DIABETES POLICY

1 DIABETES POLICYWIRRAL care HOMES Supporting the managementof residents with diabetesCONTENTS1. Introduction 5 Scope of the document 6 Key documents to support care staff in the management of residents with DIABETES 7 Incidence of DIABETES

2 In care home residents 8 Why controlling DIABETES is important 92. What is DIABETES ? 11 What is DIABETES ? 12 Different types of DIABETES 13 Screening for DIABETES 143.

3 Medications for use in DIABETES 18 Insulin 20 Insulin administration and storage 21 Needle size 234.

4 Diet and DIABETES 26 Carbohydrate containing foods and drinks 27 Strategies to reduce added sugars in the diet 27 For residents with DIABETES identified as overweight or obese 29 Malnutrition 30 Palliative care 315. DIABETES glycaemic control and HbA1c 34 What HbA1c target should we be aiming for?

5 35 Review of HbA1c 366. Blood glucose monitoring 38 Frequency of monitoring 39 Blood glucose monitoring in an emergency 39 Type 1 DIABETES and blood glucose monitoring 40 Blood glucose meters

6 40 Calibration and quality assurance of meters 41 Who can carry out blood glucose monitoring? 42 Residents performing their own blood glucose monitoring 43 Consent 43 Blood glucose targets 447. DIABETES and foot care 46 Everyday foot care 46 Nail cutting 48 Urgent referrals for diabetic foot problems 488.

7 Managing hypoglycaemia (low blood glucose) 52 Signs and symptoms of hypoglycaemia 53 Causes of hypoglycaemia 54 Treatment for hypoglycaemia 55 What to do if residents are unable to swallow? 57 Use of a hypo box 589.

8 Managing hyperglycaemia (high blood glucose) 62 Symptoms of hyperglycaemia 62 Treatment for hyperglycaemia 63 Very high blood glucose levels 6310. Sick day rules 6611.

9 Complications and annual DIABETES review 7012. Roles and responsibilities of staff 7413. Useful resources 78 14. References 80 Appendices Appendix 1 MUST screening tool 86 Appendix 2 Food First approach 87 Appendix 3 Locally

10 Approved blood glucose meters 88 Appendix 4 Audit checklist 90 List of Figures Figure 1 Differences between Type 1 and Type 2 DIABETES 13 Figure 2 Sites used for insulin injections 21 Figure 3 How to roll and invert an insulin pen 22 Figure 4 Examples of hypo boxes 58 CONTENTS would like to thank all colleagues from the Healthy Wirral team for their ongoing support in the development of this thanks go to the following people for their expertise, commitment and time in reviewing and writing the content of this document.