Care of People with Diabetes: A Manual of Nursing Practice, 2nd edition

Diabetes Mellitus is a chronic disease affecting a large percentage of the population world-wide. In the UK alone there are over 1.4 million people diagnosed with diabetes, a new diagnosis of type 2 diabetes is made every five minutes, and as many as a million people are suspected to have the condition without knowing it. As many as one in ten patients in hospital have diabetes and diabetes accounts for almost a tenth of NHS spending, largely due to the high costs of complications such as heart disease, blindness, kidney disease, stroke, and amputation which all require specialist nursing care. This manual is an essential guide to the care and management of people with diabetes mellitus, aimed at nurses and healthcare professionals, and written by an experienced clinical nurse specialist with extensive knowledge of evidence-based diabetes care. This revised and updated second edition of Care of People with Diabetes serves as an essential companion to clinical practice with a particular emphasis on the acute care setting. Detailed information is included on the underlying pathophysiology and types of diabetes, assessment and management of diabetes, formulating care plans, and patient instruction. New chapters are included on sexual health, older people, and complementary therapies and the chapter on special circumstances has been substantially revised. Important new information is also included on corticosteroids, brittle diabetes, autonomic neuropathy, teeth, gums and haemochromatosis. Contents......Page 9 List of Figures......Page 19 List of Tables......Page 20 Example Forms and Instruction Sheets......Page 22 Foreword......Page 23 Preface......Page 25 Acknowledgements......Page 28 List of Abbreviations and Symbols......Page 29 1.3 Classification of diabetes......Page 31 1.4 Type land Type 2 diabetes......Page 32 1.5 Diagnosis of diabetes......Page 38 1.6 Oral glucose tolerance test (OGTT)......Page 39 Example Instruction Sheet 1: Preparation for an oral glucose tolerance test......Page 40 1.8 Management of diabetes mellitus......Page 41 1.9 Diabetes education......Page 46 1.10 Complications of diabetes......Page 47 1.11 Cost of diabetes......Page 48 1.12 Aim and objectives of nursing care of people with diabetes......Page 49 References......Page 51 2.2 Characteristics of the nursing history......Page 52 2.3 Nursing history......Page 53 Example of an assessment chart......Page 54 3.1 Documenting in the medical record......Page 59 References......Page 63 4.1 Introduction......Page 64 4.3 The role of blood glucose monitoring in the care of diabetes......Page 65 4.4 Guidelines for the frequency of blood glucose monitoring......Page 66 4.5 Blood glucose meters......Page 68 4.7 Non-invasive/minimally invasive blood glucose testing......Page 69 4.8 Monitoring blood ketones......Page 70 Blood glucose testing checklist......Page 71 4.11 Limitations of urine glucose testing......Page 74 4.13 Monitoring ketones......Page 75 4.15 Micral-test......Page 76 4.16 Nursing responsibilities......Page 77 4.19 Fructosamines......Page 78 4.21 C-peptide......Page 79 4.24 Oral glucose tolerance test (OGTT)......Page 80 References......Page 81 5.2 Role of the nurse......Page 82 5.3 Obesity......Page 83 5.4 Method of screening for dietary characteristics and problems......Page 84 5.5 Principles of dietary management for people with diabetes......Page 85 5.6 'Sugar-free'foods......Page 86 5.10 Alcohol......Page 87 5.14 Example questions to ask when taking a diet history......Page 88 References......Page 89 6.2 Introduction......Page 90 6.4 Biguanides......Page 91 6.7 Alpha-glucosidase inhibitors......Page 93 6.8 Drug interactions......Page 96 6.10 Combining OHAs and insulin......Page 97 6.11 Lipid lowering agents......Page 98 References......Page 99 7.2 Basic insulin action......Page 101 7.4 Types of insulin available......Page 102 7.6 Injection site and administration......Page 104 7.8 Common insulin regimes......Page 107 7.9 Continuous subcutaneous insulin infusion (CSII)......Page 114 7.10 Sliding scale and top-up regimes......Page 116 7.11 Intravenous insulin infusions......Page 117 7.12 Uses of insulin infusions......Page 118 7.13 Risks associated with insulin infusions......Page 119 7.15 Mistakes associated with insulin infusions......Page 120 7.17 Insulin allergy......Page 121 References......Page 122 8.3 Definition of hypoglycaemia......Page 124 8.4 Recognising hypoglycaemia......Page 125 8.7 Treatment......Page 126 8.8 Nocturnal hypoglycaemia......Page 128 8.11 Drug interactions......Page 129 8.13 Psychological effects of hypoglycaemia......Page 130 8.14 Guidelines for the administration of glucagon......Page 131 References......Page 132 Rationale......Page 133 9.3 Outpatient stabilisation......Page 134 References......Page 137 Example protocol for outpatient stabilisation onto insulin......Page 138 10.3 Diabetic ketoacidosis (DKA)......Page 140 10.4 Hyperosmolar non-ketotic coma (HONK)......Page 147 10.7 Lactic acidosis......Page 149 References......Page 150 Rationale......Page 151 11.3 Nursing responsibilities......Page 153 11.5 Rehabilitation......Page 155 11.8 Cerebrovascular disease......Page 156 References......Page 157 12.2 Introduction......Page 158 12.3 Aims of management......Page 159 12.4 Preoperative nursing care......Page 160 12.5 Major procedures......Page 161 12.7 Minor procedures......Page 162 References......Page 164 Example Instruction Sheet 2(a): Instructions for diabetic patients on oral hypoglycaemic agents having procedures as outpatients under sedation or general anaesthesia......Page 165 Example Instruction Sheet 2(b): Instructions for diabetic patients on insulin having procedures as outpatients under sedation or general anaesthesia......Page 166 13.2 The objectives of care......Page 167 13.5 Eye procedures......Page 168 13.6 Care of the patient having radiocontrast media injected......Page 170 Introduction......Page 172 14.2 Aims of therapy......Page 173 14.3 Routes of administration......Page 174 14.5 Nursing responsibilities......Page 175 References......Page 177 14.7 Objectives of care......Page 178 14.8 Nursing responsibilities......Page 179 References......Page 180 14.10 Introduction......Page 181 14.11 Diagnosis and management......Page 182 14.12 Nursing care......Page 184 References......Page 185 14.15 Effect on blood glucose......Page 186 14.17 Management......Page 187 References......Page 188 14.20 Management......Page 189 Reference......Page 190 14.22 Introduction......Page 191 References......Page 192 14.28 Management......Page 193 References......Page 194 Reference......Page 195 15.2 Introduction......Page 196 15.4 Eye problems associated with diabetes......Page 197 15.5 Resources for people with visual impairment......Page 198 15.7 Nursing care of visually impaired patients......Page 199 References......Page 200 16.3 Risk factors for renal disease......Page 201 16.5 Renal disease and anaemia......Page 202 16.7 Renal disease and the elderly patient......Page 203 16.9 Renal dialysis......Page 204 16.10 Objectives of care......Page 205 16.12 Commencing CAPD in patients on insulin......Page 206 16.14 Education of patient about CAPD......Page 207 16.15 Renal disease and herbal medicine......Page 208 References......Page 209 17.2 Sexual health......Page 210 17.4 Sexual problems......Page 211 17.5 Possible causes of sexual difficulties and dysfunction......Page 212 17.7 Women......Page 213 17.8 Men......Page 214 17.9 Investigation and management......Page 215 17.10 Sexual counselling......Page 216 17.12 Role of the nurse......Page 217 References......Page 218 18.2 Introduction......Page 219 18.3 Metabolic changes......Page 222 18.5 Education approaches......Page 223 18.7 Factors that can affect metabolic control......Page 224 18.9 Quality of life......Page 225 18.11 Medications......Page 226 18.12 Nutrition......Page 228 18.13 Hypoglycaemia......Page 229 18.14 Diabetes and falls......Page 230 References......Page 231 Rationale......Page 233 19.3 Infection......Page 234 19.4 Neuropathy......Page 235 19.6 Nursing responsibilities......Page 237 19.8 Wound management......Page 239 References......Page 241 20.2 Introduction......Page 243 20.3 Diabetes in children and adolescents......Page 244 20.4 Strategies to enhance compliance in adolscence......Page 245 20.5 Ketoacidosis in children......Page 246 References......Page 247 21.2 Introduction......Page 248 References......Page 250 22.2 Introduction......Page 251 22.4 Type 1 diabetes......Page 254 22.5 Type 2 diabetes......Page 255 22.6 Compliance/non-compliance......Page 256 22.7 Quality of life......Page 257 References......Page 258 23.2 Introduction......Page 260 Sample diabetes education record chart......Page 262 23.3 Empowerment......Page 264 23.5 The role of the bedside nurse in diabetes education......Page 265 23.7 Guidelines for instructing patients about insulin delivery systems......Page 267 Example Instruction Sheet 3: How to draw up insulin - one bottle only......Page 269 Example Instruction Sheet 4: How to draw up insulin - two bottles......Page 270 Example Instruction Sheet 5: How to give an insulin injection......Page 271 Example Instruction Sheet 6a: Managing your diabetes when you are ill: patients with Type 1 diabetes......Page 272 Example Instruction Sheet 6b: Managing your diabetes when you are ill: patients with Type 2 diabetes......Page 275 References......Page 278 24.2 On day of discharge......Page 279 25.2 Introduction......Page 281 25.6 Nursing actions......Page 282 25.8 Hypoglycaemia......Page 283 25.9 Hyperglycaemia......Page 284 25.11 The patient who has not taken their insulin or diabetes tablets and it is 11 am or later......Page 285 25.12 Managing diabetic foot ulcers at home......Page 286 25.13 The patient who does not follow the management plan......Page 287 25.15 Storage of insulin......Page 288 25.16 Guidelines for premixing and storing insulin doses for home and district nursing services......Page 289 References......Page 290 26.2 Introduction......Page 291 26.4 Integrating complementary and conventional care......Page 293 26.5 Can complementary therapies benefit people with diabetes?......Page 294 26.6 How can complementary therapies be used safely?......Page 299 26.7 Nursing responsibilities......Page 300 References......Page 301 27.1 The emergency department......Page 303 27.2 The outpatient department......Page 305 A.l Diabetic associations......Page 306 A.4 Other professional associations......Page 307 A.5 Pharmaceutical companies......Page 308 B.3 Recommended journals......Page 309 Appendix C: Reading Material for People with Diabetes......Page 310 Index......Page 311 'This remarkably comprehensive book reflects the depth of knowledge and experience of its author and will assist nurses in the process of diabetes management. I wholeheartedly recommend this text to all health professionals whether working directly in, or on, the fringe of diabetes. ' From the foreword by Marg McGill, Chair, International Diabetes Federation Consultative Section on Diabetes Education Care of People with Diabetes is an essential guide to the care and management of people with diabetes mellitus, with particular emphasis on the acute care setting. It is written by an experienced clinical nurse specialist with extensive knowledge of evidence-based diabetes care. The book serves as an essential companion to clinical practice for nurses and health professionals. This third edition of Care of People with Diabetes has been extensively revised, and includes new information on smoking cessation, diabetes and driving, coeliac disease and Polycystic Ovarian Syndrome. Key features: Fully revised new edition of a successful text Provides the evidence for best practice Includes protocols for consistent care and improvement of patient outcomes Each chapter includes lists of key points, boxes highlighting key information, further reading, patient information, and patient care sheets. Care of people with Diabetes is an essential guide to the care and management of people with diabetes mellitus, with particular emphasis on the acute care setting. It is written by an experienced clinical nurse specialist with extensive knowledge of evidence-based diabetes care. The book serves as an essential companion to clinical practice for nurses and health professionals. Detailed information is included on the assessment and management of diabetes, formulating care plans, types of diabetes, the underlying pathophysiology and patient instruction. New chapters are included on sexual health, older people and complementary therapies. The chapter on special circumstances has been substantially revised. Important new information is also included on corticosteroids, brittle diabetes, autonomic neuropathy, teeth, gums and haemochromatosis Diagnosing and classifying diabetes Assessment and nursing diagnosis Monitoring diabetes mellitus Nutritional aspects of caring for people with diabetes Medication commonly used in diabetes management Hypoglycaemia Hyperglycaemia, diabetic ketoacidosis (DKA), hyperosmolar coma and lactic acidosis Long term complications of diabetes Management during surgical and investigative procedures Special situations and unusual conditions related to diabetes Diabetes and sexual health Diabetes in the older person Diabetes in children and adolescents Women, pregnancy, and gestational diabetes Psychological and quality of life issues related to having diabetes Diabetes education Discharge planning Community and primary care nursing and home-based care Complementary therapies and diabetes Managing diabetes in the emergency situations. Besides the 1.4 million UK patients suffering diabetes, up to a million have the condition without realising it. This manual of nursing practice has been revised and updated. It includes guidelines on the care of diabetic patients to enable consistent care and improved patient outcomes