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How to find your way around …
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How to find your way around …
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Diabetes Awareness
Level 1 is aimed at all clinical staff.
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Objectives
The objective of this lesson is to give an overview of diabetes. Along with the
basic principles of managing the care of a person with diabetes.
At the end of this lesson you should have an understanding of:o
o
o
o
o
What diabetes is and the signs and symptoms
Medication and treatment
Nutrition and Diet
Where to find additional help / information within the Trust
Identification and treatment of hypoglycaemia
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Introduction
What is diabetes?
Diabetes is a common life-long health condition, where
the amount of glucose in your blood is too high because
the body cannot use it properly.
This is either because the pancreas does not produce
enough insulin, or because cells do not respond to the
insulin that is produced.
Insulin is the hormone produced by the pancreas that
allows glucose to enter the body’s cells, where it is used
as fuel for energy so we can work, play and generally
live our lives.
Within the UK there are over 3 million people that have
been diagnosed with diabetes with research also
estimating that there are also nearly a million people
that are unaware that they have the condition.
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Type 1 Diabetes
Type 1 diabetes often develops before the age of 40.
In type 1 diabetes, the pancreas (which is the small gland behind the stomach)
does not produce any insulin. Insulin being the hormone that regulates blood
glucose levels. If the amount of glucose in the blood is too high, it can damage the
body's organs.
If a person has type 1 diabetes, they will need to take insulin
injections for life.
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Question
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Type 1 Diabetes is treated
with…
Tablets
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Insulin
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Type 2 Diabetes
Type 2 diabetes develops when the body can still make some insulin, but not enough, or when the
insulin that is produced does not work properly (known as insulin resistance).
Type 2 diabetes usually appears in people over the age of 40, with a greater prevalence among the
Asian and Afro-Caribbean community. It is also becoming more common in children, adolescents
and young people. It my be possible to control the symptoms by altering the persons lifestyle, such
as controlling their diet and regular exercise.
Type 2 diabetes is a progressive condition, that can lead to the person requiring medication to keep
their blood glucose at normal levels. This will usually take the form of tablets, but later on it may
include injected therapies.
This type of diabetes accounts for between 85 and 95 per cent of all people with
diabetes within the UK.
Diabetes Types
In addition to Type 1 and Type 2, there are other types of diabetes. The most
common are:
o Gestational diabetes - Gestational diabetes mellitus (GDM) is a type of
diabetes that arises during pregnancy (usually during the second or third
trimester). In some women, GDM occurs because the body cannot
produce enough insulin to meet the extra needs of pregnancy.
o Steroid induced diabetes – High blood glucose levels whilst taking
steroids, which may subside once the steroids are stopped. However,
some people will develop type 2 diabetes.
We will focus on type 1 and type 2.
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Signs and Symptoms
Blurred vision
Increased thirst and
frequent urination
In Type 2 diabetes the
signs and symptoms may
not be so obvious, as the
condition develops more
slowly over a period
of time.
Feeling tired or ill
Recurrent skin, gum or bladder infections
Increased risk of fungal infections
Dry, itchy skin
Unexpected weight loss
Slow healing cuts or bruises
Loss of feeling in the feet or tingling feet
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Diagnosis of Diabetes
Diabetes is diagnosed when…
Fasting blood glucose is higher than 7.0mmol/l
or
A random plasma blood glucose is higher than 11.0mmol/l
Diabetes can also be diagnosed with an Oral Glucose Tolerance Test
or HbA1c (blood test).
The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a
protein within red blood cells, joins with glucose in the blood, becoming 'glycated'.
By measuring glycated haemoglobin (HbA1c), we are able to get an overall picture of
what our average blood sugar levels have been over a period of weeks/months.
Ref WHO.
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Question
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What range is considered as a
normal blood glucose level?
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0-5 mmol/l
4-8 mmol/l
5-9 mmol/l
5-10 mmol/l
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Treatment
Successful treatment can make all the difference to
long-term health, and achieving a balanced diabetes
treatment is key to living with all types of diabetes.
Treatment varies for each individual, and is not based
solely on the type of diabetes that they have.
Treatment of Type 1 diabetes
Type 1 treatment requires insulin with dose
adjustment to match diet and lifestyle.
Treatment of Type 2 diabetes
Treatment typically includes diet, exercise and
medication. Type 2 is a progressive condition, often
requiring insulin once lifestyle and other medications
have not achieved target blood glucose levels.
All should be offered a structured education
programme.
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Treatment
Please click on the arrows below:
Diet and lifestyle
Healthy eating, regular exercise,
alcohol intake, weight management
and smoking cessation.
Oral Medication
Examples include Metformin, Gliclazide
and Sitagliptin.
GLP1 eg. Byetta and/or insulin
Injectable Therapies
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Diet and Nutrition
Food choices that are made impact on the management of diabetes and a persons longterm health. It is recognised that there are some key messages that help in the
management of diabetes, these are:o Eat three meals a day - Avoid skipping meals and space the meals out over the day, as
this helps control the blood glucose levels
o Include starchy carbohydrate foods – such as bread, pasta, chapattis, potatoes, yam,
noodles, rice and cereals. The amount of carbohydrates are important to control the
blood glucose levels
o Cut down on fat consumed in particularly saturated fats - use unsaturated fats or oils,
especially monounsaturated fat (eg olive oil and rapeseed oil)
o Eat more fruit and vegetables - help with the overall diet
o Limit sugar and sugary foods - to reduce the sugar consumption
o Drink alcohol in moderation only
Lifestyle changes
Changes that can be made in every day life to help control diabetes
and reduce the risk of developing complications are:o
o
o
o
o
Healthy diet
Stop smoking
Losing weight and reducing waist size
Alcohol intake is within acceptable limits
Increasing physical activity
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Question
Continue
People with diabetes should
avoid eating bananas.
True
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False
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Hypoglycaemia
Some of these symptoms are more visible than others.
A ‘hypo’ (Hypoglycaemia) is triggered when blood glucose levels fall below 4
mmol/l. Common symptoms include (please click on the pictures):
SHAKING
DIZZINESS
SWEATING
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HUNGER
ANXIOUS
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Hypoglycaemia
Some of these symptoms are more visible than others.
More common symptoms include (please click on the pictures):
PALLOR
IMPAIRED
VISION
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IRRITABLE,
BEHAVIOURAL
CHANGES
WEAKNESS,
FATIGUE
FAST
HEARTBEAT
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HEADACHE
Question
Continue
Which of the following is NOT a sign
of hypoglycaemia?
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Pallor
Irritability
Thirst
Sweating
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Hypoglycaemia – what should I do?
If possible check blood glucose but do not delay in treatment.
NOTE: If your patient is semi or unconscious, DO NOT GIVE FLUID BY MOUTH.
Dial 999 immediately or contact a doctor.
TREATMENT OF HYPOGLYCAEMIA
Give a quick acting carbohydrate ie. Glucose as
90-120ml LUCOZADE
OR 3-5 GLUCOSE TABLETS eg. Dextrosol
OR 1-1½ tubes GLUCOGEL
OR 3-4 teaspoons sugar (in water or squash) NOT milk NOT food supplements
OR 150-200ml orange juice or regular coca cola
If possible, check blood glucose after 10-15 minutes. If still below 4mmol/l, repeat the above
treatment and seek medical advice.
Once symptoms have passed and blood glucose has risen above 4 mmol/l, give a small snack e.g.
biscuit, toast, cereal or if it is a meal time, give normal meal with normal insulin/tablet dose.
Note: Hypoglycaemic incidents and treatment must be recorded in the patients’ notes
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Possible Complications
Eye damage
(Retinopathy)
Vascular disease- Cardiovascular,
Cerebral, Peripheral (leading to heart
attacks, stokes and amputations)
Kidney damage
(Nephropathy) sometimes
requiring dialysis or
transplantation
Nerve damage
(Neuropathy)
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Foot Care
Foot care is incredibly important as foot related complications are common for those with
diabetes. Foot ulcers for example, which affect as many as 1 out of 10 people with diabetes,
can all to easily develop from blisters and small wounds too posing a threat of amputation.
It is recommended that:Apply
moisturiser to
keep the skin
supple
Feet are
washed daily
and are dried
carefully
Cut toe nails straight
across and file the
corners. Do not cut
down the sides or
cut too short.
Any breaks in the skin
should be covered
with a dry sterile
dressing and seek
advice from a
podiatrist.
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Look for signs
of infection,
red or swollen
areas.
Do not cut corns
or callouses,
refer to podiatry.
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Avoid walking
barefoot.
SEPT Teams
Within the Trust there are several teams that will be able to help and advise you further on
Diabetes, treatment and Trust procedures. Please log onto the intranet and search
diabetes using the search SEPT.net facility:
For team information
please click on Diabetes.
For links, click on Links for
Diabetes.
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Remember, if you want to find more information / evidence
about this subject or anything else which is relevant to your
work or study, join your local healthcare library.
For staff in Essex contact Basildon Healthcare Library.
www.btuheks.nhs.uk
[email protected]
01268 524900 EX3594
It may be that you work in a different
area,
for example Luton.
Details of all the Health Libraries in
the East of England can be found at
this site…
www.eel.nhs.uk
You are welcome to join any of these.
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Review of Objective(s)
Before completing the test, please ensure you have acquired the relevant
knowledge against the modules objective(s) below:
“The objective of this lesson is to give an overview of diabetes. Along with the
basic principles of managing the care of a person with diabetes.
At the end of this lesson you should have an understanding of:o
o
o
o
What diabetes is and the signs and symptoms
Medication and treatment
Nutrition and Diet
Where to find additional help / information within the Trust
o Identification and treatment of hypoglycaemia”
If not, please take this opportunity to revisit the presentation content.
CONTINUE
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Progression
Are you likely to advise on or administer insulin?
Yes
No
Upon completing the Level 1
test, please complete the Level 2
Diabetes Awareness course as
part of your professional
accountability.
Please complete the test for
Level 1 Diabetes Awareness.
Continue
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