CHOOSING A CARE HOME

 

CHOOSING A CARE HOME

Moving home is an important decision at any time of life. The following tips may be helpful if you, or someone you care for, is an older person with diabetes considering a move to a residential care setting.

Check

Before you visit any care provider it is always helpful if you, or someone you trust can do some research. Take a look at things like:

• The Care Quality Commission report for the service.


• If the service is approved by the local council.


• What other people think about the provider.


• What level of care service is provided, eg will you need nursing provision?


• If the location and surroundings seem right for you.


• If the service suits your cultural needs.

Visit

Visiting at different times of the day, or staying for a few days to get the ’feel’ of the place is always a good idea. Speak to different members of staff, other residents and relatives, take notice of the decor and cleanliness, room sizes and facilities, food options and meal times. Look to see what activities are going on and how staff behave with residents and each other.

Ask about bringing your own furniture or possessions, whether guests can stay overnight or visit at any time, and how much choice and freedom you will have to live life the way you enjoy it.

Ask

There are some questions you could ask which might help to give you a better idea of how the care home can meet your diabetes needs:

• Are staff experienced in caring for people with your type of diabetes and what diabetes training have they had?


• Have staff had training in nutrition, exercise/activity benefits and mental health for older people with diabetes?


• Is there a member of staff who is responsible for diabetes care in the home?


• Does the care home have a written diabetes policy?


• Are staff able to support you with blood glucose monitoring or insulin administration, if this is something you require or may require, in future?


• Is there a system to support accurate self-medication?


• Do residents with diabetes have written diabetes care plans?


• Do residents with diabetes have an annual diabetes review?


• How will food options fit with your likes, preferences and diabetes needs? Is there support to keep active and exercise?


• How are hypos managed? Is there a written policy for hypo management and prevention?


• Is there a GP responsible for the home or can you choose your GP or keep your existing GP?


• Is there access to a Diabetes Specialist Nurse?


• Is there a podiatrist/chiropodist who visits or access to a foot care team?


• Is there access to eye screening?


• Is there access to a dietician?


• What support is there to attend hospital appointments?

 

 

 

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TYPE1UNCUT – VIDEOS FOR AND BY YOUNG ADULTS WITH TYPE 1 DIABETES

 

TYPE1UNCUT – VIDEOS FOR AND BY
YOUNG ADULTS WITH TYPE 1 DIABETES

 

 

How did the #Type1uncut project come about?

Diabetes UK was funded by the Garfield Weston Foundation to provide a series of online resources to help young adults aged 16-30 with Type 1 diabetes to manage their condition. (Although that’s not to say that some of the resources won’t be just as relevant for anyone older or younger!)

Free factsheets

The first phase funded the creation of a series of factsheets for young people to give to others to let them know about Type 1 diabetes (available to download for free on this page).

#Type1uncut

 

For the second phase of the project Diabetes UK has worked with 26 young adults with Type 1 diabetes, from all four nations of the UK, to co-create a YouTube channel of videos about subjects that matter to them.

The group have worked with Diabetes UK both face to face and through social media to help bring #Type1uncut to life. We also plan to hold regular Google+ Hangouts with a wider audience, using some of the videos as starting points for discussion.

We hope that people will find the content useful, and share it on social media using the hashtag #type1uncut – and that more young people with Type 1 diabetes will be keen to create videos for the channel.

#Type1uncut YouTube channel

We launched #Type1uncut with the first seven videos during Diabetes Week,  8-14 June 2014, with more new videos over the following months.

The group has grown and over the summer we've been working on our next films - watch out for videos about hypos during Hypo Awareness Week, 29 September 2014 to 5 October 2014, followed by subjects including sport, sex and research later in the year.

 

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DIABETIC KETOACIDOSIS (DKA)

 

DIABETIC KETOACIDOSIS (DKA)

 

Consistently high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA). This happens when a severe lack of insulin means the body cannot use glucose for energy, and the body starts to break down other body tissue as an alternative energy source. Ketones are the by-product of this process. Ketones are poisonous chemicals which build up and, if left unchecked, and will cause the body to become acidic – hence the name 'acidosis'.

DKA is a life-threatening emergency

Although most common in people with Type1 diabetes, anyone who depends on insulin could develop diabetic ketoacidosis. In exceptionally rare cases, people controlling their diabetes with diet or tablets have been known to develop DKA when severely ill.

The most likely times for DKA to occur are:

• At diagnosis. (Some people who do not realise they have Type 1 diabetes do not get diagnosed until they are very unwell with DKA.)


• When you are ill.


• During a growth spurt/puberty.


• If you have not taken your insulin for any reason.


• DKA usually develops over 24 hours but can develop faster particularly in young children. Hospital admission and treatment is essential to correct the life-threatening acidosis. Treatment involves closely monitored intravenous fluids, insulin and glucose.

How to recognise DKA:

• High blood glucose levels: DKA is often (but not always) accompanied by high blood glucose levels. If your levels are consistently above 15mmol/l you should check for ketones.


• Ketones in the blood/urine. Ketones are easily detected by a simple urine or blood test, using strips available on prescription.


• Frequently passing urine


• Thirst


• Feeling tired and lethargic


• Blurry vision


• Abdominal pain, nausea, vomiting


• Breathing changes (deep sighing breaths)


• Smell of ketones on breath (likened to smell of pear drops)


• Collapse/unconsciousness.

What to do if you have symptoms of DKA

If you have high blood glucose levels and any signs of DKA you must contact your diabetes team immediately. Left untreated, DKA can be fatal. If picked up early, it can be treated with extra insulin, glucose and fluid.

• Make sure you check for ketones if your blood glucose is over 15mmol/l.


• You may need to take extra insulin.


• You may need to test your blood glucose and ketone levels frequently (e.g. every two hours).


• Drink plenty of unsweetened fluid.

If you are unable to eat, replace meals with snacks and drinks containing carbohydrate to provide energy (e.g. sips of sugary drinks, sucking boiled sweets).

 

 

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KIDNEYS (NEPHROPATHY)

 

KIDNEYS (NEPHROPATHY)

Kidney disease can happen to anyone but it is much more common in people with diabetes and people with high blood pressure. Kidney disease in diabetes develops very slowly, over many years. It is most common in people who have had the condition for over 20 years. About one in three people with diabetes might go on to develop kidney disease, although, as treatments improve, fewer people are affected.

What is kidney disease?

The kidneys regulate the amount of fluid and various salts in the body, helping to control blood pressure. They also release several hormones. Kidney disease (or nephropathy to give it its proper name) is when the kidneys start to fail.

If the kidneys start to fail they cannot carry out their jobs so well. In the very early stages there are usually no symptoms and you may not feel unwell, this can mean there are changes in blood pressure and in the fluid balance of the body. This can lead to swelling, especially in the feet and ankles.

As kidney disease progresses, the kidneys become less and less efficient and the person can become very ill. This happens as a result of the build up of waste products in the blood, which the body cannot get rid of. Kidney disease can be a very serious condition.

Why are people with diabetes more at risk?

Kidney disease is caused by damage to small blood vessels. This damage can cause the vessels to become leaky or, in some cases, to stop working, making the kidneys work less efficiently. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications. It is also very important to keep blood pressure controlled.

How does my doctor check for kidney disease?

As part of your annual health care review you should have a blood and urine test. Your urine will be checked for tiny particles of protein, called 'microalbumin'. These appear during the first stages of kidney disease, as the kidneys become 'leaky' and lose protein. At this stage, kidney disease can often be treated successfully, so this test is very important. The blood test will measure urea, creatine, and estimated glomerular function (eGFR) showing how well the kidneys are working.

I had protein in my urine but now the test is negative.
How can this happen?

Kidney disease is not the only reason for protein to appear in the urine. If you have a urinary tract infection (UTI) this can lead to protein being passed out in the urine. People with poorly controlled diabetes can be more prone to urinary tract infections because glucose in the urine provides a breeding ground for bacteria. This might need treatment with antibiotics.

In some cases, if the infection persists, it can cause damage to the kidneys, so it is very important for people with diabetes to visit their doctor if they develop a urinary tract infection.

What sort of treatment might be recommended?

This depends on the individual, the type of diabetes and other factors, such as blood pressure. Keeping blood pressure under control is extremely important, and tablets for lowering blood pressure are often used.

An increasingly common form of treatment for people with diabetes is ACE inhibitor or angiotensin II receptor antagonists (AIIRAs). These are particularly successful as they not only lower blood pressure but also help protect the kidneys from further damage. These medications are sometimes used in people who have normal blood pressure, due to their protective effect on the kidneys. Your doctor should discuss any treatment with you before starting you on it, explaining what it does and how it will help.

What if kidney disease gets worse?

There are many ways of treating kidney disease if the kidneys are no longer able to function properly. You may need to limit certain foods in your diet, such as protein foods or foods high in potassium, phosphate or sodium. This aims to prevent waste products building up in your body. As there may be a number of different things to consider, the diet can be quite complicated to follow. If you need to make any changes to your diet, you should receive detailed advice from a registered dietitian.

Controlling blood pressure is also very important. If the kidneys have been damaged, the filtering and cleaning of the blood cannot be done normally.

In some cases, dialysis might be needed to do this job for the kidneys. There are various types of dialysis, and your doctor will discuss with you which one would be best for you.

What can I do to look after my kidneys?

Taking care of your kidneys is an essential part of managing your diabetes.

• Attend all your medical appointments.


• Keep your blood glucose levels and blood pressure levels within your target range.


• Have your urine tested for protein and a blood test to measure kidney function at least once a year.


• Get help to stop smoking.


• Eat healthily and keep active.

 

 

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NERVES (NEUROPATHY)

NERVES (NEUROPATHY)

 

Neuropathy is one of the long-term complications of diabetes.

What is neuropathy?

Neuropathy is one of the long-term complications which affects the nerves. Nerves carry messages between the brain and every part of our bodies, making it possible to see, hear, feel and move. Nerves also carry signals that we are not aware of to parts of the body such as the heart, causing it to beat, and the lungs, so we can breathe. So, damage to the nerves can cause problems in various parts of the body.

Diabetes can cause neuropathy as a result of high blood glucose levels damaging the small blood vessels which supply the nerves. This prevents essential nutrients reaching the nerves. The nerve fibres are then damaged or disappear.

There are three different types of neuropathy: sensory, autonomic and motor.

Sensory neuropathy

Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.

Symptoms can include:

• Tingling and numbness


• Loss of ability to feel pain


• Loss of ability to detect changes in temperature


• Loss of coordination – when you lose your joint position sense


• Burning or shooting pains – these may be worse at night time.

The main danger of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened. This is dangerous because you may not notice minor injuries caused by:

• Walking around barefoot


• Sharp objects in shoes


• Friction from badly fitting shoes


• Burns from radiators of hot water bottles.

If ignored, minor injuries may develop into infections or ulcers. People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication.

Charcot joint is a rare complication of people with diabetes who have severe neuropathy. It happens when an injury to the foot causes a broken bone, which may go unnoticed because of the existing neuropathy. The bone then heals abnormally, causing the foot to be come deformed and misshapen. Treatment includes immobilizing the foot in a plaster cast and in some cases surgery.

Autonomic neuropathy

Autonomic neuropathy affects nerves that carry information to your organs and glands. They help to control some functions without you consciously directing them, such as stomach emptying, bowel control, heart beating and sexual organs working.

Damage to these nerves can result in:

• Gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhoea


• Loss of bladder control, leading to incontinence


• Irregular heart beats


• Problems with sweating, either a reduced ability to sweat and intolerance to heat or sweating related to eating food (gustatory)


• Impotence (inability to keep an erection).

Motor neuropathy

Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. This can lead to problems such as:

• muscle weakness, which could cause falls or problems with tasks such as fastening buttons.


• muscle wasting, where muscle tissue is lost due to lack of activity


• muscle twitching and cramps.

How is neuropathy treated?

There are many treatments available to relieve the symptoms caused by neuropathy. This may include medication for nausea and vomiting, painkillers for sensory neuropathy or treatment to help with erectile dysfunction. Good control of blood glucose levels can improve the symptoms of neuropathy and can reduce the progression of the nerve damage.

Steps you can take to avoid neuropathy

• Keep your blood glucose levels within your target range.


• Have your feet checked at least once a year.


• Tell your diabetes healthcare team if you think you’re developing any signs of neuropathy.


• If you think you’ve lost sensation in your feet, protect them from injury and check them every day.


• And talk to your diabetes healthcare team.

 

 

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EYES (RETINOPATHY)

 

EYES (RETINOPATHY)

 

Diabetic retinopathy or ‘retinopathy’ is damage to the retina (the 'seeing' part at the back of the eye) and is a complication that can affect people with diabetes. Retinopathy is the most common cause of blindness among people of working age in the UK.

What causes retinopathy?

To see, light must be able to pass from the front of the eye through to the retina, being focused by the lens. The retina is the light-sensitive layer of cells at the back of the eye – the ‘seeing’ part of the eye. It converts the light into electrical signals. These signals are sent to your brain through the optic nerve and your brain interprets them to produce the images that you see.

A delicate network of blood vessels supplies the retina with blood. When those blood vessels become blocked, leaky or grow haphazardly, the retina becomes damaged and is unable to work properly. Retinopathy is damage to the retina.

Risks to your eyes

Persistent high levels of glucose can lead to damage in your eyes. To reduce the risk of eye problems, blood glucose, blood pressure and blood fats need to be kept within a target range, which should be agreed by you and your healthcare team. The aim of your diabetes treatment, with a healthy lifestyle, is to achieve these agreed targets.

Smoking also plays a major part in eye damage so, if you do smoke, stopping will be extremely helpful.

Types of retinopathy

There are different types of retinopathy: background retinopathy, maculopathy and proliferative retinopathy.

Background retinopathy

The earliest visible change to the retina is known as background retinopathy. This will not affect your eyesight, but it needs to be carefully monitored. The capillaries (small blood vessels) in the retina become blocked, they may bulge slightly (microaneurysm) and may leak blood (haemorrhages) or fluid (exudates).

Maculopathy

Maculopathy is when the background retinopathy (see above) is at or around the macula. The macula is the most used area of the retina. It provides our central vision and is essential for clear, detailed vision. If fluid leaks from the enlarged blood vessels it can build up and causes swelling (oedema). This can lead to some loss of vision, particularly for reading and seeing fine details, and everything may appear blurred, as if you are looking through a layer of fluid not quite as clear as water.

Proliferative retinopathy

Proliferative retinopathy occurs as background retinopathy develops and large areas of the retina are deprived of a proper blood supply because of blocked and damaged blood vessels. This stimulates the growth of new blood vessels to replace the blocked ones. These growing blood vessels are very delicate and bleed easily. The bleeding (haemorrhage) causes scar tissue that starts to shrink and pull on the retina, leading to it becoming detached and possibly causing vision loss or blindness.

Once the retinopathy has reached this stage it will be treated with laser therapy. Beams of bright laser light make tiny burns to stop the leaking and to stop the growth of new blood vessels.

 

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CARDIOVASCULAR DISEASE

 

CARDIOVASCULAR DISEASE

Damage to the heart and blood vessels is collectively known as cardiovascular disease and people with diabetes have a higher chance of developing it. The term cardiovascular disease (CVD) includes heart disease, stroke and all other diseases of the heart and circulation.

Cardiovascular problems

Your major blood vessels consist of arteries which carry blood away from your heart, and veins which return it. Damage to these vessels is referred to as macrovascular disease.

Capillaries are the tiny vessels where the exchange of oxygen and carbon dioxide takes place. When damage occurs to these vessels it’s referred to as microvascular disease.

When fatty materials such as cholesterol form deposits on the walls of the vessels (known as plaque), furring up the artery and reducing the space for blood to flow, this is described as arteriosclerosis or atherosclerosis. If the plaque ruptures the artery walls, blood cells (called platelets) try to repair the damage, but this will cause a clot to form. Over time, the walls of the blood vessels lose their elasticity. This can contribute to the development of high blood pressure or hypertension, which can cause more damage to the blood vessels.

The force of the blood being pumped from the heart can make the clot break away from the artery wall and travel through the system until it reaches a section too narrow to pass through. If this happens the narrow section will become partially or completely blocked.

Blockage of an artery leads to the part of the body it supplies being starved of the oxygen and nutrients it needs. This is the cause of heart attack or strokes (affecting the brain).

Narrowing of the blood vessels can affect other parts of the body, such as the arms or legs. This is called peripheral vascular disease (PVD). PVD may produce intermittent claudication (pain in the calf muscle). If left untreated, amputation of the limb may eventually be necessary.

What causes cardiovascular disease?

Blood vessels are damaged by high blood glucose levels, high blood pressure, smoking or high levels of cholesterol. So, it is important for people with diabetes to manage these levels by making lifestyle changes such as eating a healthy diet, taking part in regular activity, reducing weight if you are overweight and stopping smoking.

Steps you can take to help prevent CVD

• If you smoke, ask for help to stop.


• Eat a healthy, balanced diet.


• Be more physically active.


• If you are overweight, try to get down to a healthy weight. Any weight loss will be of benefit.


• Take your medication as prescribed.


• Get your blood glucose levels, blood pressure and blood cholesterol checked at least once a year and aim to keep to the target agreed with your healthcare team.


• If you have any chest pain, intermittent pain when walking, impotence or signs of a stroke, such as facial or arm weakness or slurred speech, you should contact your doctor as soon as possible.

 

 

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