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 in care home residents 8 Why controlling DIABETES is important 92. What is DIABETES ? 11 What is DIABETES ?

2 12 Different types of DIABETES 13 Screening for DIABETES 143. Medications for use in DIABETES 18 Insulin 20 Insulin administration and storage 21 Needle size 234.

3 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? 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 40 Calibration and quality assurance of meters 41 Who can carry out blood glucose monitoring?

4 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. 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?

5 57 Use of a hypo box 589. Managing hyperglycaemia (high blood glucose) 62 Symptoms of hyperglycaemia 62 Treatment for hyperglycaemia 63 Very high blood glucose levels 6310. Sick day rules 6611. Complications and annual DIABETES review 7012. Roles and responsibilities of staff 7413. Useful resources 78 14.

6 References 80 Appendices Appendix 1 MUST screening tool 86 Appendix 2 Food First approach 87 Appendix 3 Locally 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.

7 These include: Helen Hackett Community DIABETES Dietitian, Wirral Community NHS Foundation Trust Caroline Lyons DIABETES Specialist Podiatrist, Wirral University Teaching Hospital NHS Foundation Trust Dr King Sun Leong Consultant in DIABETES and Endocrinology, Wirral University Teaching Hospital NHS Foundation TrustI would especially like to thank Jacqui Kent, Care Homes Pharmacist, Chiltern and Aylesbury Vale CCG and Gill Dunn, DIABETES Specialist Nurse, Chiltern and Aylesbury Vale CCG for sharing their knowledge, information and expertise in helping to develop this LeongDiabetes Specialist NurseWirral Care Homes: Supporting the Management of Residents with DiabetesThis care home resource supports the implementation of recommendations in the NICE guidance on Type 1 DIABETES in adults, Type 2 DIABETES in adults and nutrition support in adults. It also supports statements 1, 2 and 3 in the NICE quality standard for nutrition support in adults.

8 National Institute for Health and Care ExcellenceMay 2018 Scope of the document 6 Key documents to support care staff in the management of residents with DIABETES 7 Incidence of DIABETES in care home residents 8 Why controlling DIABETES is important 9 INTRODUCTION 6 Author: Karen Leong, DSN, WUTH | Version 1 | Devised: January 2017 | Review date: December SCOPE OF THE DOCUMENTThis is an operational document to assist care home staff in the day to day management of residents with DIABETES . It may also be used as a teaching reference to support new and existing staff with the development of their DIABETES knowledge. The guidance included in this POLICY is based on evidence based literature, best practice and other subject specific guidelines. Visits were also carried out at local care homes prior to the production of this document to identify background information about the context and level of support required by care staff.

9 This was essential to ensure the POLICY is relevant to meet the needs of staff and the end of this POLICY , in Appendix 4, is an audit checklist. This can be used to audit standards of DIABETES care in your place of work. It is recommended that the audit is carried out at least once a year. If any areas require changes to be implemented please ensure that any new actions are re-audited again within a RECOMMENDATION:The Care Quality Commission [CQC], (2015) recommends that care homes should have a DIABETES POLICY in place which describes the elements of good DIABETES care and meets evidence based standards. This recommendation is also echoed by DIABETES UK (2010), the International DIABETES Federation [IDF], (2013) and the Institute of DIABETES for Older People [IDOP], (2014).KEY RECOMMENDATION:It is recommended that all residents with DIABETES should have a DIABETES care plan which is developed with the resident, their family/ carers , GP or other specialist health care provider Consultant or DIABETES Specialist Nurse ( DIABETES UK, 2010 & IDF, 2013).

10 KEY RECOMMENDATION:Within each care home it is recommended that one or more designated staff members should be responsible for DIABETES management and maintaining a high standard of DIABETES care (IDF, 2013 & IDOP, 2014). This would be a DIABETES Champion or DIABETES Key Worker role for someone who has regularly attended updated DIABETES training : Karen Leong, DSN, WUTH | Version 1 | Devised: January 2017 | Review date: December KEY DOCUMENTS TO SUPPORT CARE STAFF IN THE MANAGEMENT OF RESIDENTS WITH DIABETESThe following documents provide useful information to support care staff when managing residents with DIABETES . Staff who are responsible for the care of residents with DIABETES should be aware of the content of these documents:USEFUL DOCUMENTS DIABETES UK Good clinical practice guidelines for care home residents with DIABETES (2010). Available at: DIABETES UK DIABETES in care homes awareness, screening, training (2010).