Learning Guide
Diabetes
28547 Support a person with diabetes in a health or wellbeing setting / Level 3 / 3 creditsName:
Workplace:
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) 10
The impact of diabetes 13
Supporting a person with diabetes 14
Illness and diabetes 14
What to look out for: 15
Signs of dehydration or bladder infection 15
Reporting and monitoring 16
Glossary 17
Diabetes (US 28547) Learning Guide © Careerforce – Issue 1.0 | July 2015
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:
· 28547 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.
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.
· 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.
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 amongMāoriand 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.
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.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 between2% 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.
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 ifmost of the weight is around the waist).
· has been diagnosed with pre-diabetes, in which the glucose (sugar) in the blood is higher thannormal, 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.
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.
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.
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.
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 riskof 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.
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.
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.
Symptoms of Hypoglycaemia
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.