Learning Guide. Diabetes Support a person with diabetes in a health or wellbeing setting. Name: Workplace: Issue 1.0

Transcription

1 Learning Guide Diabetes Support a person with diabetes in a health or wellbeing setting Level 3 3 credits Name: Workplace: Issue 1.0

2 Copyright 2017 Careerforce All rights reserved. Careerforce (Community Support Services ITO Ltd) is the owner of the copyright of this publication. Other than as permitted by the Copyright Act 1994, no part of this publication may be reproduced, copied or transmitted in any other form or by any means, without prior written permission of Careerforce, PO Box , Christchurch, 8144, New Zealand.

3 Contents Introduction... 1 What is diabetes?... 2 How common is diabetes?... 3 Type 1 diabetes... 3 Type 2 diabetes... 3 Gestational diabetes and pregnancy... 4 What can cause diabetes?... 5 How might diabetes affect a person?... 6 Health and functional status... 6 Signs, symptoms and complications... 6 Damage to nerves (neuropathy)... 7 Damage to blood vessels (vascular disease)... 7 Eye damage... 7 Diabetic kidney disease... 7 Bladder infections... 8 Foot problems... 8 Atherosclerosis and skin problems... 9 Gum, Mouth and Teeth Problems... 9 Thyroid issues... 9 Vaginal infections... 9 Hypoglycaemia (Low Blood Sugar) The impact of diabetes Supporting a person with diabetes Illness and diabetes What to look out for: Signs of dehydration or bladder infection Reporting and monitoring Glossary Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July 2015

4 Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July 2015

5 Introduction This learning guide is about supporting people who have diabetes. How to use your learning guide This guide supports your learning and prepares you for the unit standard assessment. The activities and scenarios should be used as a general guide for learning. This guide relates to the following unit standard: Support a person with diabetes in a health or wellbeing setting (level 3, 3 credits). This guide is yours to keep. Make it your own by writing notes that help you remember things, or where you need to find more information. Follow the tips in the notes column. You may use highlight pens to show important information and ideas, and think about how this information applies to your work. You might find it helpful to talk to colleagues or your supervisor. Finish this learning guide before you start on the assessment. What you will learn This topic will help you to: understand what diabetes is and what causes it understand how diabetes may impact a person s life support a person who has diabetes know what changes and observations you must report. More info If you have a trainer, they should give you all the forms that you need for this topic. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

6 What is diabetes? Diabetes is a disease where the body cannot control its blood glucose levels properly. This could develop either because the body doesn t make enough (or any) insulin, or because the cells have become resistant to insulin. Imagine a door that allows glucose to go from the blood into the cells. Insulin is the key for this door. If the door can t open (the key (insulin) is missing or doesn t fit anymore) the glucose can t get into the cells. If this happens, the glucose level in the blood rises. More info Blood glucose levels are also referred to as blood sugar levels. Sugar is the common word for glucose. If blood glucose levels aren t kept under control, diabetes can be life-threatening. Diabetes can lead to other health conditions, including kidney failure, eye disease, foot ulceration and a higher risk of heart disease. Keeping blood glucose at a safe level means a person is less likely to have other health problems. There s no cure for diabetes, but there are things a person can do to stay well. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

7 How common is diabetes? There are over 240,000 people in New Zealand who have been diagnosed with diabetes (mostly type 2). It is thought there are another 100,000 people who have it but don t know. Some facts about diabetes are: it is most common among Māori and Pacific Islanders. They are three times more likely to get it as other New Zealanders. that south asian people are also more likely to develop diabetes. the number of people with both types of diabetes is rising. Type 1 diabetes Type 1 diabetes is usually diagnosed in children and young people. Type 1 diabetes is less common than type 2 diabetes. Type 1 diabetes is when the body has stopped producing insulin. People with type 1 diabetes need to inject insulin to live, usually two times a day. When insulin is injected, the blood glucose level drops. As part of your role, you may need to make sure the person eats within a certain period of time after injecting insulin. If the person does not eat, their glucose level may become too low, causing hypoglycaemia. More info Hypoglycaemia or having a hypo is when blood glucose levels drop below the normal range. This means when blood glucose levels are less than 4.0 mmol/l. An insulin pump, like the one pictured, delivers insulin through a catheter In a steady dose and as directed. A small needle allows the catheter to be inserted in fatty tissue, and it's taped in place. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

8 Type 2 diabetes Type 2 diabetes usually develops in adults but it is becoming more common in children. Type 2 diabetes is the only type of diabetes linked with obesity. Type 2 diabetes is when your cells have become insulin resistant (the key doesn t fit anymore) or your body doesn t produce enough insulin to keep you healthy. This usually occurs in overweight people but can also be a result of other genetic or lifestyle factors. A person with Type 2 diabetes may be on a weight reduction diet that includes: small, regular meals. limited sweet food, carbohydrates and fat. focus on fruit, vegetables and wholegrains. People with Type 2 Diabetes will usually have medication, which helps the insulin work more effectively. Sometimes, they will also end up needing insulin injections as well. Gestational diabetes and pregnancy Gestational diabetes is a form of diabetes that develops during pregnancy if the body cannot fully cope with the additional insulin demands of both the mother and baby. It is estimated that between 2% and 3% percent of pregnant women are affected by gestational diabetes during pregnancy. If the mother s body cannot produce sufficient insulin to overcome this, diabetes in pregnancy can develop. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

9 What can cause diabetes? The exact cause of Type 1 diabetes is not known. However, there are some risk factors that make a person more likely to develop diabetes. For example, if a person: is of European descent, aged 40 years or older. has diabetes in the family (grandparents, parents, brothers or sisters). is of Maori, Asian, Middle Eastern or Pacific Island descent, aged 30 years or older. has high blood pressure. is overweight (especially if most of the weight is around the waist). has been diagnosed with pre-diabetes, in which the glucose (sugar) in the blood is higher than normal, but not high enough to be called diabetes. gave birth to a large baby weighing more than 9lbs / 4kg or have had gestational diabetes (diabetes during pregnancy). has had high blood glucose in the past. More info Risk factors are things which increase the likelihood of a person s developing a disease or injury. The following lifestyle choices can help a person avoid or control diabetes: being physically active and getting regular exercise (at least 30 minutes of moderate physical activity each day). eating healthy food. keeping weight in a healthy range. not smoking. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

10 How might diabetes affect a person? Health and functional status Health is a measured by how well a person is described in terms of physical, emotional and social aspects of life. Functional status is a measure of how well a person is able to perform normal activities in daily living. Living with diabetes can have a serious impact on a person s health and functional status. For a person to manage their diabetes well, they must moderate their lifestyle. This can include: measuring and monitoring food intake carefully. This can make eating out or going on holiday difficult. ensuring they have enough daily exercise. This can include walking, swimming, playing sport or strenuous gardening. having to refrigerate medication such as insulin. This is a consideration when it comes to camping or other outdoor activities, especially in summer. reducing stress is important as stress hormones can increase the amount of sugar in the blood, affecting blood glucose control. Signs, symptoms and complications Some of the signs that may lead to a diagnosis of diabetes are as follows: excessive thirst. frequent need to urinate. numbness, tingling or pain in the hands, feet or legs. dizziness. heart and vascular problems. high blood pressure. high cholesterol levels. Many of the issues people face are related to other complications, caused by the diabetes. Not everyone with diabetes will develop these complications. The most common complications are described. More info Complications are the negative effects of having a condition or illness. These complications can cause long term damage to the body. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

11 Damage to nerves (neuropathy) There are a range of different neuropathies (or forms of nerve damage) that people with diabetes can develop. Almost all of these conditions affect the peripheral nerves. Effects can include: excessive sweating numbness or tingling in the hands or feet loss of functions not normally under conscious control, for example, proper digestion. This can lead to nausea, constipation or diarrhoea. lack of arousal in the penis or clitoris Damage to blood vessels (vascular disease) A person with diabetes is more likely to develop heart or blood vessel problems (cardiovascular disease). Diabetes contributes to high blood pressure and is linked with high cholesterol. If blood glucose levels or blood pressure remain high for long periods of time, it can damage the small blood vessels in a person s body. This significantly increases the risk of heart attacks and stroke. Heart disease can occur without the presence of chest pain. It may cause shortness of breath, sudden nausea or swelling in the ankles. Eye damage Diabetes eye damage is sometimes called a 'silent' disease. This is because the damage can be happening a long time before the person notices any change. Eventually eyesight becomes blurred and can result in blindness. For many years diabetes has been the leading cause of blindness in New Zealand. However, with new treatments available, this is decreasing. Existing damage can often be halted, or prevented, from getting worse. Diabetic kidney disease Diabetic nephropathy is the term for kidney disease as a result of diabetes. The fine blood vessels in the kidneys can become thickened and damaged. Eventually they become leaky and instead of filtering the blood properly, they start to leak very important things such as protein out into your urine. This damage can result in general poor health and eventually kidney failure. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

12 Bladder infections High levels of glucose in the urine are an excellent source of food for any bacteria or germs. This increases a person s risk of getting bladder or kidney infections. Some people with diabetes are troubled with frequent urine (bladder) infections. Over time this can worsen kidney damage. Some people with diabetes may develop problems emptying their bladder. This can cause a backlog pressure on the kidney and increase kidney damage. Foot problems Foot problems in diabetes are often caused by nerve damage and/or damage to the blood vessels. Nerve damage can result in a range of problems, including leg and foot ulcers. One of the most serious is that either the whole, or part, of the feet can become numb or insensitive to pain. If a person s foot is numb they can walk all day with a very bad blister and never know it. They could burn their foot badly on a heater and not know to pull their foot away. To make matters worse, the person would not know that they need treatment for their damaged foot. healthandbloom.com Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

13 Atherosclerosis and skin problems Thickening of the arteries (atherosclerosis) narrows them and affects the skin on the legs. People with diabetes tend to get atherosclerosis at younger ages than other people do. Thickened blood vessels have less blood flowing through them. This causes the skin to become hairless, thin, cool and shiny. The toes can become cold and toenails can thicken and discolour. Exercise can cause pain in the calf muscles because the muscles are not getting enough oxygen. Affected legs can heal slowly because less blood is flowing through blood vessels and the infection-fighting white cells cannot get to where they are needed. Even minor scrapes can result in open sores that heal slowly. Gum, Mouth and Teeth Problems Gum disease is the most common mouth problem for people with diabetes. Diabetes can weaken the mouth's germ fighting powers. It can also cause damage to the blood vessels supplying the gums. An infection in the gum can cause blood glucose levels to rise, making diabetes harder to control. Thyroid issues This is when there is too little or too much thyroid hormone circulating in the body. Thyroid imbalance can affect energy levels, weight management, memory, body temperature and many more. People with diabetes who develop thyroid issues may find it hard to manage their diabetes. This is because the way their body uses glucose is altered. Vaginal infections The vaginal secretions of women with diabetes often contain increased amounts of glucose, providing an excellent source of food on which germs (bacteria and fungi) can grow. Media Find out more about how diabetes can affect a person. Visit /living_well_with_dia betes/kiwis_living_wi th_diabetes Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

14 Hypoglycaemia (Low Blood Sugar) People become hypoglycaemic (hypos) when their blood glucose level drops below 4.0 mmol/l. This can happen when: meals or snacks are missed or delayed. less carbohydrates are eaten than usual. a person does more exercise or activity than usual. too much insulin is present. Why is it important to treat Hypoglycaemia? When the blood glucose levels are low the body is starved of glucose, its main source of energy. The brain is also starved of glucose. This means it doesn t function as well. Repeated hypoglycaemia (hypos) can lead to memory problems, difficulty concentrating and carrying out tasks. Frequent hypos can also lead to hypo unawareness. This is where the person does not experience the warning symptoms of hypoglycaemia. Without symptoms the person is not alerted to the need to treat the problem. This can be very dangerous for the person and those around them if they try to do tasks, for example, driving a car or cooking. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

15 Symptoms of Hypoglycaemia More info Hypoglycemia is the American spelling. In New Zealand, we use the English spelling that includes an a. What should you do? If you suspect a person is having a hypo in a hospital setting, inform an RN at once. Hypos are a medical emergency, which must be treated quickly. When blood glucose levels are low the brain is being starved of glucose which could result in brain damage. An RN should do a blood glucose level on the patient; if it is below 4mmol/L the patient will need grams of glucose without delay. In a hospital setting, glucose is sometimes administered intravenously (through an IV). More info A blood glucose level is a simple finger prick blood test to measure the amount of glucose in the blood. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

16 Each organisation will have its own policies and procedures around glucose administration and it is important that you understand what they are for the area you are working in. Once glucose has been administered, the blood glucose is checked again after 10 minutes. If still below 4 mmol/l further glucose is given. Once the glucose level is above 4mmol/L it is important to then give the person a protein/carbohydrate snack, if their next meal is not due. If you are working in the community where there is not an RN on site: call your RN or dial 111 for an ambulance treat the hypo by giving glucose (sugar), as per the person s individual plan. stay with the person until help arrives. Important: If the patient is unconscious or showing signs of drowsiness ring your emergency bell. If you are in the community, ring 111. The patient will need an injection of glucose. Type One diabetic patients usually carry an intramuscular injection of glucose with them. Quick sources of glucose or carbohydrate There are a variety of ways to provide glucose quickly. Remember that the instruction of the RN or service plan must be followed. The following are examples of what may be used. Note that the person may be drowsy and need assistance to take the glucose preparation. glucose tablets (dosage depends on the type). 6 jelly beans. 2 teaspoons of sugar dissolved in water. a small glass of ordinary soft drink or cordial (not diet varieties). 2 heaped teaspoons ordinary jam or honey. Hypofit gel sachets can be useful when patients are already drowsy and cannot cooperate with chewing tablets, if their teeth are poor or they have dentures. It is important never to give a hot drink with sugar to treat a Hypo as the patient may not be able to drink it quickly enough to absorb the glucose. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

17 The impact of diabetes As you have read, both types of diabetes and there complications can have a number of impacts on a person s health and functional status. When describing these impacts we can group them into: Physical impacts, such as: changes to the body feet, skin and gums. fatigue. side effects of medication. loss of intimacy. Emotional impacts, such as: a sense of grief or loss. fear or uncertainty over what the future holds. financial stress (change in employment or medical costs). depression or denial over the diagnosis. anxiety resulting from the constant stress of managing their diabetes. Talk Talk to someone you know with diabetes (or someone who has a friend/family member with diabetes). Ask how it has affected their life? Psychosocial impacts, such as: changes in how someone is perceived or seen by others. fear of becoming hypoglycaemic in public or while driving. work restrictions or the ability to do heavy work or shift work can be affected by dietary requirements. children at school may be embarrassed about having to eat differently or take medication at school. Cognitive impacts such as: issues with memory loss. poor concentration, attention and ability to process information. Environmental impacts, such as: the need for medical devices such as an insulin pump can restrict the choice in activities. the need for disposal of sharps (needles). Psychological impacts, such as: the need to accept the situation. learning to adapt to limitations. learning to appreciate different things to optimise quality of life. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

18 Supporting a person with diabetes The best way for a person to avoid complications is by keeping both blood glucose levels and blood pressure at a healthy range. The Service Plan will contain all the information you need about dietary and medication requirements. It is important that you read this and follow the instructions clearly. Because of the risk of skin infections, skin should be kept supple with moisturiser and protected from harsh weather and soaps. You may need to provide support for a person suffering from diabetes burnout. This is where the person is tired and frustrated with the constant effort of managing their diabetes. They may start to exercise less or eat junk food. They may even forget to monitor their blood glucose levels. If a person doesn t eat properly, their blood glucose levels become too low. They may become hypoglycaemic. It is important that you are alert to these signs and know exactly what to do and how to report effectively. Illness and diabetes During an illness or infection the body will release extra glucose into the blood stream to help combat the illness. This release of glucose makes it even more difficult for a person with diabetes to manage their blood glucose levels. When a person you are supporting is ill, they will need to be very careful with their diet and general diabetes management. High blood glucose levels can lead to dehydration so it is important to make sure the person drinks plenty of water. If the person is unable to keep food down due to illness, you must consult with the Registered Nurse. The person may need drinks with carbohydrates in them. Insulin levels may also fluctuate during this time and will need to be carefully monitored. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

19 What to look out for: An important part of your role is to observe the person for any changes that may indicate problems. These changes might include: Signs of dehydration or bladder infection Dehydration Bladder infection Dry mouth or bad breath Dry skin Headaches or dizziness Reduced urine output, especially if darker in colour Irritability or confusion Frequent need to urinate Lower back pain Cloudy urine that smells unusual Raised body temperature Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

20 Reporting and monitoring As a support worker, you may be required to monitor food and fluid intake of a person. You may even be required to assist with monitoring blood glucose levels. The Registered Nurse will provide you with special forms for monitoring purposes and will explain how to use these. Any changes that you notice must be reported to the Registered Nurse. The Service Plan will provide information on what to do to address most signs and symptoms. This may vary from making a record in the person s notes to phoning an ambulance immediately. More info Record of care may include patient notes, daily diary, shift notes. Write You have noticed that John has not kept strictly to his diet today. He missed afternoon tea and only ate half of his dinner. He did eat his bedtime snack. What might you write in his record of care? Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

21 Glossary The meanings below describe how the word is used in this learning guide. The word may have other means when used in other ways. Administered / administration Atherosclerosis Backlog Bladder Carbohydrate Cells Cholesterol Conscious control Constipation Diabetic Diagnose Diarrhoea Digestion Drowsy/drowsiness Excessive Filtering Frequent Functional status Genetic Gestational Giving a person food, fluid or medicine Thickening of the arteries A build-up that happens when something does not flow freely The organ in the body that holds urine after it passes through the kidneys and before it leaves the body Various substances found in certain foods (such as bread, rice and potatoes) that provide your body with heat and energy Very small parts that together make up the body A substance in the body that, when too high, can cause a fatty build up in the arteries, restricting blood flow When we do something on purpose such as walk, swallow or speak. Some bodily functions occur without us being aware of them, such as our heart beating or our blood flowing we do not have conscious control of these things Being unable to have a bowel movement easily Having diabetes When a doctor or specialist confirms that a person has a certain illness or disease based on certain evidence. When a person passes waste in a liquid form instead of solid When our body changes food to a simpler form after it is eaten When a person is having difficulty staying awake. More than usual Allowing a controlled amount to move between areas Happens often A measure of how well a person is able to perform the activities of daily living Passed down by origin (parents or ethnicity) Occurs during pregnancy Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July

22 Glucose Sugar Hypoglycaemia When the blood sugar level drops below 4 mmol/l Impact Impaired Insensitive Insulin Intramuscular injection mmol Monitoring Nausea Neuropathy Numbness Optimise Peripheral Produce Protein Resistant Scenario Symptoms Thyroid Vaginal Vascular The effect of something Not working as well as usual - weakened Unable to sense/feel A chemical produced in the pancreas which helps the body process glucose. An injection directly into the muscle Millimole (a measure of quantity) Observing and recording what you see An urge to vomit Nerve damage Unable to feel sensation To make the most of something The peripheral nerves send information from the brain and spinal cord (central nervous system) to the rest of the body To make something Found in eggs, meat, quinoa etc Does not respond to or is not affected by Example of a situation How an illness affects and person Produces hormones that affect the way we use food as energy Affecting the genital vagina Related to the blood vessels. Diabetes (US 28547) Learning Guide Careerforce Issue 1.0 July