Diabetes mellitus is a chronic disabling disorder that is increasing in prevalence.
To enhance diabetes care for its service users, this organisation acknowledges the importance of its staff co-operating with the health professionals delivering the diabetic service.
The wellbeing and quality of life sustained by the service user will be enhanced by the well-planned and comprehensive care and support of staff. Many of our service users have lived with diabetes for many years, and their views and the way they manage their diabetes must be incorporated, wherever possible, into their diabetic care plan.
There are two types of diabetes, known as Type 1, which normally starts at a young age and requires insulin injections, and Type 2, which is strongly linked to old age, obesity, and family history, but can be a result of steroids use and pancreatic cancer. Type 2 is frequently controlled by diet or diet and medication
The Policy
Liaison with Community Diabetes Care Service
Regular liaising with the community diabetes team is important for staff to ensure they are up to date with the treatment being given, the assessed risk of hypoglycaemia, and other complications for each service user.
The specialist diabetes nurse can provide advice and support to both the service user and staff.
Other community-based healthcare professionals, e.g. dietician, podiatrist, and pharmacist, can provide important contributions to optimising diabetes care.
[INSERT CONTACT DETAILS HERE OF ALL RELEVANT PROFESSIONALS AND NHS DEPARTMENTS]
Prevention
We encourage our service users to have regular check-ups with their GP or attend outpatient appointments and follow the advice given to them concerning healthy living, including tailored physical activity, weight management, and dietary advice, to help in preventing the onset of diabetes in people who are at high risk.
Diet and Nutrition
Diet plays an important part in controlling diabetes. All service users will have a menu and diet plan in place from the diabetic nurse/nutritionist. Staff involved in preparing food will work with the service user and follow this plan. The service user’s choice and preferences will always be taken into consideration in the preparation of agreed diets. If the service user continually refuses and chooses other foods, the worker must record and report immediately to their supervisor or manager, who may need to contact other professionals for guidance.
When working with service users, it is their choice what foods they eat, and this organisation will provide both service user and their family with information and support to encourage a healthy diabetic diet and work with healthcare professionals to this end.
All service users are screened for malnutrition when the service commences and when required as their physical condition changes. The MUST tool [INSERT HERE IF ANOTHER TOOL IS IN PLACE] is used for this purpose.
The presence of a co-existing disease may lead to physical and cognitive impairment in a service user with diabetes and can make activities, such as eating difficult or impossible and place the service user at nutritional risk.
This organisation will work with a dietician, the speech and language team (SALT), and GP or hospital specialist as required.
Care or Support Plan
Within their main care or support plan, each service user will have individualised diabetes care or support plan.
The agreed objectives summarised in the diabetes care plan will include diet, foot care, eye care, wellbeing review arrangements, medication, and the need for a regular medication review. The service user is encouraged to be fully involved in this care plan. For those service users assessed as lacking the capacity to make a decision, a best interest decision will be made concerning the management of medication and diabetes, following the Mental Capacity Act 2005 Code of Practice
Review Arrangements of the Diabetic Care Plan
Each service user with diabetes requires documented evidence of a review. This will be carried out monthly [INSERT HERE IF DIFFERENT]. The frequency of the review should be decided with the healthcare professional or specialist diabetes nurse. This review will also include measures of walking ability, balance, mood assessment, and cognitive function.
Foot Care Services
Individuals with diabetes are continually monitored and the individual’s current risk of developing a diabetic foot problem is assessed
Low risk:
No risk factors present except callus alone.
Moderate risk:
Deformity
Neuropathy
Non-critical limb ischaemia.
High risk:
Previous ulceration
Previous amputation
On renal replacement therapy
Neuropathy and non-critical limb ischaemia together
Neuropathy in combination with callus and/or deformity
Non-critical limb ischaemia in combination with callus and/or deformity.
Active diabetic foot problem:
Ulceration
Spreading infection
Critical limb ischaemia
Gangrene
Suspicion of an acute Charcot arthropathy
An unexplained hot, red, swollen foot with or without pain.
Any assessed risk must be reported within 24 hours to the health care professional responsible for their diabetic care and a risk assessment and care plan review put in place to mitigate the risk
Individuals with a limb-threatening or life-threatening diabetic foot problem are referred immediately to acute services.
The NICE guideline on diabetic foot problems (recommendation 1.4.) defines the following as limb-threatening and life-threatening diabetic foot problems:
Ulceration with fever or any signs of sepsis
Ulceration with limb ischaemia
Gangrene.
All service users with diabetes should have and will be encouraged to have regular visits by or to a chiropodist to ensure any problems associated with diabetes are picked up as soon as possible. If these visits cannot be arranged by the service user or their family, they will be arranged by this organisation Transport and/or an escort service will be arranged as required.
Redness to the skin
Signs of bruising
Pain
Feeling of numbness to the area
Skin breakdown.
Staff are not permitted to cut the nails of the service user.
Staff must report any changes to the skin or problems identified by the service user immediately to their manager or supervisor.
The National Institute for Health and Care Excellence (NICE) recommends that people with diabetes have a foot assessment when diagnosed and at least annually afterwards, or if any foot problems arise and if admitted to hospital
Wellbeing
Depression is more common in people with long-term conditions but may go unnoticed in older people with complex health problems such as diabetes. Painful neuropathy, foot ulceration, and the adverse effects of medication can all contribute to depression. We recognise that anything that affects the service users’ mental wellbeing may also affect their ability to successfully manage their diabetes. Staff are trained to recognise symptoms of depression so that an early diagnosis can be made by the GP, and this will help limit the longer-term impact. Screening at the start of the service and at least annually is carried out for service users. Emotional support will be embedded in care for people with diabetes.
Psychological problems in people with diabetes may include:
Depression
Anxiety
Injection‑related anxieties
Fear of hypoglycaemia
Eating disorders
Problems coping with the diagnosis.
Eye Care Services
Service users with diabetes are likely to have a high incidence of eye disease. This may include macular disease, cataract, and refractive error. All service users will be supported to attend appointments at eye clinics as required or be encouraged to have annual eye tests.
An escort service will be arranged as required.
Staff must report any concerns, changes, or problems in the service user’s eyesight immediately to their manager or supervisor.
Note: NICE guidelines recommend that GPs refer people with Type 1 diabetes to local eye screening as soon as possible or within three months from referral. Eye screening should then take place annually.
Management of Infections
We recognise that service users with diabetes are at increased risk of a range of infections, including skin, respiratory, oropharyngeal, and urinary tract. Observing for signs of infection, such as a change in mobility, increased confusional state, or worsening lethargy, staff are aware of the need to report these signs immediately so that the appropriate medical help can be sought quickly.
Vaccination Programme
We recognise that service users with diabetes are a high-risk group for influenza and other serious infections. Each service user is encouraged to receive timely vaccinations to reduce the risk of serious infections, such as pneumococcal and influenza vaccinations. The vaccination schedule is included in their care plan, along with any other relevant evidence.
Administration of Treatments Including Insulin
Insulin will either be administered by the service user or visiting a health care professional.
All staff will be trained to recognise signs of hypoglycaemia and hyperglycaemia
Referral to hospital
We have in place a service user’s diabetes passport, which goes with the service user if they are admitted to the hospital. This passport is checked and updated at the monthly care plan review.
Liaison with the hospital team before the subsequent discharge of a service user with diabetes is essential.
Quality
An audit of our diabetic care is included in our quality monitoring systems. These include clinical audit, use of a minimum data set, frequency and completion of care plan review, and implementation of a diabetes care policy.
We audit hospital admission rate, hypoglycaemia rate, frequency of infection, pain nutrition, and attainment of high completion rates for an annual review to improve the quality of care for our service users.
As an organisation, we evaluate how we give our service users the knowledge and ability to self-manage their diabetes wherever possible, making use of available technology to support self-management through education, motivation, and self-monitoring
Related Policies
Assessment of Need and Eligibility
Care and Support Planning
Nutrition, Hydration and Food Safety
Medication
Related Guidance
NICE Guidelines [NG17], August 2015, last updated December 2020: Type 1 Diabetes In Adults: Diagnosis and Management:
https://www.nice.org.uk/guidance/ng17
NICE Guidelines [NG19], August 2015, last updated in March 2021: Diabetic Foot Problems: Prevention and Management:
https://www.nice.org.uk/guidance/ng19
NICE Quality Standard [QS6], March 2011, last updated December 2020: Diabetes in Adults:
https://www.nice.org.uk/guidance/qs6
Nice Guideline (PH38), July 2012, last updated September 2017: Type 2 Diabetes: Prevention in People at High Risk:
https://www.nice.org.uk/guidance/ph38
Nice Guidelines [NG28], December 2015, last updated December 2020: Type 2 Diabetes In Adults: Management:
https://www.nice.org.uk/guidance/NG28
Diabetes UK:
CQC My diabetes, My Care; https://www.cqc.org.uk/sites/default/files/20160907_CQC_Diabetes_final_copyrightnotice.pdf
Training Statement
All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required. [AMEND AND INSERT AS REQUIRED]
Date Reviewed: October 2022
Person responsible for updating this policy:
Next Review Date: October 2023
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