood sugar (hypoglycaemia or ‘hypo’) to long term tissue damage to organs, eyes, skin, feet and nerves can occur.
Short term: hypoglycaemia (low blood sugar), urinary tract infections, diabetic ketoacidosis (DKA) and hyperglycaemia (high blood sugar).
Long term: retinopathy, nephropathy, problems with feet, cardio vascular diseases, circulation issues and neuropathy.
Regular short-term episodes can lead to frequent hospital admissions, causing distress to the individual and their family. Their quality of life may be reduced, they may lose earnings through not being able to work, which could in turn affect their quality of life and mental health.
Longer term conditions may affect a person’s ability to live independently and therefore their wellbeing. They may have co-morbidities that require support from a range of specialists and therefore attend hospital on a regular basis, which can be stressful and cause frustration.
What are the routine checks for potential diabetic complications?
Some patients may not need monitoring at all, for others blood glucose monitoring is a frequent occurrence. Regular checks with a health professional are essential to minimise the instances of diabetic complications.
Some of the routine checks suggested during the #NurChat include:
Urine testing
Blood glucose monitoring
HbA1c test
Blood pressure (hypertension)
C-peptide test (if newly diagnosed)
Cholesterol (Lipids)
Annual retinopathy check (age 12yrs+)
It’s also important to consider the wellbeing of the individual and asses how well they are managing their diabetes. Discuss anything that’s changed in their lives that may affect their ability to
It’s especially important that people who have diabetes have the opportunity to work with a healthcare professional to select the treatments they receive and the equipment they use. Not all tools will work for everyone, and not every lifestyle change be universally applied.
Create a personalised management plan designed to help the individual achieve their goals, including:
Empower patients by helping them make their own choices about their treatment
Promote regular check-ups to create an easy path to professional support
Encourage healthy eating and regular exercise by discussing the person’s own preferences in both areas
Ask what they would find helpful to achieve their goals
Signpost local support groups and online peer networks where they may be able to get additional support.
Acknowledge the expert knowledge of the patient about their own condition
Making use of technology
Maintaining engagement with patients is crucial to effective ongoing management and technology can really help here.
Digital communication tools such as email, text, skype and even phone calls can help as much as face to face appointments. This approach will be especially effective for the younger generation, who may be less likely to attend appointments when most of their information needs can be met online.
Monitoring apps that record blood glucose levels and blood pressure may become more common place in the future. The data could be fed directly to a patient’s healthcare professional, who can remotely monitor their health through these key indicators.
In one hospital, #Nurchat hear that a pilot e-assessment scheme to screen all new admissions for diabetes was currently in place. It allows the diabetes team to identify and prioritise patients more easily. There are also plans to introduce auto bleeping to highlight abnormalities.
