for HCSWs Katharine Ramage Diabetes MCN Professional Education LeadDSN Learning Outcomes Develop an understanding of the different types of diabetes risk factors for developing diabetes how it can present and how it is diagnosed ID: 1047771
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1. Management of DiabetesDiabetes Education for HCSWsKatharine RamageDiabetes MCN Professional Education Lead/DSN
2. Learning OutcomesDevelop an understanding of the different types of diabetes, risk factors for developing diabetes, how it can present and how it is diagnosedDemonstrate an awareness of diabetes complications, signs and symptoms to recognise and how to reduce risksUnderstand the impact of diet and lifestyle on diabetes and their role in managing the conditionDemonstrate knowledge of the range of assessment and monitoring methods related to the management of diabetesDevelop an understanding of foot problems related to diabetes and learn how to assess and refer appropriately
3. What is Diabetes?
4. “…a disorder of carbohydrate metabolism characterised by impaired ability of the body to produce or respond to insulin and thereby maintain normal blood sugar (glucose) levels in the blood.”Oxford dictionary
5. Not one conditionType 1Autoimmune conditionComplete lack of insulinLess common than T2D but increasing prevalenceDiagnosis at any age but more common in children and young peopleEnvironmental factorsType 2Defects in insulin action and secretionInsulin resistanceGradual onset -may be asymptomatic at diagnosisStrong association with weight and lifestyle
6. Do you know of any other types of Diabetes?MODY (Maturity Onset Diabetes in the Young)LADA (Latent Autoimmune Diabetes in Adulthood)Steroid induced diabetesNeonatal diabetesSecondary Diabetes eg: Cystic Fibrosis, pancreatitis, alcoholGestational Diabetes
7. Prevalence of DiabetesCountryNumber of peopleEngland3,319,266Scotland301,523Wales198,883Northern Ireland99,833UK Total 3.9 millionDiabetes UK Stats and Facts 20191 in 15 people in the UK have diabetes including 1 million with undiagnosed T2D2019
8. Risk factors for T2 diabetesGenetic predispositionEthnicity Family historyIncreasing ageObesity Sedentary lifestylesEnergy dense dietsDeprivation8
9. Presentation of Type 2Weight lossPolyuria (Increased passing of urine)Polydipsia (Excessive thirst)Change in eyesightGenital thrushLethargyChange in Libido
10. Presentation of Type 1Weight lossPolyuriaPolydipsiaChange in visionGenital thrushLethargyChange in menstruationChange in hair textureDisturbance of libido
11. Diagnosis Random Blood Glucose/OGGT/Fasting glucose ( please see guidelines )Hco3/Beta ketones, U+E, LFT, HbA1c, Lipid profile, TFTUrineGAD, IA2 and ZnT8 antibodiesC-peptide, 3 years post diagnosisIn type 1, random glucose usually high and associated with ketones
12. Guidelines and Evidence to support care and treatment for diabetesSIGN, 2010,Update 2017Evidence based Nutrition guidelines for the preventions and management of Diabetes. Diabetes UK2018 Sources:
13. Guidelines and Evidence to support care and treatment for diabetesFramework for Prevention and early intervention T2DScottish Government 2018SIGN 154Pharmacological management of glycaemic control in people with type 2 diabetesNov 2017
14. Diabetes resources Edinburgh Centre for Endocrinology and Diabetes: http://www.edinburghdiabetes.comThe Lothian Diabetes Handbook - provides the recommended management guidelines for staff caring for all patients in Lothian with diabetes -Available on the intranet (currently being updated)Diabetes UK: www.diabetes.org.uk
15. How and why do we manage diabetes?Prevention of complications
16. Aim of TreatmentRelieve acute symptomsAvoid extremes of hypo and ketoacidosisReduce risk of micro and macrovascular complicationsMaintain near-normal control of blood glucose levelsBlood pressure controlWeight loss in overweight/ obese, weight maintenanceMaintain quality of life SIGN 116, 2010 & 2017
17. ComplicationsMicrovascularLoss of vision - RetinopathyRenal failure -NephropathyFoot ulceration - NeuropathyMacrovascularCardiovascular Disease – stroke, heart disease i.e. MIPeripheral arterial disease
18. Bate and Jerums (2003) Med J Aust; 179 (9): 498-503Mainly type 1: Hypoglycaemia; Diabetic ketoacidosisMainly type 2: Hyperosmolar hyperglycaemic stateLong term:Short term:
19. Smokers - advise to stop and offer supportComponents of diabetes managementType 1 (10% of adults)Diet + insulinType 2 (90% of adults)Gestational (5% preg.)Lifestyle alone Lifestyle + medicationStrong association with obesityLifestyle management important for ALL types of diabetes and those at high risk
20. Monitoring/ScreeningHbA1c measurementBlood pressure measurementCholesterol level measurementRetinal screeningFoot checksUrinary albumin testingSerum creatinine testingWeight measurementSmoking status check
21. Support self managementStructured Education Programmes to support self management in diabetes and for prevention of type 2 diabetes
22. Progress..........There is no ‘one size fits all’ treatment for diabetes and that certainly applies to diet and nutritionThere is no ‘diet for diabetes’Giving advice is no longer a case of issuing a list of do’s and don’tsPerson centred approach to education to promote supported self management