Diabetes Care & Support
of People with Intellectual Disability
or Acquired Brain Injury
Jayne Lehmann
Diabetes Nurse Specialist
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
© EdHealth Australia 2013
1
Disclaimer
The information in this publication is of a general nature and focuses on the care of diabetes in people with
an intellectual disability or acquired brain injury. Every effort has been made to ensure the content is
accurate at the time of writing.
However, medicine is an ever-changing science, and each person’s medical condition is unique. You must
not rely on the information in this Manual for the treatment of an individual’s diabetes. Always discuss the
ideas and options with the person’s doctor before starting any health treatment to ensure it is appropriate
for their situation.
To the maximum extent permitted by law, the publisher, author, editor and each of their bodies corporate,
and all other people involved in producing this information will not be liable for any loss, expense, damage,
action or claim that results from the use of, or reliance on, this Manual, the information that it contains, or
any web site and other information sources that are referred to in this information. References to web
sites or other sources of information are not endorsements of those web sites or sources of information
and we have not checked and do not warrant the accuracy or completeness of the information you may
derive from these sources.
Microsoft Word clipart has been utilised in the production of this Manual and additional referenced
images. Appropriate consents or de-identification have been conducted on the images depicting people
with ID or ABI.
ISBN: 978-0-9875372-0-1
Recommended citation:
Lehmann, J. Diabetes Care and Support of People with Intellectual Disability or Acquired Brain
Injury, South Australia, 2013.
© EdHealth Australia, 2013
PO Box 109 Highgate SA 5063
Phone:
08 8271 0947
Email:
jayne@edhealth.com.au Website: www.edhealthaustralia.com
Front cover photo: Jayne Lehmann
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
© EdHealth Australia 2013
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Author’s Note
Most people have little or no experience of a life lived with intellectual disability or acquired brain injury.
Not surprisingly health professionals can find it challenging to provide diabetes care to someone with a
disability. Equally those supporting people with disabilities often have insufficient diabetes care knowledge.
Is this why people with disabilities experience poorer health than those without disabilities?
The Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury Manual aims to
improve diabetes health in people with disabilities. It draws on the knowledge, sills and insights I’ve gained
from 27 years experience as a Credentialled Diabetes Educator, and 19 years of caring for our daughter
who has an intellectual disability.
Over the past five years I’ve had the opportunity to work with a number of disability organisations in
relation to their care of diabetes. I also started the first Diabetes Assessment and Education Clinic for
people with an intellectual disability in Australia in 2010. Conducted in Brighton South Australia, the service
delivers a specialised service to improve diabetes outcomes, strategies and resources to support clients
with low health literacy.
Some of the most challenging and inspirational experiences of my career have come from working with
people with disabilities. At times I felt I had trained for 27 years to be able to help a particular client, their
needs were so complex. The inspiration from people with whom I have worked, their support workers,
nurses, managers and families are woven throughout the Manual. They have shown me just how involved
they can be with their diabetes care.
Novo Nordisk Regional Diabetes Support Scheme Grants (2011, 2012) enabled the Manual and Clinic to get
off the ground. Thank you Gary Radler Photography (www.garyradler.com) and models; beautiful images
capturing people with disabilities positively and respectfully.
Sarah inspired this manual but without the support of my family and our shared journey of her care and life
in our family it would not have been written. My husband, John, and daughters Charlotte and Bec have
made it an easier ride than it could otherwise have been. Our sense of humour and camaraderie has been a
source of sustenance and release and they, together with Sarah, are my life’s foundation.
My final words are appropriately borrowed from Sarah, who exclaims when extremely proud of an
achievement …I did it!
Jayne Lehmann BN(Ed) DipAppSc(Nsg) FRCNA RN CDE
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
© EdHealth Australia 2013
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Table of Contents
Disclaimer ………………………………..………………………………………………………………………………..……………….………….. 2
Author’s Note ……………………….…………………………………………………………………………………………….…………………..3
Contents ................................................................................................................................................. .... 4
How to use the manual ……..………………………………………………………………………………………………………….….……..8
Resource codes ............................................................................................................................................. 9
Limitations of the information in this manual ........................................................................................... 10
Other resources .......................................................................................................................................... 11
Section 1: Diabetes and Disability………………………………………………………..…..……….……….15
Why are people with disabilities at increased risk of diabetes? ……………………………….….…..16
Section 2: Person Centred Planning…………………………………………………………………….17
Special considerations in diabetes care of people with ID ………………………………………….…..18
Special considerations for the diabetes care of people with an ABI ………………………………. 23
Section 3: Diabetes Care Update..……………………………..………………………………….…….25
Diabetes overview …………………..……………………………………………………………………………..……. 25
What is diabetes? ……………………………………………………………………………………………………..….. 26
What causes diabetes? …………………………………………………………………………………………..…….. 27
What are the symptoms of diabetes? …………………………………………………………………………....29
How is a person diagnosed with diabetes? …………………………………………………….…………….…30
What increases your risks of getting diabetes? ………………………………………………………….……31
Can diabetes be treated? ………………………………………………………………………………………………..31
Treatment of diabetes …………………………………………………………………………………………………….32
Section 4: Lifestyle and Diabetes............................................................................................................34
A person’s outlook on life ....................................................................................................35
Healthy eating ......................................................................................................................35
Weight management............................................................................................................36
PEG feeds .............................................................................................................................36
Exercise ................................................................................................................................36
Stress management .............................................................................................................38
Smoking................................................................................................................................39
Alcohol .................................................................................................................................39
Going out ........................................................................................................................... 40
Keeping family members up-to-date ................................................................................. 41
Going on holidays with diabetes ..........................................................................................42
RESOURCE: Holiday Diabetes Care Checklist for People with ID or ABI ……………………………………………45
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
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Section 5: Medication and Diabetes…………………………..…………………………….…….…….50
Tablets................................................................................................................................. 50
Insulin……………………………………………….…………………………………………………………………………..52
Who can give insulin injections?......….………………………….………………………………………..........52
Starting insulin ………………………………………………………………………………………………………………54
How is insulin given? ….………….………………………………………………………………….………………… .55
Insulin pumps ………………………….…….……………………………………………………………….….………….55
How do we know which insulin device is best? …………………………….……………………………….56
Where do purchase insulin needles? …………..………………………….…………….……………………….56
How can needle stick injuries be prevented? ......................................................................57
Where is insulin injected? ....................................................................................................58
Where is insulin stored? ......................................................................................................59
Other injectable diabetes products......................................................................................60
RESOURCE: C hecklist: Type 2 Diabetes - Starting insulin …………………………….61
Section 6: Health Issues Associated with Diabetes...............................................................................63
Foot and leg care .................................................................................................................64
Preventing food and leg problems..................................................................................... 65
RESOURCE: Yearly diabetes health check............................................................................................66
Going to hospital .........................................................................................................67
Emergency hospital visit or admission ........................................................................67
Pre-hospital admission clinic...................................................................................... 68
During hospitalisations ………………..…….……………………………………………………………….. 68
Discharge from hospital .............................................................................................68
RESOURCE: Health professional feedback form………………………………………………………………………….…70
Section 7: Blood Glucose Monitoring ...................................................................................................71
Where do you get a blood glucose meter from?........................................................71
Choosing the right meter ……………………………………………………………………………………..72
Where do you get the strips/electrodes for the meter? ……………………………………….73
Who should check a person’s blood glucose level?....................................................73
How accurate are the blood glucose meters? ...........................................................73
How do we prick the person’s finger? ……………………………………………..………………….75
Where is it best to prick the finger for a sample of blood?........................................75
How often should blood glucose levels be checked? ………………………………..……….. .76
What d the blood glucose monitoring results mean? ................................................77
How often should blood glucose levels be checked? ……………..…………………………….78
How do you decide how often to check glucose levels? ………..…………………………….79
Example BGM regimens …………………………………………………………..………………………….81
Type 2 diabetes diet controlled and oral hypoglycaemic medication controlled…. 81
Type 1 diabetes or Type 2 diabetes insulin requiring ………………………………..…………82
RESOURCE: Blood glucose monitoring charts:Low literacy client chart ………………………………………….84
Chart for daily checking, rotating times…………………………………………………………………………….…..85
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
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Chart for twice a day checking, rotating times ………………………………………………………………………86
General blood glucose checking chart to customise for an individual’s needs ………………………. 87
RESOURCE: Diabetes Health/Care Plans …………………………………………………………………………………………..88
How to use the diabetes health/care plans……………………………………….…………………………………...89
Diabetes Health/Care Plan for those not at risk of hypoglycaemia …….………………………………..…91
Diabetes Health/Care Plan for those at risk of hypoglycaemia ….……………………………………………92
Section 8: Emergency Diabetes Care ....................................................................................................93
When to call the doctor and other health professionals ...................................................93
Guidelines for calling the doctor .......................................................................................94
General health ..........................................................................................................94
Hypoglycaemia .........................................................................................................94
Foot or leg problem ..................................................................................................95
Sick days ...................................................................................................................95
When to see other health professionals ............................................................................96
Diabetes educators............................................................................................. ...96
Dietitian, exercise physiologist, podiatrists, dentists..............................................97
Hypoglycaemia management ............................................................................................97
Identification...........................................................................................................97
Treatment ..............................................................................................................98
Conscious ...................................................................................................98
Unconscious/uncooperative ......................................................................99
Epilepsy and diabetes ...............................................................................100
Prevention ................................................................................................100
People who are tube or PEG fed …………………………………….….. 101
RESOURCE: Hypoglycaemia management chart ................................................................................102
Sick days ................................................................................................................................103
Type 1 diabetes – sick days and ketoacidosis .........................................................103
Sick day guidelines ............................................................................103
When to call the doctor ....................................................................105
Type 2 diabetes – sick days ......................................................................................105
Sick day guidelines ............................................................................105
When to call the doctor ....................................................................106
.
Medicare reimbursement for diabetes care services ..........................................................107
Health Assessments ...........................................................................................................107
Enhanced Primary Care GP Management Plan/Team Care Arrangement …………107
Type 2 Diabetes Risk Evaluation ……………………………………..…………………………………108
Allied mental health professional item numbers......................................................108
Section 9: Pathways of Care ...............................................................................................................109
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
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Pathway of Care: Impaired Glucose Tolerance ……………..………………………………………….…110
Pathway of Care: Newly diagnosed type 1 diabetes ..........................................................112
RESOURCE: Newly Diagnosed Type 1 Diabetes – Post Hospitalisation Checklist ………………………………119
Pathway of Care: Newly diagnosed type 2 diabetes ....................................................... 120
RESOURCE: Newly Diagnosed Type 2 Diabetes Checklist ……………………………………………………………….. 127
Section 10: Diabetes Education Tips and Tricks ...............................................................................128
Why is the level of literacy important for people with diabetes? ….…………….……129
Assessing health literacy……………………………………………………………………..……….…..130
Low literacy handouts……………………………………………………………………..…………….…………….130
Low literacy support tools …………………………………………………………………………………..………132
Additional low literacy education strategies ……………………………………………………………………..133
Food models …………………………………………………….………………………………………………… 133
Impact of physical disability on diabetes self care ……………………………………………………….135
Pulling it all together ……………………………………………………………………………………………….…..136
Case study 1 …………………………………………………………………………………………………………….... 136
Case study 2…………………………………………………………………………………………………………………139
RESOURCE: Low literacy diabetes education handouts …………….…………………….…………………………..….144
For people on sulphonylurea or insulin:
Check and Act – before meals; hypo risk ………………….144
Check and Act – 2 hours after meals; hypo risk………….145
For people not on sulphonylurea or insulin: Check and Act – before meals; no hypo risk ……………..146
Check and Act – 2 hours after meals; no hypo risk …...147
RESOURCE: Low literacy diabetes education handouts ……………………………………………………………………148
How to check your blood glucose level ………………………………………………………………..………149
Understanding your diabetes numbers……………………….……………………………………….…….……150
Understanding low blood glucose levels ……………………………………………………………....………151
Understanding high blood glucose levels …………………………………………………….………..………152
Staying healthy with diabetes ……………………………………………………………………………..………..153
When to see the doctor ……..……………………………………………………………………………………….154
How do you feel about having diabetes? …..…………………………………………………..………………..155
Example of a customised handout produced for a person with diabetes to reinforce self care
issues related to foot care (name changed).156
Last words …………………………………………………………………………………………………………………………..……………….157
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
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How to use the Manual
The Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury Manual (the
Manual) will be of interest to family members, informal carers, paid carers and support people, nursing
staff, service managers and health professionals supporting people with diabetes and disabilities.
Whilst the Manual will help to update your knowledge of contemporary diabetes care, remember each
person’s diabetes is different. To ensure the information is customised to suit each of the people with
diabetes you support, discuss with their doctor, diabetes educator or other allied health professional any of
the suggestions and ideas you consider appropriate for an individual.
People with intellectual disability (ID) and acquired brain injury (ABI) have great potential to be involved in
their diabetes if they are appropriately supported. An active and person centred approach underpins the
ideas presented to encourage the individual to do as much of their care as possible. In fact, if they are not
involved, it will be difficult for them to keep their diabetes on track for good health; they need to be at the
centre of their diabetes care planning to ensure success.
Manual Icons
Diabetes Care Tip
Practical ideas and real-life, de-identified examples are included to
illustrate application of the information.
Resources
Resources have been included for use with people with ID or ABI. A
description is provided showing how to use each resource.
References
These are provided to support an evidence based approach to the
information included in the Manual and for further follow-up.
Case Study
Scenarios to illustrate some of the concepts described in the Manual.
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
© EdHealth Australia 2013
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Resource codes
The copyright of the resources in this Manual remains with EdHealth Australia, who assigns permission for
the forms to be photocopied or printed for use with individual clients. Permission is not given for the
scanning or modification of the forms or Manual. The following codes are used to indicate the target use
and function of each of the resources.
Codes
This resource is suitable for…
T1
T2
People with type 1 diabetes
People with type 2 diabetes
The education and support of people with ID or ABI about their
diabetes and its care
Carers to use
Health professionals to use to advise on an individual’s diabetes care
and support e.g. doctor, diabetes educator, registered nurse or allied
health professional
Staff education
Printable
Enlarge to display as a poster.
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
© EdHealth Australia 2013
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Limitations of the information in this Manual
Like any resource, the Manual does not provide you with a definitive reference covering all that is required
to appropriately support someone with diabetes and an ID or ABI.
The Manual does not:

Make you an expert in diabetes care

Give you all of the information and skills you need to care for someone with diabetes

Replace ongoing observation and assessment of each person’s diabetes care needs

Replace an individualised health or care plan

Replace individualised medical advice

Replace a comprehensive diabetes assessment and education by a diabetes educator or
Credentialled Diabetes Educator

Replace an individualised dietary assessment by a dietitian

Give advice on the appropriate individualised dietary planning for people with diabetes

Give you the ability to work outside of your scope of practice

Provide a low literacy format for people with ID or ABI to understand

Address the needs of children and young adults under the age of 18 years

Address the needs of women with gestational diabetes

Address non-diabetes related issues associated with ID or AB

Replace the policies and procedures of your employing organisation.
Diabetes Care and Support of People with Intellectual Disability or Acquired Brain Injury
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