Care of People with Diabetes

Professor Trisha Dunning is Inaugural Chair in Nursing at Deakin University and Barwon Health, Australia. She is an honorary Life Member of the Australian Diabetes Educators Association, a Vice President of the International Diabetes Federation and a distinguished Life Fellow of the Royal College of Nursing, Australia.

Foreword xv Preface xvi Acknowledgements xviii List of Abbreviations and Symbols xix 1 Diagnosing and Classifying Diabetes 1 Key points 1 What is diabetes mellitus? 2 Prevalence of diabetes 2 Classification of diabetes 3 Overview of normal glucose homeostasis 4 The metabolic syndrome in children and adolescents 7 Type 1 and Type 2 diabetes 8 Type 2 diabetes in Indigenous children and adolescents 15 Gestational diabetes 15 Example Information Sheet: Preparation for an oral glucose tolerance test 20 Screening for diabetes 21 Preventing Type 2 diabetes 22 Preventing Type 1 diabetes 25 Managing diabetes mellitus 25 Key points 25 Aims of management 27 Exercise/activity 29 Diabetes education 32 Complications of diabetes 33 Aim and objectives of nursing care of people with diabetes 34 Technology and diabetes management 36 A sobering final comment 38 References 38 2 Holistic Assessment, Nursing Diagnosis, and Documentation 44 Key points 44 Rationale 44 Holistic nursing 45 Care models 45 Characteristics of an holistic nursing history 47 Nursing history 49 Example Health Assessment Chart 50 Instruments to measure health status 54 Documenting and charting patient care 54 Care plans 55 Nursing responsibilities 56 Documentation by people with diabetes 57 References 58 3 Monitoring Diabetes Mellitus 60 Key points 60 Rationale 60 Introduction 61 Monitoring 1: Blood glucose 61 Key points 61 Blood glucose testing checklist 71 Monitoring 2: Urine glucose 73 Key points 73 Monitoring 3: Additional assessment 76 Self-care 80 The annual review 81 References 81 4 Nutrition, Obesity and Exercise 84 Key points 84 Rationale 84 The importance of good nutrition 85 Obesity 85 Overview of the pathogenesis of obesity 86 The significance of abdominal obesity 87 Nutrition, obesity and stress 88 Methods of measuring weight 88 Managing obesity and diabetes 90 Malnutrition and under-nutrition 90 Method of screening for dietary characteristics and problems 93 Principles of dietary management for people with diabetes 94 Goals of Dietary Management 97 Dietary management: obesity 98 Bariatric surgery 99 Complementary weight loss programmes 101 Factors associated with making dietary changes 101 Nursing responsibilities 102 References 107 5 Medicines Management 111 Key points 111 Introduction 112 Quality Use of Medicines (QUM) 112 Quality Use of Medicines and Diabetes 113 Oral Glucose-Lowering Medicines (GLM) 114 The incretin hormones 124 New medicines for type 2 diabetes 125 Medicine interactions 126 When should insulin be initiated in Type 2 diabetes? 128 Barriers to insulin therapy 132 Some strategies to overcome the barriers 132 Insulin therapy 133 Types of insulin available 134 Injection sites and administration 137 Mixing short- and intermediate-acting insulins 138 Commonly used insulin regimens 139 Interpreting morning hyperglycaemia 140 Continuous subcutaneous insulin infusion (CSII) 141 Continuous blood glucose sensors 142 Subcutaneous insulin sliding scales and top-up regimes 143 Uses of insulin infusions 145 Insulin allergy 147 Transplants 148 Stabilising diabetes 148 Stabilising diabetes in hospital 149 Community and outpatient stabilisation 150 Lipid-lowering agents 152 Monitoring lipid medicines 157 Antihypertensive agents 157 Antiplatelet agents 160 Medication safety, adherence and medication self-management 161 Enhancing medication self-care 163 Example protocol for outpatient stabilisation onto insulin 166 References 167 6 Hypoglycaemia 174 Key points 174 Rationale 174 Introduction 175 The counter-regulatory response 176 Definition of hypoglycaemia 178 Recognising hypoglycaemia 180 Counter-regulatory hormonal response to hypoglycaemia 181 Causes of hypoglycaemia 181 Preventing and managing hypoglycaemia 182 Hypoglycaemic unawareness 183 Prevalence of hypoglycaemic unawareness 183 Nocturnal hypoglycaemia 184 Relative hypoglycaemia 187 Medicine interactions 187 Objectives of care 188 Treatment 188 Prolonged hypoglycaemia 189 Patients most at risk of hypoglycaemia 190 Psychological effects of hypoglycaemia 191 Consequences of hypoglycaemia 192 Guidelines for administering glucagon 193 Adverse reactions 194 References 194 7 Hyperglycaemia, Acute Illness, Diabetic Ketoacidosis (DKA), Hyperosmolar Hyperglycaemic States (HHS), and Lactic Acidosis 198 Key points 198 Rationale 199 Prevention: proactively managing intercurrent illness 199 Self-care during illness 201 Hyperglycaemia 201 Diabetic ketoacidosis (DKA) 203 Brittle diabetes and hyperglycaemia 210 Euglycaemic DKA 210 Hyperosmolar Hyperglycaemic States 211 Presenting signs and symptoms 212 Lactic acidosis 213 Lactic acidosis associated with Metformin 215 References 216 8 Long-Term Complications of Diabetes 218 Key points 218 Introduction 219 Pathophysiology of diabetes complications 219 Cardiovascular disease and diabetes 221 Key points 221 Rationale 222 Medicines and cardiovascular disease 223 Complementary medicines (CAM) 226 Other management considerations 227 Mental health and cardiovascular disease 228 Nursing responsibilities 229 Telephone coaching 233 Cerebrovascular disease 233 Signs and symptoms 234 Diabetes and eye disease 235 Key points 235 Rationale 235 Introduction 235 Risk factors for retinopathy 236 Diabetes and renal disease 241 Key points 241 Introduction 241 Stages of chronic kidney disease 241 Risk factors for renal disease 242 Renal failure 243 Renal disease and anaemia 245 Diet and renal disease 245 Renal disease and older people 247 Kidney biopsy 247 Renal dialysis 247 Objectives of care 249 Nursing responsibilities 250 Commencing CAPD in patients on insulin 250 Educating the patient about CAPD 251 Supportive care 252 Renal disease and herbal medicine (see also Chapter 19) 252 Peripheral and autonomic neuropathy 253 Key points 253 Introduction 253 Vascular changes 254 Infection 255 Diabetes-related peripheral neuropathy 257 Other pain management strategies 258 Stages of peripheral neuropathy 259 Risk factors for developing foot problems 259 Objectives of care 260 Nursing responsibilities 260 Classification of foot ulcers 262 Wound management 262 Wound management techniques under study 264 Rehabilitation 264 Autonomic neuropathy 265 Key points 265 Introduction 265 Diagnosis and management 267 Nursing care 268 References 269 9 Management During Surgical and Investigative Procedures 277 Surgical procedures 277 Key points 277 Rationale 277 Introduction 278 Children with diabetes undergoing surgical procedures 279 Older people with diabetes and surgical procedures 280 Aims of management 280 Preoperative nursing care 281 Major procedures 284 Postoperative nursing responsibilities 286 Minor procedures 287 Insulin pump therapy in patients undergoing surgery 288 Emergency procedures 289 Bariatric surgery 290 Investigative procedures 290 Key points 290 Rationale 290 The objectives of care 291 General nursing management 291 Eye procedures 292 Complementary therapies and surgery and investigative procedures 295 Preoperative phase 295 Postoperative phase 296 Implications for nursing care 297 References 297 Example Instruction Sheet 2(a): Instructions for people with diabetes on oral glucose-lowering medicines having procedures as outpatients under sedation of general anaesthesia 298 Example Instruction Sheet 2(b): Instructions for people with diabetes on insulin having procedures as outpatients under sedation or general anaesthesia 299 10 Conditions Associated with Diabetes 300 Key points 300 Introduction 300 Enteral and parenteral nutrition 301 Aims of therapy 301 Routes of administration 302 Choice of formula 304 Nursing responsibilities 304 Diabetes and cancer 306 Management 307 Objectives of care 308 Nursing responsibilities 309 Managing corticosteroids in people with cancer 310 Complementary therapies and cancer 311 Smoking, alcohol, and illegal drug use 312 Smoking 312 Nicotine addiction 314 Assisting the person to stop smoking 315 Medicines to support smoking cessation 317 Alcohol addiction 317 Illegal drug use 319 Effects on diabetes 321 Interactions with medicines 322 Management issues 322 Brittle diabetes 323 Introduction 323 Causes of brittle diabetes 324 Management 324 Oral health and diabetes 325 Introduction 325 Causal mechanisms 326 Management 326 Diabetes and liver disease 327 Introduction 327 Managing people with diabetes and liver disease 328 CAM medicines 329 Haemochromatosis 329 Iron overload 330 Management 330 Diabetic mastopathy 330 Diagnosis 330 Management 331 Diabetes and coeliac disease 331 Signs and symptoms 332 Diagnosis 332 Management 333 Cystic fibrosis-related diabetes 333 Diagnosis 334 Signs and symptoms 335 Management 335 Sleep disturbance and diabetes 335 Diagnosis 336 Management 337 Diabetes and tuberculosis 337 Management 337 Diabetes and HIV/AIDS 338 Management 338 Diabetes and hearing loss 339 Causes of hearing loss 339 Management 340 Diabetes and musculoskeletal diseases 341 Management 342 Corticosteroid and antipsychotic medications and diabetes 342 Key points 342 Introduction 342 Management 344 Antipsychotic medicines 345 Diabetes and driving 346 Prevalence of and risk factors for driving crashes 346 Diabetes-related effects on driving 349 Hypoglycaemia effects on driving 352 Strategies to enhance driving safety 353 Information for people with diabetes to help them drive safely 354 Diabetes and fasting for religious observances 355 Education and counselling 356 References 356 11 Diabetes and Sexual and Reproductive Health 365 Key points 365 Rationale 365 Sexual health 366 Sexual development 367 Sexual problems 367 Possible causes of sexual difficulties and dysfunction 368 Sexuality and older people 369 Women 369 Men 370 Investigation and management 371 Medication management for ED 372 Non-pharmacological therapy 372 Complementary medicines for sexual problems (CAM) 373 Involving partners in ED management 374 Sexual counselling 374 The PLISSIT model 376 Role of the nurse 377 References 377 12 Diabetes in Older People 379 Key points 379 Rationale 380 Introduction 380 Determining functional status 386 Geriatric syndromes 388 Cognitive functioning 388 Depression and older people with diabetes 394 Dementia 394 Managing diabetes in older people 395 Management aims 395 Factors that affect management decisions 396 Guidelines for administering diabetes medicines with enteral feeds 401 Education approaches 402 Self-care 403 Factors that can affect metabolic control 404 References 414 13 Diabetes in Children and Adolescents 422 Key points 422 Rationale 422 Introduction 423 Managing children and adolescents with diabetes 425 Aspects of care that apply to both Type 1 and Type 2 diabetes in children and adolescents 425 Managing Type 1 diabetes 427 Managing childhood Type 2 diabetes 430 Medication self-management 431 Other conditions associated with diabetes 431 Complementary therapy use in children 432 Strategies for enhancing adherence during adolescence 433 Ketoacidosis in children 434 References 434 14 Women, Pregnancy, and Gestational Diabetes 438 Key points 438 Rationale 438 Polycystic ovarian syndrome 439 Pregnancy 442 Complications of pregnancy 446 Effects of diabetes on the baby 447 Longer term effects of maternal hyperglycaemia on the child 448 Gestational diabetes 448 Risk factors for gestational diabetes? 449 Managing gestational diabetes 450 Type 1 diabetes 451 Type 2 diabetes 452 Menopause and diabetes 452 Signs and symptoms of menopause 453 Managing the menopause 453 Contraception options for women with diabetes 454 Complementary approaches to managing the menopause 456 References 458 15 Psychological and Quality of Life Issues Related to Having Diabetes 463 Key points 463 Rationale 464 Introduction 464 Depression 469 Symptoms of depression 470 Maintaining mental health and managing depression 470 Screening for psychological distress and depression 472 Antipsychotic medicines and diabetes 473 Type 1 diabetes 473 Type 2 diabetes 474 Compliance/adherence/concordance 475 Psychological distress and cardiovascular disease 476 Quality of life 478 References 479 16 Diabetes Education 483 Key points 483 Rationale 484 Introduction 484 Learning styles 486 Education and other theories/models 489 Communication the central element of effective teaching and learning 492 Teaching: an art and a process 494 Health literacy 495 Survival skills 498 Sample diabetes education record chart 499 Empowerment 501 Special issues 502 The nurses role in diabetes education 502 Insulin administration 504 Guidelines for teaching people about insulin delivery systems 504 Documenting diabetes education 505 Examples instruction sheets 505 Example Instruction Sheet 3: How to draw up insulin from one bottle 505 Example Instruction Sheet 4: How to draw up insulin from two bottles (usually a short/rapid acting and an intermediate acting insulin) 506 Example Instruction Sheet 5: How to give an insulin injection using syringes or insulin pens 506 Example Instruction Sheet 6a: Managing your diabetes when you are ill: patients with Type 1 diabetes 506 Example Instruction Sheet 6b: Managing your diabetes when you are ill: patients with Type 2 diabetes 508 Evaluating diabetes education 509 References 511 17 Nursing Care in the Emergency, Intensive Care, Outpatient Departments, Community and Home-Based Care and Discharge Planning 516 Key points 516 Community, practice and home care nurses are in an ideal position to deliver preventative health care education 516 Rationale 516 The emergency department 517 Intensive Care (ICU) 519 The outpatient department 519 Community, Practice Nursing, and Home-Based Care 520 Introduction 520 How to obtain advice 521 General points 521 Disposing of sharps in the home situation 527 Storing insulin 528 Practice nurses 528 Discharge Planning 529 Key points 529 References 530 18 Managing Diabetes at the End of Life 532 Key points 532 Introduction 533 Palliative care and diabetes 534 Key issues in palliative and end of life care 534 The end of life process 538 Key management considerations for managing diabetes at the end of life 540 Glycaemic targets 541 Blood glucose monitoring 541 Hyperglycaemia 542 Hypoglycaemia 542 Medicine management 543 Type 1 diabetes 543 Type 2 diabetes 544 Nutrition and hydration 545 Diabetogenetic medicines 546 Managing corticosteroid-induced diabetes in palliative care patients 547 Antipsychotic medicines 547 Supporting family/carers 548 Withdrawing treatment 548 Diabetes education 549 References 549 19 Complementary and Alternative Therapies 552 Key points 552 Rationale 552 Introduction 553 CAM philosophy 555 Integrating complementary and conventional care 556 Can complementary therapies benefit people with diabetes? 558 Spirituality 561 CAM and surgery 561 Herb/medicine interactions 567 How can complementary therapies be used safely? 568 Nursing responsibilities 569 Identifying quality health information on the Internet 570 References 572 Index 575