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TreatmentTreatment will vary between individuals, however it ultimatelydepends upon getting the right balance of food, exercise seThere are different treatments available and these will varybetween individuals.Treatment for Type 1 diabetesWhen someone has type 1 diabetes they will need regular insulininjections, to keep their glucose levels normal. All people with Type1 diabetes require treatment with insulin therapy. Insulin for thisgroup of individuals is their lifeline. Type 1 diabetes is a lifethreatening condition without insulin therapy. Insulin therapy inpeople with Type 1 diabetes must never be stopped.Balancing insulin, diet and physical activity controls Type 1diabetes.The specific insulin used will vary from person to person and will15

depend on which insulin regimens are used. Insulin regimens useshort / rapid acting insulin to stimulate normal mealtime insulinlevels, and long acting insulin to provide a backgroundconcentration of insulin.If a person is treated with insulin, regular meals are especiallyimportant. Food should be given within specified timescales of theinsulin injection (Refer to individual assessment plans for details oftimescales). If for any reason a meal is delayed check for signsand symptoms of low blood glucose (hypoglycaemia).Treatment options for Type 2 DiabetesThe management of Type 2 Diabetes has several treatmentstages. If diagnosis has been delayed, the person with diabetesmay progress through the stages very quickly.The aim of Type 2 Diabetesmanagement is to reduce the body’sresistance to insulin and preserve theinsulin producing cells of the pancreas.Diet and physical activity are importantfactors in management of Type 2Diabetes. Losing weight, if necessaryand increasing exercise/activity will make insulin work better asthis reduces insulin resistance.The aim with this treatment option is to promote weight loss if overweight, and to reduce insulin resistance, which is linked to obesityand physical inactivity. The general recommendations in relationto physical activity are to aim for 30 minutes per day 5 days per16

week. However any physical activity is better than none, as thisimproves the body’s sensitivity to insulin.There are several different types of glucose lowering medicinesused to treat type 2 diabetes. Medication to reduce the bloodglucose level may be required if adequate control cannot beachieved or maintained with diet and exercise alone.In some cases of type 2 diabetes, it may also be necessary to treatthe condition by insulin therapy (injection).Insulin is required at the stage where failure of the insulinproducing cells become so severe that the individual is unable toproduce sufficient insulin.Dietary informationWhat a person eats affects their diabetes. Choosing a healthy diethelps to control blood glucose levels.It is important that a person with diabetes eats a normal balanceddiet with a wide variety of different foods. The preferred dietrecommended in diabetes is one, is high in fibre rich, starchy foods(such as cereals, fruit, potato, rice, pasta, beans, peas andvegetables) and low in fat, salt and sugar.17

Regular meals of starchy foodshelpto maintain a balanced bloodglucose level. For thoseindividuals on certain medication,missing meals or snacks, or noteating the starchy part of the meal may lead to too low bloodsugar.It is suggested that people who need assistance to monitor theirfood intake are given the appropriate help to do so. If this isrelevant to any of the service users you are supporting, you willneed to discuss this with your line manager.If the starchy part of the meal or a snack is missed, an alternativeshould be offered as soon as possible to prevent a hypoglycaemicattack. If a person is having regular hypoglycaemic attacks aDoctor and dietician should be contacted for further advice.How to eat more fibre Have more fruit based desserts andsnacks; e.g. crumbles made withoat flakes Encourage a whole grain and highfibre breakfast cereal such as porridge or bran flakes, and18

wholegrain breadIt is recommended to have at least 6-8 medium cups of fluid inorder to prevent bowel problems; this could include water, tea,coffee, and sugar free squash.Solid foods, especially fruit and vegetables are another essentialsource of fluid. It is also important to note that more fluid may beneeded when carrying out physical activity or during hot weather.Adding sugar to food and drinks should be avoided. The aim is toreduce foods high in sugar, this can be achieved by: Use of artificial sweeteners instead of sugars Diet or sugar free fizzy drinks Low sugar or reduced sugar jams Diet yoghurts instead of low fat yoghurts which are high insugarIt is also important to remember that some food such as fruitcontain natural sugars. Therefore it is important to monitor eachindividual and their dietary requirements.It is advised that people with diabetes eat less fried and fatty foods Encourage fruit based desserts and snacks Encourage low fat snacks Use less butter or margarine Eat fewer crisps, meat pies, pastries, biscuits and fried foods Use skimmed or semi-skimmed milk in drinks, in cooking and19

on cereals. Eat oily fish containing omega 3 at twice a week (not fried)Reduce the amount of salt, for example do not use salt whencooking and use salt sparingly on meals. It is also advisable not touse ‘lo salt’ alternatives as they may contain additives.It is recommended that any alcohol should be taken in moderation,e.g. ½ pint of beer or lager, 1 glass of wine, 1 single measure ofspirit. Please refer to individual plans for further guidance, as thiswill vary from person to person. Starchy food or a snack should beeaten if an excessive amount of alcohol is drunk in order toprevent hypoglycaemia in those on glucose lowering drugs (e.g. asandwich before bed). Remember eachindividual is different, for some people alcoholmay not be suitable at all. Always refer to careplans for details.‘Diabetic foods’ are available; however there isno need to use special ‘diabetic’ foods. Many foods sold assuitable for people with diabetes are high in fat and some productscan cause diarrhoea.Eating for a special occasion, e.g. a birthday is an opportunity tochoose something different. An occasional treat should not affectdiabetes control, if managed appropriately.Diabetes U.K. recommends that all people with diabetes shouldhave access to a state registered dietician for specific individualadvice. The dietician can also offer advice to care staff andcatering staff.20

Complications of DiabetesEarly treatment and effective management will reduce the risk ofserious diabetes complications. Not all people will developcomplications.Hypoglycaemia (Low blood glucose) is an acute situation (happensquickly) if the person with diabetes has not had enough starchyfood, too much medication, unplanned exercise or excessivealcohol.Low blood sugar is often caused by: Missed or late meals Not enough food Too much insulin or tablets More activity than usual e.g. additional exercise Too much alcohol Hot weatherSome common symptoms, which a person may experience, are: Shakes or tremor Palpitations Sweating Hunger Mood change Poor co-ordination Blurred vision21

Fast pulseRecommended treatments for hypoglycaemia are given in 2stagesFirst stage (Fast acting): glucose tablets x 3 or a small glass of Lucozade or Fizzy drink such as lemonade/coke or Fresh orange juiceSecond stage, a starchy snack (Long acting): 2 plain biscuits or A piece of fruit i.e banana or A sandwich or Next meal if this is dueIf no action is taken then the person may become confused, haveslurred speech, experience seizures and may even lapse into acoma. If they become unconscious do not give anything by mouthand ensure medical assistance is sought immediately.To prevent a hypoglycaemic attack happening the person shouldtake regular meals, correct medication, eat extra starchy food,participate in planned physical activity and moderate their alcoholintake.Hyperglycaemia (High blood glucose) occurs when the bloodglucose level rises above 11 mmols and is usually present when aperson is newly diagnosed with diabetes, poorly controlled orunwell.The signs and symptoms of hyperglycaemia and why they occurare: Excessive thirst due to the body trying to dilute the high22

concentration of glucose in the bloodFrequent passing of urine to eliminate un-required glucoselinked with thirstTiredness, due to reduced amounts of insulin which allowsglucose to be turned into energyWeight loss due to fat being broken down to produce energyInfections such as frequent occurrence of thrushSome of the causes of hyperglycaemia include: Too much food (try to eat a balanced diet) Not enough medication (ensure dosage correct) Illness (seek medical help) Not enough exercise (exercise in moderation)Some of the long term complications of diabetes:Coronary Heart Disease is much more common among peoplewith diabetes and is the main cause of death (up to 50% in Type 2diabetes). Tight diabetic control reduces the risk of CoronaryHeart Disease.People with diabetes should beencouraged to stop smoking.Stroke is more frequent in people withdiabetes, and vascular dementia is also relatively common.Neuropathy is damage to the small nerves in the feet and legscaused by high glucose levels, which eventually leads tonumbness. Normally nerves pick up all kinds of stimuli, such aspain, temperature and pressure. If the nerves become damaged,23

the person with diabetes may be unaware of these stimuli andinjuries can occur without their knowledge. The person withneuropathy may complain of a variety of symptoms including pinsand needles, burning, coldness, numbness of varying degrees orincreased sensitivity in the feet so that even the weight of thebedclothes on the feet is too much to bear. The symptoms areusually worse at night and can sometimes be relieved by pacingthe floor. Symptoms of neuropathy may be present right from theonset of the diabetes and may, in fact, be the first presentingfeature. Any person experiencing symptoms like these, but who isnot known to have diabetes should be checked for the condition.Retinopathy occurs when degenerative changes take place in theretinal blood vessels, leading to loss of vision. Retinopathy can betreated by laser therapy. Diabetes is the leading cause ofblindness in the working population. All individuals with diabetesshould have their eyes examined for evidence of diabeticretinopathy every year. This is not done as part of the routine eyecheck at the opticians.Nephropathy is disease of the kidney. Raised blood pressureaccelerates the development of nephropathy (test for protein in theurine).Renal disease is more common in individuals with Type 1 diabeteswith 20% - 40% of these developing some degree of renal failure.Diabetic nephropathy accounts for 25% of the people who developend-stage renal failure each year.Erectile dysfunction (Impotence) may have physical orpsychological causes or a mixture of the two. Diabetes can cause24

damage to the blood supply to the penis and to the nerves whichcontrol an erection.Ischaemia is another condition which may occur. It refers to poorblood supply to the feet and legs. If the blood supply is notsufficient, injuries will not heal, sores may develop and the personis less likely to be able to fight infections.The ischaemic foot will be pale and may have a waxy feel to theskin. There will be little or no hair growth on the lower legs andtoes. The skin will be cold to the touch and the person maycomplain of aching in the legs, even at rest. The symptoms, likethose of neuropathy, can be worse at night and the person willoften dangle the legs out of the bed to relieve the pain.Infection is a further complication of neuropathy and ischaemia.The presence of neuropathy allows the infection to take holdbefore the person is aware of the problem due to their inability tofeel pain. If the person has ischaemia they are less likely to beable to fight the infection because of the insufficient blood supplyand the infection will spread quickly.Signs of infection in the foot are redness, heat, and inflammationwith or without discharge of pus. Don’t forget the ‘smell test’! Aninfected wound has a distinct and unpleasant odour. Any areas likethis need URGENT medical attention.A podiatrist plays an important role in caring for people withdiabetes. Every person with diabetes should see a StateRegistered Podiatrist/Chiropodist once a year. As well as being25

able to provide treatment to nails, corns and callus, the podiatristwill assess the feet and check for any signs of nerve damage orpoor blood supply. This will help to identify people most at riskfrom developing problems later on, and enable the podiatrist towork out a treatment plan for that person to prevent the risk ofcomplications.Preventative MeasuresThere are a number of Government initiatives, which aim toimprove the general health and well being of people. Five-a-day programme - introduced in order to increase theconsumption of fruit and vegetables. Sport programmes - a number of initiatives are taking placewithin leisure centres and local communities in order toencourage people to become activeHow do you think the five-a-day programme will help peoplewith diabetes?26

Other preventative actions include: Discouraging service users from walking around on barefeet, even on carpeted areas. The wearing of slippers should be avoided; the personshould be encouraged to wear a well fitting shoe. The shoeshould be long enough, broad enough and deep enough toprevent pressure on the toes and borders of the foot. Theshoe should fasten with a high lace or strap to prevent thefoot moving around inside the shoe. The use of hot water bottles and electric blankets should bediscouraged as these can cause severe burns if the feet arenumb or the blood supply is poor. Any corns or areas of hard skin on the feet should be treatedregularly by a state registered podiatrist because if itbecomes too thick, the underlying tissue can be damagedand ulcers can develop. People who are mobile should be encouraged to take atleast a few steps on a regular basis to keep the circulationgoing. People, who are able to be mobile with assistance,should be encouraged to move/turn to prevent pressuresores.27

Remember if you notice anything unusual on the feet;report it immediately in order to encourage the personto seek professional help.Daily foot Care is essential. Encourage service users to washtheir feet in warm water every day. Be careful to check thetemperature of the water carefully with a thermometer. You mustrefer to individual care plans for details of the requiredtemperature.Guidelines for bath water temperature are 37ºC - 44ºC, andshower is 37ºC – 41ºC, however this is specific to the individual.You must follow the individual’s risk assessment Encourage service users to dry well between the toes, beingcareful not to pull the toes apart too much as this can causeulcers to develop Check shoes and slippers for foreign bodies by shaking theshoe to remove loose objects; check the soles of the shoesand run your hand around the inside of the shoe to check theinner sole and upper of the leather for rough areas.Danger signsRemember that the earlier problems are identified, the moresuccessful the treatment is likely to be. The person or carer shouldbe encouraged to take a few moments to do these daily checks28

and this may be enough to prevent the person suffering seriousComplications.Check for: Swelling in the foot or part of the foot. Colour change. This includes speckles of red/brown in hardskin. This may be the first sign of an ulcer under the skin.Also look for red/blue patches on the foot; any area thatlooks unusually pale or dark; rashes or bruises should alsobe reported. Pain or throbbing in the foot. This may be due to infection,poor blood supply or injury. Sores, splits, cut on the skin or blisters. These are alwayspotential areas for bacteria to enter the foot and causeinfections. Any area of discharge from the foot of pus, blood or fluid. Corns calluses and nail problems should be attended to bythe podiatrist on a regular basis.Is treatment working?29

Monitor your service user Are they free from symptoms? Are they content? Are they losing weight? Are there any skin changes? Are they getting things mixed upmore?All people on insulin should self monitor blood glucose levels. Ingeneral terms we should aim for levels between 4 and 10 mmol/lLess than 4 mmol/l Low4 - 10 mmol/l IdealOver 10 mmol/l HighTo monitor blood glucose levels the service user should beprovided with a blood glucose meter. This is a device used toanalyse the amount of glucose from a small sample of blood,normally obtained from a finger, which is placed on a disposabletesting strip, and then inserted into the meter.There are several meters available, with different designs andfunctions. For example some meters have a large display screenwhich may be more suitable for people with poor eyesight. It isimportant to select an appropriate meter which is easy to use. Youalso need to ensure that the person using the blood glucose meterknows how to use the device correctly, and that it is in full workingorder.A venous blood test is the most accurate method for measuringblood glucose, and should be carried out every 3-6 months, or at30

least once per year. This test shows how well diabetes control hasbeen over a 3 month period. This will be carried out by a healthprofessional.Role of the carerMany people with diabetes will need some form of emotional andpsychological support to be able to tackle the challenges thispresents and to care for themselves effectively from day to day.Each person with diabetes should be treated as an individual. Thisis in-line with person centred planning. The service users wishesshould be considered and always respected. All informationregarding the person with diabetes must be confidential (unlessthe health of the individual is at risk, then you must let the personknow that you need to inform your line manager). Carers are in anideal position to monitor the person with diabetes’ general health,whilst enabling the person to carry out daily living activities.Observe physical and mental state whilst, for example moving.Remember, monitoring the service users general health andwell-being is essential. Carers must report their concerns to theirline manager immediately.It is imp

Diabetes UK report that since 1996 the number of people diagnosed with diabetes has increased from 1.4 million to 2.9 million. By 2025 it is estimated that five million people will have diabetes. It is estimated that most of these cases will be Type 2 diabetes