Diabetes is a common condition characterised by high levels of glucose in the blood. There are two main types – Type 1 diabetes, where the body fails to produce any insulin and Type 2 diabetes where the body produces insulin but fails to manage it effectively. Diabetes.co.uk estimates that diabetes affects around 4 million people in the UK, and most people diagnosed with the condition are able to manage with minimal external care requirements. For the older population, however, there might be a need for additional support to manage the condition effectively.

What is Type 2 Diabetes?

To gain a good understanding of what diabetes is, it is important to understand what role insulin plays in the body. Insulin is a hormone produced by the pancreas which works to regulate the levels of glucose (blood sugar) in the blood, specifically by keeping glucose levels from getting too high (hyperglycemia) or too low (hypoglycemia). In Type 2 diabetes (previously referred to as non-insulin-dependent diabetes), the body is either ineffective at using the insulin it produces (insulin resistance), or it is simply not producing enough insulin to cope with its metabolic requirements.

As a result of this reduced ability of the body to regulate blood glucose levels, food that most people consider ordinary could be considered metabolic poison to people with diabetes. For this reason, people with diabetes are advised to avoid foods containing sugar.

Once a person is diagnosed with diabetes, it becomes necessary to carry out a series of regular tests and checks to prevent some of the major complications which could result from improperly managed diabetes.

Regular tests required for people diagnosed with diabetes include:

• Blood sugar tests (HbA1C test) every 3 months to confirm that the blood sugar levels remain within the normal range. Once it is established that levels are relatively stable, the tests are carried out every 6 months.
• Annual podiatry (feet) checks to ensure that a healthy supply of blood to the feet is maintained and that there are no ulcers or infections.
• Annual eye checks to assess the possibility of damage to the blood vessels supplying the eye (retinopathy).
• Annual checks for high blood pressure, heart and kidney disease, as patients with diabetes are at increased risk of heart disease.

How is Type 2 Diabetes managed?

Type 2 diabetes is a manageable condition, and the good news is that all that many people can control their diabetes by taking active steps to stay well. Lifestyle modifications such as avoiding dietary carbs and regular exercise can prevent the need to go on long-term medication. NICE, the body that oversees best clinical practice specifically recommends high-fibre, low-glycemic-index (low-GI) carbohydrates such as vegetables, beans and pulses for people with diabetes. In addition to this, the NICE guidelines (NG28) also state that treatment for Type 2 diabetes should suit individual needs and preferences. With this in mind, patients with complex care needs may find that lifestyle modifications may simply not be sufficient enough to manage their diabetes effectively.

For example, if a person is elderly or has other existing co-morbidities, managing their diabetes may involve as much as 24-hour round-the-clock care. If this person is dependent on insulin, he/she is at a greater risk of hyperglycemia or hypoglycaemia and will need to be under round-the-clock care. At HP Homecare, implementing this level of care would involve a meeting with the hospital team at the initial stage. This meeting would involve a collaboration between the hospital team and the home care team to create a care plan for looking after the patient at home. This plan will include training for any additional equipment that the patient needs (e.g, a hoist) as well as an emergency protocol, to be implemented in the event of an emergency. Our carers will be trained to the specifications of the care plan and assigned to the patient on a 12-hour shift cycle pattern to ensure that she is under constant companionship and monitoring for any worrying signs such as blisters on the feet, for example. Personal hygiene tasks such as washing, cooking, cleaning would be included under this package as well as medicine administration through the day and night.

Most patients with diabetes are usually prescribed oral medication such as metformin, which works by preventing the liver from delivering too much glucose into the bloodstream especially during the night. In addition to metformin, some patients may also be prescribed insulin therapy which entails having a dose of insulin injected under the skin around mealtimes to enable the body process dietary glucose correctly. The quantity of insulin required to effectively process the patient’s dietary glucose is dependent on the nature of food eaten, the timing of meals, exercise and other factors. As insulin is an injectable drug, the carers are trained to administer insulin in the area recommended by the diabetes nurse for effective delivery into the bloodstream. The high level of dependence of this patient on medication means that the carer's role includes ensuring that the patient never misses a dose of medication or insulin.

But diabetes home care is not just as simple as round-the-clock care with fully trained carers. The nature of diabetes as a progressive disease requires regular visits from a clinical visiting nurse weekly or bi-weekly depending on the patient. These regular visits ensure that medication and blood glucose levels are closely monitored and that if there is any need to change medication or system of care, action is taken quickly.

Multidisciplinary Management

One of the benefits of having round the clock care administered at home is that there is a strict regime of record-keeping which ensures continuity of care. This is a vital aspect of patient management, as there is a bigger multidisciplinary team involved in the care of patients with advanced diabetes, and these records could be crucial in making important clinical decisions further down the line.

The multidisciplinary team involved in the management of a diabetes patient includes:

• The GP, who prescribes medication
• A diabetes nurse based in hospital
• Practice nurse
• Podiatrist or foot specialist for annual feet checks
• Endocrinologist
• Dietician, who reviews the diet
• Ophthalmologist, who reviews annual retina screening for monitoring retinopathy
• Pharmacist, for reviewing medication
• Psychologist to deal with the emotional effects of diabetes

Ultimately, diabetes is unlikely to affect every person in the same way. So when considering care solutions for diabetic patients, it is best to take patient’s needs and preferences into consideration. If you would like to discuss your care options with an expert, feel free to call to speak to a member of our expert team at HP Homecare. This article concludes our series on diabetes management, and our next few articles will cover both self-directed and nurse-led home care for patients following surgery.