Diabetes Management
Script
Note: This script may vary slightly to the recording
Slide 2 Segment 1
In this segment I will discuss
• What is Diabetes?
• The Pancreas
• How quickly sugar enters the blood stream
• Types of Diabetes
• Signs and Symptoms of Diabetes
• Diagnostic Tests for Diabetes
• What is Hypoglycaemia and Hyperglycaemia and how they differ
Slide 3
Diabetes is a condition where the body has too much glucose in the blood. It is described
as a metabolic disorder and come under the Department of Endocrinology in health care.
Slide 4
The simple definition is there is too much glucose in the blood, but why does this happen?
Well what normally happens when you eat carbohydrate the glucose enters the blood
stream. When this happens the gland called the pancreas secretes insulin which is a
hormone. This Insulin is necessary to break down this glucose or sugar as it is often called,
so the glucose can enter your cells. This is what gives you energy. Without Insulin the
glucose cannot enter your cells so it just stays in the blood stream which makes you very
unwell.
In case you may get a bit confused, I just want to point out than when people talk about
glucose and sugar, they are referring to the same thing.
Slide 5 – Where is the Pancreas situated?
The pancreas is a gland as I said, and you will see in this picture it is situated just below the
stomach. The insulin is produced in the pancreas and secreted into the duodenum through
the pancreatic duct. Insulin is not secreted into the stomach as the stomach juices and
enzymes destroy insulin which is why insulin can never be given as a tablet.
So when you eat sugar (that is carbohydrates) the intestines break it down into glucose from
where it enters the blood stream. Most of your cells have what is called insulin receptors.
It is these receptors that suck the glucose from the blood which make the cells really fat so
you have energy. When you have too much glucose the excess gets stored in the liver so
your body can call on this glucose when the body needs more energy.
However if the pancreas is not producing any insulin or not enough insulin for the body to
function or the cells are resistant to insulin and the receptors will not allow the glucose to
enter the cells, the glucose will just remain in the blood with levels getting higher and higher
till a person becomes really unwell. This is the condition that is called Diabetes.
Slide 6 Types of Diabetes
1
There are two types of Diabetes. They are called Type 1, which used to be called IDDM
(Insulin Dependent Diabetes Mellitus) and Type 2 which used to be called NIDDM (NonInsulin Dependent Diabetes Mellitus) but now many Type 2 people have to use insulin
which is why they are called Type 1 and Type 2.
In Type 1 Diabetes the pancreas cannot make enough insulin or doesn’t make any insulin at
all. These people are always going to require insulin by injection. As I said earlier, insulin
cannot be given in a tablet form as the stomach juices destroy it.
Now in type 2 Diabetes it is different. The pancreas is either sluggish at producing enough
insulin required by the body or the body’s cells have become resistant to insulin which
means the insulin receptors in the cells cannot suck the insulin into the cells.
So as you can see the two Diabetes are different and why you need to understand how
important insulin is to our bodies.
Slide 7 What happens when we eat food?
As I mentioned before, the glucose is transported around your body for you cells to take the
glucose out, make the cells fat and give you energy. This slide should make it a little easier
to understand. Once you eat food glucose rises in your blood. At this point the Pancreas
recognizes that it has a job to do so it releases insulin. The receptors I talked about earlier
recognize insulin has been released and they unlock and allow the insulin into to get into
your cells so you have energy.
Now let’s make this a bit more relevant. Glucose is what is called a carbohydrate. If you
don’t have any carbohydrate in your meal there will be no glucose available for insulin to
work on and you will become hungry and have no energy.
For example, have you ever had just a salad without any meat or potato or rice? Well this is
mainly fiber and while fiberis really good for you, without some protein (meat, fish, eggs,
cheese or pulsars) and any carbohydrate like potato, rice, pasta, bread or grains you will
find you will probably get hungry very quickly. You may also become tired and have no
energy. This is because you haven’t given your body any fuel – there is no glucose in your
blood to give you energy.
So now let’s have a look at how long it takes for food to be utilized by your body once it
enters your blood stream.
Slide 8 – How long does it take for food to enter the blood stream
You can see here that when you eat sugary foods it goes into your blood stream
immediately. So a jelly bean, or can of coke or lemonade will act immediately.
Now when you have some bread, potato, pumpkin, kumara, rice or pasta (not all of it at
once I hope) it will take about 1-2 hours to enter your blood stream. It is slower than straight
sugar.
With Protein, which is essential as a body builder of muscles and tissues, it takes around 4
hours to enter the blood stream and finally the fat that you eat, enters the blood stream in
2
about 6 hours. By this time if you have a balanced diet, you should be starting to be feeling
hungry somewhere around the 5-6 hour mark.
So if you don’t have a balanced diet, you will become hungry very quickly. To find out more
about a balanced diet, you need to do the Nutrition topic.
Slide 9
So what happens when there is little or no insulin in the body? Well the glucose builds
up in your blood as it has to go somewhere so it goes to the kidneys and is passed out in
urine. This is why sometimes a urine test may be done to see how much glucose is in the
urine however, mostly these days blood tests are done as it is a much more accurate
diagnostic too. I will talk about this in a later slide.
Slide 1 Segment 2
Now let’s look at the
• Difference between Type 1 & Type 2 Diabetes
• Signs & Symptoms of Diabetes
• The tests for diagnosis of Diabetes
• Hypoglycaemia and Hyperglycaemia and how they are different
Slide 2
So how do Type 1 and Type 2 Diabetes differ from each other?
Let’s look firstly at Type 1 diabetes. Here the age is significant. Most people with Type 1
Diabetes are under 30 years of age. So the only people you will see in your care with Type
1 diabetes are those who will have had the condition for a number of years.
Type 2 diabetes on the other hand usually affects people over 40 years of age although this
is not exclusively the case these days. There are a lot of younger people being diagnosed
with type 2 diabetes as it is often related to obesity. You have probably heard a lot of
discussion on radio and TV about this problem.
Type 1 usually starts suddenly. What actually caused the pancreas to suddenly stop
producing insulin is not really known but there is evidence there is a genetic component or a
viral infection may cause it. I have a friend who developed type 1 diabetes shortly after he
nearly drowned so there is some thinking that stress can also play a part in the development
of diabetes.
Type 2 diabetes on the other hand has a very slow onset. This means that a person may
have diabetes for some years before it is diagnosed. So it is a gradual onset that affects
mostly people over 40 but not exclusively. There is a strong obesity link that makes the
insulin receptors resistant to insulin, as I said the insulin cannot get into the cells. Poly
Cystic Ovary Disease or PCOS, which is very common among women, is also a contributor.
However there are many reasons diabetes occurs and sometimes the cause is not known.
There are less people who have Type 1 diabetes, around 10% of the people will have this
type of diabetes but Type 2 on the other hand affects around 90% of people so this is why
you will see more type 2 diabetics than type 1.
I mentioned before the cause of Type 1 diabetes can be genetic, result of an autoimmune
response which basically means the body turns on itself and kills off its cells and the
3
pancreas stops producing insulin. It could be from viral infection or stress or the
environment and for some people there is a genetic component – meaning it is in their
genes.
Type 2 diabetes on the other had does have a familial connection which could be related to
diet and cholesterol levels. Obesity is a strong indicator to and as I said, age. It is more
common in the age group you are looking after
So how are these conditions treated? Well type 1 must have insulin which can only be
given by injection. Can’t be made into a tablet as I said as the stomach juices destroy
insulin.
Type 2 on the other hand can be treated with medication. It is important for you to know
what tablets a person is on as it is essential to know when they should have them. I will talk
about this later.
Now to recap the difference between the 2 diabetes. Type 1 the pancreas doesn’t produce
insulin. Type 2 the pancreas does produce insulin but not enough for the body to use or the
cells receptors doesn’t allow the insulin into the cells – they are resistant.
Slide 3
Signs and symptoms.
It is really important for you to know these. Firstly there will be an increase in thirst. The
person will want to drink more. The difference between the two is that type 1 it will be a
sudden thirst while type 2 the need to drink more will gradually increase. Thirst is much
slower.
Both Type 1 and 2 will notice they need to go to the toilet a lot more but type 1 it will be
sudden and type 2 will be more gradual.
Weight. Type 1 there will be a sudden weight loss. Often extreme and unexplained.
While type 2 people are more likely to be overweight. When they lose weight there will be a
reduction in blood sugar levels which is why it is important to manage a person’s weight.
Irritability is common in both types of diabetes. If the cell become deprived of sugar this can
make a person very tired and irritable. For type 1 it is sudden and unexplained while type 2
it is a more gradual and increasing tiredness, lethargy and of course this makes a person
very irritable.
Yeast infections just keep increasing especially in women. Again these infections are more
sudden with type 1 and a more gradual increase in type 2. A person may just feel they are
never free of them so reoccurring yeast infections is an indicator of diabetes.
The eyes are very sensitive to glucose. In fact diabetics are required to have regular eye
checks as prolonged high blood sugar levels and high blood pressure can lead to blindness.
If a person has wounds that won’t or are difficult to heal can also be an indicator. Too much
glucose in the blood will not allow healing to take place as for wounds to heal the body
requires protein. Protein is essential for cell growth, repair and maintenance. Glucose,
however is a carbohydrate and is for energy.
4
Nerve damage can occur in many parts of the body in diabetics. Researches do not know
exactly why this happens but believe it will be due to many factors. However one of the
early signs of diabetes is tingling in feet and hands.
So as you can see there are a number of signs and symptoms of diabetes. In type 1 they
are sudden while in type 2 more gradual however if these symptoms are ignored a person
would eventually die from a diabetic coma which is why early detection and management is
very important.
Slide 4
Diagnosis of diabetes.
If diabetes is suspected the doctor may do a simple test for blood sugar levels in the surgery
or facility. I will talk more about this later on but essentially it entails pricking the end of a
finger, putting a small drop of blood on a test strip that has been inserted into a glucometer,
and see what the level is. If it is above 11 the doctor may order a second test.
This is a Fasting Glucose test. This is where the person has a blood test taken first thing in
the morning, before they have had anything to eat or drink and the glucose level determined
from this test. If this is abnormal a third test may be done.
This is a Glucose Tolerance Test. This is where a person is given a drink of glucose and
blood is tested every two hours to see how long it takes for the glucose to leave the blood
stream.
Slide 5
Know the difference between Hypoglycemia and Hyperglycemia
It is really important for you to know the difference between high and low blood sugar and
how it affects a person. If you don’t the client will become very unwell and could die.
Knowing these symptoms will enable you to identify early if a person has too much or too
little sugar in their blood so you can do something quickly and prevent a diabetic crisis from
occurring.
When a diabetic person becomes unwell with the flu, or some other infection the diabetic
can have a hyperglycemia attack. This can also occur when a person becomes unwell
and are not eating like in cases of nausea, vomiting or diarrhea. These would be the most
common conditions you are likely to experience. These are the times you need to be very
aware of the signs of hyperglycemia
So if your client looks excited or nervous, has rapid, shallow breathing, complains of a
headache or says they are very hungry then you need to look at the other signs. Do they
have a fast pulse or is their skin moist and pale then you need to check their blood glucose
level and report this to your Registered Nurse or Medical Practitioner immediately plus
record all of these signs and symptoms. These people need sugar immediately.
So you would give them some glucose according to what is written in the clients care plan
or instructed by your Registered Nurse or Medical practitioner. This could be 4 jelly beans
or a sweet drink like lemonade or some 2 glucagon tablets or some other way of getting
sugar into the blood stream quickly. Remember, sugar in this form goes immediately to the
blood stream and will raise the blood sugar level.
However getting their blood sugar level up with this form of glucose will not last for long and
the blood sugar will drop very quickly so you need to give them a more complex
5
carbohydrate which is absorbed into the blood stream much slower that is in around 1-2
hours so they need a sandwich or a meal.
So first give quick acting glucose in the form of something sweet then follow up with a
sandwich or if it is close to their meal time, give them this meal. This will enable to second
wave of glucose to be absorbed more slowly and maintain a stable blood sugar and reduce
the risk of a crisis. You need to be constantly observant as to what is happening with your
client over this time. If they continue to be unwell, you need to know what to do. Your
registered nurse will instruct you or if they are not around, a medical practitioner.
Now hyperglycemias another story. This is when the blood sugar gets too high.
When their blood sugar rises they will be feeling really awful and will be showing you a lot of
signs like being drowsy and confused, be incredibly thirsty, have deep labored breathing
and have a really funny fruity odor on their breath. Their skin will be flushed and dry and
they may complain of abdominal pain. All of these signs and symptoms need to be reported
to your Registered Nurse or medical Practitioner immediately. Take their blood sugar levels
and report that too.
So what causes hyperglycemia in diabetics? Well they may have skipped a meal, or had
too many carbohydrates, eating too many calories, illness, infection, increased stress,
increased exercise, or less exercise than they normally do.
You must be familiar with the person’s Care Plan and know what you need to do if any of
these situations arise. Have a discussion with your Registered Nurse on the specific needs
of your client and know what to look for.
While there is always a possibility a person may go hyperglycemic or hypoglycemic for that
matter, generally speaking if a person has been a diabetic for a long time and is well
controlled they will know how to manage their diabetes. They will usually know what they
can and can’t eat and, if they are on insulin, know how to adjust their insulin to meet the
requirements of their lifestyle.
Where it does become an issue is for people who develop diabetes in later life and they
don’t know how to manage it. People especially at risk are those with dementia so it is up to
you help and monitor their diabetes.
The whole idea is for diabetics to eat regularly food that includes protein, carbohydrate, fats
and fiber in balanced amounts to keep their blood sugar within normal levels so their blood
sugar never goes too high or too low. The nutrition topic will help you understand the food
groups.
Slide 1 Segment 3
Now let’s look a bit closer at Type 1 diabetes and the
• Medications used
• Insulin Pen
• Injection sites
• How to administer insulin
• Problems that can occur with insulin injection
6
Slide 2 – Medication Type 1
Now let’s look at how diabetes is managed. I have talked about management on and off
throughout the presentation so this is a recap. Let’s look more at Type 1 first.
People with Type 1 diabetes are always on insulin. Insulin comes in short, medium and
long acting. It is only ever given by injection usually via a small pen that has a cartridge
inserted in it. This is usually a combination of insulin i.e. short, medium or long acting,
depending on the person’s requirement.
In a pen the correct dose is dialed up and is administered usually into the abdomen
although it can be given in to the top of the arm, the buttocks or the outsides of the top of
the legs. This is commonly given twice a day but sometimes more frequently. The amount
you have to give will be charted on their medication chart.
You must take a person Blood Sugar Level before the insulin is administered and record it
in their records. Insulin is always given 30 mins before food. So it is important that you
know when the meal is going to be served and ensure the person has their insulin in time.
The insulin that is in use can be kept at room temperature as this will reduce the possibility
of inflammation occurring over the injection site but all other insulin must be kept in the
fridge. Insulin also should not be exposed to extremes of temperature as it will affect it
potency.
Before you insert a new cartridge into the pen you must always check the expiry date. Do
not give insulin that is past its expiry date.
A penmix needle can be reused for up to a week although the manufacturers recommend it
as a single use only. It is the only time a needle is ever recapped. Where possible get the
client to inject their own insulin. They will have been specifically trained to do this. It is safe
for them to recap their own needle.
However, if you have to give the insulin then you must make sure you have been trained to
do so. To recap the needle, I suggest you do not hold the needle cap between your fingers
rather you place the needle cap on a flat surface and slide the needle into the cap. Once it
is in the cap, you can then secure the cap with your fingers.
You must at all times keep yourself safe and if by any chance you do sustain needle stick
injury make sure you fill out an Accident Incident Form and notify your Registered Nurse
immediately. They will advise you what to do.
Insulin pen should always be inverted and rolled in your hands about 10 times before giving
the insulin to make sure the long and short acting insulin is mixed. Once the insulin has
been administered, leave the needle in the skin for about 5 seconds to make sure all the
insulin has been administered. You need to also make sure there is no airlock or blockage
in the needle to ensure the full dose of insulin is administered.
While it is preferable for a diabetic to give their own insulin, many diabetics have diabetic
neuropathy which impairs their vision. This mean they may not be able to see well enough
to draw up their insulin. It may be up to you to dial up the required amount of insulin for
them to administer. Get them to check the dialed up amount if they can see enough or
7
another staff member to ensure you have dialed up the correct amount. It is dangerous to
give more or less than what has been prescribed. And don’t forget to wash your hands
before you handle the insulin
Always keep the pen protected in the pouch or container provided by the manufacturer.
This is what an insulin pen looks like. There are many different brands on the market but
they all do the same job.
Slide 3
Insulin Sites
These are the sites used for administering insulin. It is more commonly given in the
stomach area as shown but as the absorption rate is quicker however it can be given in the
legs, arms or buttocks as shown on the diagram but it takes longer to be absorbed by the
body. Always rotate the sites in which insulin is given in a circular motion if possible. Some
people have a site grid that they use to make sure a different site is used each time. If you
use the same spot repeatedly, your body reacts by creating changes in the fatty tissue just
under the skin. It can either cause the fat tissue to deteriorate, and create a pit under the
skin or it can grow a little extra fat tissue there, and create a lump just under the skin. Either
one of these will change the absorption time of insulin. Slides 17-19 will show you what
these complications look like.
Slide 4
Injecting Insulin
Always pinch the skin up and insert the needle at right angles to the body as shown in this
picture. Insulin is always given into the subcutaneous fat layer of the skin and never given
into the muscle. If it goes into the muscle the insulin will be absorbed too quickly and the
person’s blood sugar may drop the person become hypoglycemic. The fat layer is usually
thicker than the needle length which is why insulin is usually given in the stomach area but
as seen in the previous slide, it can be administered in other areas of the body. If you do not
inject at a 90 degree angle, you may end up with a lump under the skin. This means you
may have got between the first two layers of the skin and while the insulin will eventually be
absorbed, you may find the blood sugars are a little higher than normal for a while.
While most people have a good deal of fat in their stomach area, if a person is particularly
thin the needle may have to be put in at a 45 degree angle. However, your registered nurse
will advise you if this is the case. Always remember, if you are unsure ask. This way you
will not only keep yourself safe but also the client.
Skin does not need to be wiped with an alcohol swab before insulin is given. Providing
basic hygiene is applied and a person has a regular bath or shower, the likely hood of
getting an infection is very small so the skin does not need to have any special care before
injecting. Alcohol swabs do not sterilize the skin, it only cleans it like soap and water so
unless there is some reason why the area you are injecting into have become really dirty
then special cleaning of the area is not necessary.
Slide 5
What can go wrong? The reason the insulin administration sites are rotated is because
some people may develop a rash around the area or a condition called Lipoatrophy which is
where there is a loss of subcutaneous or the fatty layer under the skin where the insulin is
injected into. It is where a pitting appearance of the skin develops. While this is a rare
immune reaction, you need to know that if it occurs you need to report it immediately. It can
8
be prevented by changing to a highly purified insulin preparation. You can see lipoatrophy
on this slide. It is easy to recognize.
Slide 6
Another condition is Lipohypertrophy. This is where the fatty tissue or subcutaneous layer
becomes thickened and hard. Essentially it is a lump of fatty tissue that develops under the
skin when insulin is injected into the same site repeatedly you can see it on this slide but the
risk of this complication is lessened by rotating insulin injection sites
Slide 7
A generalized skin rash can occur as you see in this image. While this is rare, you need to
be able recognize any problems that may occur and report them.
So it is really important for you to report any skin problems around the injection site that you
observe immediately.
Slide 8
So to recap - the important things to know about insulin administration
Always wash your hands before drawing it up the insulin or administering it. This is basic
infection control principles that you should know.
It is always better for the person to give their own insulin where possible. While you may
have to draw up the insulin or dial up the right amount for them to give it if they have poor
eyesight or some other cognitive problem they probably can still be able to give it
themselves.
Do not give insulin unless you have been properly trained and are comfortable with giving it.
You do not need to put yourself at risk or the client in your care. If you don’t understand
then ask your Registered Nurse.
If a person is not eating, do not give insulin. Report this to your Registered Nurse or Doctor
and wait for instructions. Record the instructions given and what you did in the client’s
progress notes.
Always make sure you do a blood sugar level before you give insulin. If the blood sugar
level is below 4 withhold the insulin and check with your Registered Nurse or Medical
Practitioner for instructions and always write down the instructions you were given. This
way you are less likely to make any errors and you are covering yourself if anything goes
wrong.
Once a person has been given insulin they must have food within 30 mins so don’t just give
it because it is the right time on the chart or it fits in with your work schedule. Make sure
that the meal is ready for them so they can eat within the required time.
Remember always check with your Registered Nurse or Medical Practitioner if you have any
doubts.
Slide 24 Segment 4
9
We’ve looked at Type 1 diabetes and how it is treated, now we will look more into
Type 2 Diabetes and discuss
• Management of type 2 Diabetes
• Where the problem lies
• Medications for Type 2 Diabetes
Slide 2
As I mentioned earlier, this is the most common type of diabetes you are going to come
across as it occurs more frequently in people over 40 years of age. The people at risk are
those who are overweight especially where the weight sits around what is called the central
body area – the middle abdomen.
The problem here is that in the early stages there are little or no symptoms for the person to
notice and go to the doctor as this type of diabetes develops really slowly and often over
many years. However the damage from diabetes is still occurring in the body over this time.
Mostly people with Type 2 Diabetes are treated with diet, exercise and sometimes
medication as their pancreas is still producing insulin but not enough for their body or the
insulin may not be able to get into the cells. It is like the key to the door has been lost so
the receptors on the muscles and fat cells cannot open the door to let the glucose in to give
you energy. Now if the pancreas can produce enough insulin to overcome this resistance
the blood sugar levels will remain normal but once the pancreas starts to fail and insulin
production reduces the glucose level in the blood will rise.
However while initially people with Type 2 diabetes may be put on a medication it is
becoming more and more common for them to go on to insulin injections to manage their
diabetes. This will only happen when their diabetes is no longer able to be controlled by
diet, exercise and oral medication.
Slide 2
The major problem for Type 2 diabetes is not so much obesity but where the fat lies. You
may have heard of central body fat so what does that mean? If you look at these pictures it
will show you where the body fat collects. This is why these people are more at risk of
developing Type 2 diabetes.
Slide 3
Medication
You may have to give the medications in your work place so you need to know what
diabetic medication a person may be on. It is likely to be Metformin, Glizide or
glibenclamide however the most common is likely to be Metformin.
However for a person to be on medication the pancreas has to be producing some
insulin for the tablet to work. These medications have to be given on time and as charted.
This is usually at breakfast but some people may have it two or three times a day. This is
why you need to know what medication a person is on.
A small proportion of people may feel sick when they take metformin so if they complain of
feeling unwell after their medication you must report this to your Registered Nurse or
Medical Practitioner. Often these people find that having the tablet in the middle of the meal
10
prevents them feeling unwell. You must listen to what the client is telling you and not just
pass it off. I f in doubt, always ask your Registered Nurse.
Also if people cannot eat you must also report this to your Registered Nurse or Medical
Practitioner as the medication may need to be stopped.
I can’t reiterate enough the importance of you observing, recording and reporting what you
see, what you hear and what you notice is going on for your client. Please do not ignore
anything a person tells you and make sure you record the time of day, how often you
have noticed changes and of course the date. All of this is important information.
Remember your Registered Nurse is depending on you to pass on all information even if
you think it is irrelevant. It is not your call to decide how relevant it is. You role is report and
record all changes in your client.
Slide 1 Segment 5
Controlling blood sugar levels are an important part in management of diabetes so in
this segment I will discuss
• How to take a blood sugar measurements
• When to take a blood sugar measurement
• Glucose levels and when it becomes dangerous to the person
• Hypoglycaemia and hyperglycaemia
Slide 2
Blood Sugar level Recording
Before you start this procedure you must always follow infection control principles so wash
your hands and put gloves on before you start this procedure. Get the client to wash their
hand too.
Firstly you prick the finger with the automatic lancet device, put a drop onto the strip, let the
glucometer give you a reading and record it.
Slide 3
Gently squeeze the finger so there is a small amount of blood from the prick.
Slide 4
Allow a small amount of blood to drop on to the testing strip
Slide 5
Wait for the Glucometer to give you a reading
Slide 6
Record the result
You need to be instructed on how to do this procedure by your Registered Nurse so don’t
go and do it without being shown first. Diabetics need to have their blood sugar measured
on a regular basis. The frequency will be written in their Care Plan and/or Medication Chart.
Remember too, if a client is used to doing the blood sugar measurement themselves, then
they should continue to do so but either they have to write the reading down in a note book
or you need to record in their notes. This is how a person’s diabetes is monitored.
11
Slide 7
A person on insulin MUST have their blood sugar level taken before you administer the
insulin as I said earlier so don’t forget this. You need to know what the level is before you
give the insulin because if it is too low the person should not have the insulin and you need
to seek advice.
However a person who is controlled by diet and/or medication will usually have it done only
once a day in the morning or less frequently so you need to read the clients care plan and
do as instructed. You also need to look for special instruction on what to do when blood
sugar levels change. You will see on the next slide what levels are normal and what
dangerous levels are.
Slide 8
Blood Recording levels
You need to know what is normal and what is dangerous for diabetics. You will see on this
slide the Red is danger. If the blood sugar is over 11 then you need to report this. The
person may have missed their medication or insulin or they may have eaten too many
sweets or cakes that have a lot of sugar that reaches the blood quickly.
If the blood sugar level is between 4-7 then the diabetes is pretty well controlled.
And if the blood sugar level is below 4 then they have not had enough sugar. Too much
insulin or medication and too little sugar and they may becoming hypoglycemic and require
some quick acting sugar to help their blood sugar to rise.
So you see why it is important to record and report the blood sugar of your clients especially
if they are on insulin.
Slide 9
If a person has a blood sugar level over 11 they are at risk of having a hyperglycemic
episode and could go into shock. This is a medical emergency. So if a person has mental
confusion or loss of coordination, they could be going into diabetic shock. You need to
report these levels and any other symptoms or signs immediately to your Registered Nurse
or follow the instruction on their Diabetes Management Plan as they may require insulin.
You don’t want a person to go into diabetic shock. Never be afraid to report a blood sugar
level or put off reporting it.
Slide 10
Hypoglycemia on the other hand the person needs glucose. Their Care Plan will tell you
what to give but it may be something like 4 jelly beans or a glass of lemonade or 2 glucose
tablets but you must always remember to give them a sandwich, a glass of milk or a meal
within 10 mins or their blood glucose level will drop again. I know I have mentioned this in
earlier slides but I cannot stress how important it is for you to know what to do as you don’t
want someone to go into a diabetic coma.
Slide 1 – Segment 6
With diabetics there are some very important things you should know and look out
for in a diabetic person. They are
• Diet and the Diabetic
12
•
•
•
Foot Problems that can occur and why
Eye Problems and finally we will
Summarize this session
Slide 2
Diet and Diabetes
Food is really important for a diabetic. They have to eat on a regular basis to keep their
blood sugar at a steady level. If they eat too much carbohydrate their blood sugar will rise
so it is about balance. Remember the earlier slide on how long it takes for different food
groups to enter the blood stream? This must always be at the back of your mind. They
must never miss a meal. If they are not hungry or unwell, or refusing food or unable to eat,
you must report this immediately to you registered nurse who will advise you what you
should do
Carbohydrates should be low glycemic foods which slowly raise the blood sugar rather than
quickly like jelly beans, it means it will also slowly leave the blood stream too. The last thing
you want is for a person with diabetes to have fluctuating blood sugars as each time this
happens, the organs in their body become damages. So balance is the key.
Overeating will also affect their blood sugar so you need to understand how the body works.
Slide 3
What can go wrong with a person with diabetes.
Firstly Foot Care.
A person with diabetes is at risk of gangrene which means the foot actually dies and can
lead the person having to have their limb or part of their limb amputated. This is due to
blood supply impairment which means that oxygen doesn’t get to the feet and nerve
damage meaning they are unable to feel when there is pressure on their foot or something
is sticking into their foot. Therefore it is important these people do not wear tight shoes or
sit with their foot up against a hard surface. If you notice any skin or nail bed infection you
must report immediately. A person with diabetes should have regular foot care from a
registered podiatrist so you should never cut a diabetic's toenails in case you injure a
person. You must also report any skin infections on their foot as with the nerve damage
and circulation problems a person is at great risk of psoriasis. So take really good care of
the diabetic person’s feet. So let’s look at what happens to the diabetic foot.
Slide 4
You can see in these slides how the circulation is affected. On the Left is a normal foot
circulation and on the right is the diabetic foot.
Slide 5
This picture shows where two pressure areas have formed. With the lack of blood and
nerve supply to the foot these are very difficult to heal in fact they may never heal and lead
to gangrene. So it is essential a diabetic person has good fitting shoes that are not going to
cause any pressure and the foot kept away from any hard surfaces
Slide 6
Nail bed infection
13
This picture shows you what to look for. As soon as you see a red area on a toe nail, you
need to report immediately and the toe needs to be looked at by a podiatrist to clear the
infection up early so it doesn’t lead to ulcers or at the worst gangrene and the person
requires a part of the leg amputated.
Slide 7
Always wear soft comfortable shoes free of any pressure points. Never sit with their feet or
legs up against any hard surfaces. Relieve pressure when lying in bed. Report any cuts or
lesions on lower leg. Never sit too close to heaters. Avoid using hot water bottles or wheat
bags. Report any discoloration of toes or feet
Slide 8
Diabetic Eye Disease or Diabetic Retinopathy it is called affects the blood vessels at the
back of the eye. You can see how they are damaged in the first picture on this slide. The
second picture shows what a person sees so reporting visual disturbance, blurring vision is
really important.
Slide 9
All diabetics should have an annual eye check up to monitor the progression of the disease
and how it is affecting their vision. Some people do become what is known as “legally blind”
which means their sight is severely impaired and are blind.
Slide 10
So let’s recap. You must report to your registered nurse or medical practitioner if a diabetic
person has
 a blood sugar level goes below 4 or above 11 or
 is always complaining of being hungry and asking for food or
 isn’t eating or
 is confused and saying silly things or
 complains of a headache or fuzzy head or
 has a really strange smell on their breath – something you haven’t smelled before or
have and know it is signaling danger or
 is drowsy and difficult to rouse or
 excited or nervous or
 complains of being extremely thirsty or
 has a change in breathing pattern or
All of these are signs that could mean a person is hypoglycemic or hyperglycemic so know
your clients.
14