Diabetes self-care lecture

Question 1

outline the key self-management activities for diabetics

Answer 1

1) Managing relationships between food, activity and medications
2) Self-monitoring of blood glucose, BP and having retinal screening carried out
3) Targeting goals tailored to individual needs, for example around foot care, weight loss, injection technique
4) Applying sick day rules when ill,
5) Managing acute complications – hypoglycaemia and hyperglycaemia
6) Understanding legislative issues such as those related to driving and employment

Question 2

what is Self-care and self-management and how can it be achieved?

Answer 2

1) Describes how a person living with a long-term condition, like diabetes, controls their condition and health themselves
2) having knowledge about the condition, how it needs to be treated and what needs to be done

Question 3

explain why supporting self-management is important and what are the positive outcomes?

Answer 3

1) Approximately 95% of a person with diabetes’ management is self-management
2) The majority of people living with diabetes want to maintain an independent, healthy and active life
3) Supporting self-management of people with long-term conditions can lead to positive outcomes such as:
- reduction in visits to A&E and length of stay in hospital, better communication between professionals and patients, better symptom management, improved quality of life and health outcomes, greater independence and increased patient satisfaction

Question 4

how is education delivered to those with diabetes?

Answer 4

1) structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
2) Inform people and their carers that structured education is an integral part of diabetes care
- Will improve adherence
3) DESMOND, DAFNE

Question 5

what is DESMOND and DAFNE?

Answer 5

1) DESMOND (Diabetes Education and Self Management for Ongoing and Diagnosed)- the collaborative name for a family of group self management education modules, toolkits and care pathways for people with, or at risk of, Type 2 diabetes
2) DAFNE (dose adjustment for normal eating regimen) - way of managing Type 1 diabetes and provides people with the skillsnecessary to estimate the carbohydrate in each meal and to inject the right dose of insulin

Question 6

with regards to monitoring, what information should be given to diabetics so they know how to monitor their condition effectively?

Answer 6

1) Signs and symptoms of hypo/hyperglycaemia
2) Signs and symptoms of chronic complications
3) Blood glucose level (target level between 4-9mmol/L)
- For children and young people with Type 1 diabetes, routine daily monitoring is recommended
4) Hba1c (target level of 48mmol/mol (6.5%) or less)
5) Cardiovascular monitoring – BP, cholesterol
6) Urine proteins

Question 7

patients need to know the goals of their treatment to effectively self manage their condition . what are the treatment goals in diabetic patients?

Answer 7

1) Improve quality of life
2) Prevent short-term hypo/hyperglycaemia
3) Prevent long-term complications
4) Reduce mortality

Question 8

with regards to insulin what information should be given to patients to help them self manage their condition?

Answer 8

1) Patients should know the details of the types of insulin they use, the pen, syringes and other equipment they use
2) patients should always check they have been prescribed and dispensed the right products
3) Patients should be told to dispose of any old unused insulin to make sure it doesn’t get mixed up with new insulin
4) Patients should take responsibility to make sure they don’t run out of their products
5) If patients go into hospital they need to tell staff if they want to carry on giving their own insulin.

Question 9

1) Why should diabetics be informed about the type of insulin they are on?
2) list the different types of insulin available on the market.

Answer 9

• so they know the duration and when they use it.
  1) Rapid acting insulin analogues Aspart (NovoRapid), glulisine (Apidra), lispro (Humalog)
  2) Short-acting / soluble insulin Actrapid, Humulin S
  3) Intermediate acting insulin Isophane (Humulin I, Insulatard)
  4) Long-acting insulin glargine (Lantus), detemir (Levemir)

Question 10

explain what diabetics need to be informed about with regards to injecting, as part of self management.

Answer 10

1) Check injection sites regularly
2) Lipohypertrophy (“lumpy” injection site) can affect absorption
3) Arms should be used with caution due to rapid onset of action
4) Rotate injection site, however doing this may result in differing rates of absorption between sites e.g absorption quicker in abdomen than thighs
- Use different sites for different times of day
5) Should remove needle after each injection and not leave on the pen device

Question 11

which injection site on the body gives the most rapid absorption of insulin?

Answer 11

Abdomen – most rapid absorption -> arms -> legs -> buttocks slowest

Question 12

what information should patients be given about the storage of their insulin.

Answer 12

1) Insulin administration should only be done using insulin pens or insulin syringes, NOT standard IV syringes
2) Insulin products that are IN USE do NOT usually have to be stored in a refrigerator, provided the temperature they are stored in is lower than 25-28 degrees C
- can be kept at room temperature for 4 weeks when in use
3) Open vials, cartridges or pre-filled pens you use every day must be discarded after 28 days
4) Insulin products that are intended for future use should be stored in a refrigerator at 2-8 degrees C until they are used

Question 13

Insulin passports and patient information booklets should be offered to patients receiving insulin. what is an insulin passport?

Answer 13

1) Insulin passport – credit-card sized record of the patient’s current insulin preparations and a section for emergency information
2) Patient information booklet – provides advice on safe use of insulin

Question 14

what is the main acute complication of diabetes?

Answer 14

1) Hypoglycaemia: excessive dose of insulin or antidiabetic tablets, excessive exercise, missed meals, infection, illness
2) Hyperglycaemia: infection, illness, stress, missed doses
- reversible

Question 15

1) why should patients be informed about hypoglycemia?

2) what information should be provided to them to allow them to recognise this condition?

Answer 15

1) All patients must be carefully instructed on how to recognise, avoid and treat hypoglycaemia (<4mmol/L glucose)
2) symptoms they should look out for: shaky, dizzy, sweaty, tired and grumpy

Question 16

patients need to be able to know how self manage episodes of hypoglycemia. what information needs to be given to diabetics to help them treat this condition?

Answer 16

1) The immediate treatment is to have some sugary food or drink (about 10 to 20g of rapidly acting carbohydrate). For example:
- a glass of fruit juice or non-diet soft drink
- between three and five dextrose tablets
2) Avoid fatty foods and drinks, such as chocolate and milk, as they don’t contain as much sugar and may be absorbed more slowly
3) After having something sugary, you should have a longer-acting carbohydrate food- biscuits, a cereal bar, a piece of fruit or a sandwich, or next meal if it’s due
4) Measure blood glucose again after 15 to 20 minutes. If it’s still too low (below 4mmol), then have some more sugary food or a drink

Question 17

what information and advice needs to be given to patients in case they experience hyperglycemia.

Answer 17

1) increase the dose of insulin
2) change their diet – for example, avoid foods that cause glucose levels to rise, such as cakes or sugary drinks
3) getmore exercise
4) monitor glucose levels
5) Extreme hyperglycaemia (when normal inhibitory effect of insulin on lipolysis is no longer effective) = diabetic ketoacidosis- A&E

Question 18

how can patients reduce the risk of developing chronic complications of diabetes and what should they get checked up every year?

Answer 18

1) Optimal glycaemic control very important to prevent complications (aim for Hba1c 48-59mmol/mol or less)
2) Eye disease: look out for blurred vision- regular yearly opticians appointments needed
3) Neuropathy – sensor loss in hand and feet
- Sometimes postural hypotension so avoid sudden postural changes, alcohol; Maintain: raised head during sleep, small frequent meals
- gastroparesis, bladder and erectile dysfunction
4) Nephropathy - get a protein urea test done every year

Question 19

why should diabetic patients should be educated about their feet?

Answer 19

1) Patients should have feet checked by a trained HCP at least annually (up to monthly if high risk)
2) Risk factors include PVD, neuropathy, callus & smoking
3) Patients with non-healing or progressive ulcers with clinical signs of active infection (redness, pain, swelling or discharge) should receive intensive, systemic antibiotic therapy

Question 20

what foot care advice should be provided to patients?

Answer 20

1) Wear soft, well fitting shoes. Check regularly for cracks, pebbles etc.
2) Cut toe-nails carefully – straight across
3) Wear clean socks every day – cotton or wool
4) Wash feet daily with warm water and soap and dry
5) Avoid extremes of heat or cold
6) Do not go bare-foot
7) Do not use OTC corn or callous remedies. Never attempt to self-treat minor foot injuries

Question 21

what information should be given to patients about sick day rules?

Answer 21

1) Illness generally increases insulin requirements
2) Patient should be provided with urine strips to test for ketones (e.g., Ketostix)
3) Glucagon injection should also be available at home for family members to use in case of severe hypoglycemia. contact telephone numbers for GP
4) Should Never stop taking their insulin
Type 1 - more monitoring of blood glucose (every 4 hours) and urinary ketones
Type 2 – blood glucose
5) Continue to take tablets and/or insulin as normal even if they are not eating much
6) If they start vomiting, are unable to keep fluids down or unable to control their blood glucose or ketone levels, they must seek urgent medical advice

Question 22

when people to start to feel better how should they manage their regime as part of sick day rules?

Answer 22

As people get better and blood sugars improve and/or ketonuria resolves, they should reduce their insulin back towards their usual dose (or, for patients who were previously on an oral antidiabetic regimen, stop insulin completely), guided by blood glucose measurements

Question 23

how should patients be encouraged to manage their condition with regards to diet and weight loss?

Answer 23

1) high-fibre, low-GI sources of carbohydrate in the diet, such as: fruit, veg, wholegrains and pulses; include low-fat dairy products, oily fish, avoid trans fats
2) Target, for people who are overweight, an initial body weight loss of 5–10%
3) Exercise - walking, jogging, or biking for 30 to 60 minutes every day

Question 24

below are a few conditions patients with diabetes might encounter. for each one is there an OTC treatment or should they be referred?

1) Vaginal Thrush
2) Cystitis
3) Indigestion
4) Constipation

Answer 24

1) Vaginal Thrush: Can be treated OTC but refer recurrent bouts
2) Cystitis: Refer due to increased risk of nephritis
3) Indigestion: May be a S/E of antidiabetic drugs e.g. sulphonyureas or metformin. Could recommend a sugar-free antacid mixture, e.g. Gaviscon
4) Constipation: May be caused by antidiabetic drugs (e.g. sulphonylureas), neuropathy or poor glycaemic control. Recommend increasing dietary fibre, increase fluid intake.
- Could recommend bulk-forming laxative or senna (short-term

Question 25

below are a few conditions patients with diabetes might encounter. for each one is there an OTC treatment or should they be referred?

1) Insect bites
2) Pain
3) Nasal congestion

Answer 25

1) Insect bites: Avoid hydrocortisone cream. Refer if not improved in 1-2 days.
2) Pain: Avoid NSAIDs if nephropathy
3) Nasal congestion: Decongestant nasal sprays or drops – ensure used correctly to minimise systemic absorption. Avoid oral decongestants (may affect BP and glucose control).

Question 26

1) why should smoking cessation be done under the supervision of a GP?
2) why should patients be careful about taking vitamins?

Answer 26

1) Smoking cessation: beneficial but should be done under supervision of GP – may possibly affect glycaemic control
2) Vitamins: High dose Vitamin C can interfere with some urine testing kits

Question 27

what information about driving should be provided to diabetics?

Answer 27

1) Drivers with diabetes may be required to notify the DVLA of their condition depending on:
- their treatment, type of license, diabetic complications
2) Drivers need to avoid hypoglycaemia. Those treated with insulin should normally check their blood glucose before driving and, on long journeys, at 2 hour intervals
3) Depending on the type of license those on oral antidiabetic drugs may also need to monitor their blood glucose
4) Carry a supply of sugar and avoid driving if their meal is delayed

Question 28

if patients experience the warning signs of hypoglycemia what should they do?

Answer 28

1) Stop the vehicle in a safe place
2) Switch off the ignition and move from the driver’s seat
3) Eat or drink a suitable source of sugar
4) Wait until 45 mins after blood glucose has returned to normal, before continuing journey

Question 29

what information should be provided to diabetics about travelling?

Answer 29

1) Diet – still eat healthily, take some healthy snacks whilst travelling
2) Medicines and travel vaccines – carry insulin passport, take twice the quantity of medical supplies you would normally use, hot climates may affect how insulin and blood glucose monitors work
3) Travel insurance – most polices exclude people with diabetes, but make sure you declare it and get a policy that includes it. For travelling in Europe, get a European Health Insurance Card (EHIC)
4) Air travel – take a letter from your GP explaining you need to carry syringes or injection devices and insulin. Carry all your medicines as hand luggage, esp insulin

Question 30

what information about vaccinations should be provided to diabetic patients?

Answer 30

1) People with long-term conditions, such as diabetes, are encouraged to get a flu jab each autumn
2) A pneumococcal vaccination, which protects against pneumococcal pneumonia, is also recommended