Overview

Scope

Background

Objective  

• Minimise the risk of a diabetic medical emergency 
• Enable staff members to better support the management of diabetes in their clients through education and health promotion 
• Increase the holistic health of our clients and engage them in their own healthcare management.

Definitions

Policy

• Low blood glucose or a ‘hypo’ occurs when the level of glucose (sugar) in
  the blood drops below a certain point. This means the body does not have
  enough energy to work properly. In an older person, this is usually 6.0mmlo/L or below.
• Hypoglycaemia is dangerous with potentially serious consequences. 
• Hypo risk increases with the use of insulin or sulphonylurea, unpredictable or
  irregular eating patterns and poor kidney function

• too much insulin or diabetes medication
• delayed or missed meal
• eating less than usual carbohydrates in a meal.
• more activity than usual
• vomiting or serious illness

• dizzy, weak, drowsy (it can look like a stroke)
• feeling worried or afraid
• increasing confusion or agitation
• fast heart rate
• sweaty
• hungry 

• Hyperglycaemia or high blood glucose occurs when the BGL exceeds 15mmol/L. It often happens slowly but can also happen suddenly, depending on the cause.

• infection/illness
• not enough, or missed insulin or other diabetes medicines
• greater than usual food intake (carbohydrates)
• medications used to treat other illnesses, for example, steroids and antipsychotics
• emotional stress or pain
• undiagnosed diabetes

• increased or new confusion
• recurrent infections such as urinary tract infections
• thirsty (signs of dehydration; drier than normal lips or skin)
• irritable
• oral or genital thrush
• poor wound healing
• sleepy, tired, vague
• increased or excessive urine output

• Click the link to read our Diabetes Management Process for treating hyperglycaemia.

• Getting older can mask some symptoms of diabetes, and as the body ages, it can change how it absorbs medicine such as insulin and other diabetic medications. 
• It is important for our clients to eat a variety of foods, be as active as possible and drink plenty of fluids.
• It is helpful for clients to keep their weight stable and close to a suitable range. Remember that weight loss in people over 65 can sometimes do more harm than good, leading to muscle loss, weakness and falls.
• Clients with diabetes should eat the same healthy food as others. They often do not need a special diet; they can even eat desserts and some sugar. Some clients will have a stricter diet from their GP or dietician. Please see their care instructions for further information.
• The amount of carbohydrates in food has the greatest effect on blood glucose levels:
  ° Too much carbohydrate can cause blood glucose levels to rise.
  ° Too little carbohydrates may cause blood glucose levels to drop.

• Please see our process for taking a client's BGL.
• Monitoring blood glucose is a way to track a client's diabetes progress and reduce the risk of hypoglycaemia and hyperglycemia.
• Each client will have a different plan from their GP around how often their BGLs are taken. Some will only have an HbA1c (blood test), whereas others will have regular or random BGLs recorded. 
• There are three ways to measure blood glucose: 
  1. Blood glucose level (BGL): This involves using a glucometer and a finger prick to get a ‘snapshot’ of a resident’s glucose level at a specific point in time. 
  2. Sensor glucose level (SGL): This involves a sensor inserted into the fat layer under the skin that measures glucose levels every few minutes. The readings can be sent to an insulin pump or other device (continuous glucose monitor or CGM) or scanned with a device (flash glucose monitor). 
  3. Glycated Haemoglobin (HbA1c): this blood test is ordered 2 to 4 times a year.
     The result reflects an average blood glucose level for the last 2 to 3 months. The GP orders this blood test.
• Extra BGLs may be suggested if there is any change in treatment or diet/appetite.
• Some clients will have a target glucose range and HbA1c level specified in their diabetes plan with the GP. The GP specifies the BGL range or target, which will be included in the client's care instructions. When you check a BGL, ensure it is within range and/or on target. If it is not within the target or range, ask if this is a pattern due to the time of day or type of food or if it is a response to a new change such as diet, exercise or illness.

Responsibilities

• Read the client's care instructions
• Be aware of the client's diabetes management plan and the BGL target or range set by the client's GP.
• It is legally responsible for recording the client's BGLs as their GP prescribes.
• Read policies and procedures and education material to enable best-practice care.
• Take BGLs as and when required or instructed by the CCM
• If you need the training to take BGLs, advise the CCM before attempting the process
• Record important information in shift notes and communicate to CCMs if there are any BGL readings outside normal limits or symptoms of concern. 

• Liaise with health professionals regarding the client's diabetes management plan
• It is a legal responsibility to ensure the client's BGLs are recorded as their GP prescribes.
• Educate clients and support workers about diabetes management 
• Refer support workers to the training manager for BGL measurement skills
• Escalate any concerns around health management 

• Be aware of their BGL target or range in the GP diabetes management plan
• See their GP regularly for up-to-date changes and blood tests 
• Take responsibility for achieving their health goals when possible.

• Managing Diabetes processes
• Blood Glucose Levels - Monitoring BGLs
• Measuring BGLs process 
• Medication Management policy
• Managing Medications processes
• Falls Management policy
• Managing Client Falls process

• https://www.ndss.com.au
• https://ssoshc.com.au/wp-content/uploads/2019/03/Diabetes-Management-Policy-QA2-V2.6.18.pds
• Diabetes Australia Managing Diabetes, Blood Glucose Monitoring, and Diabetes and daily life