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.
Author(s): Trisha Dunning
Edition: 2
Year: 2003
Language: English
Pages: 320
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
