Diabetes Workbook Understand the risks associated with diabetes emergencies
Level 3
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Contents Contents 01 QCF 02 Rules of Combination - Diabetes
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Learning outcomes
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Diabetes Workbook
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Pre Training Quiz
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1. Hypoglycaemia
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2. Hyperglycaemia
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3. Blood Glucose Monitoring
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This workbook was put together by Su Down, Nurse Consultant Diabetes, Somerset Partnership NHS Foundation Trust & Gaynor Harrison. All copyright to Skills for Care publications and their contents is vested in Skills for Care unless stated otherwise. 01
QCF The Qualifications and Credit Framework (QCF): an introduction What is the QCF? The QCF is the new framework for accrediting and awarding qualifications in England, Wales and Northern Ireland. It’s at the heart of a major reform of the vocational qualifications system, which will become simpler to understand and use, more accessible to a wider range of learners, and more relevant to learners’ and employers’ needs. The QCF: • recognises smaller steps of learning and enables learners to build up qualifications bit by bit • helps learners achieve skills and qualifications that meet industry needs • enables work-based training to be recognised and formally accredited. How does it work? In the QCF, everything learnt is valuable. All qualifications in the QCF are built from smaller units of learning. Every unit and qualification has a credit value (showing how much time it takes to complete one credit represents 10 hours) and a level between Entry level and level 8 (showing how difficult it is). The structure of a QCF qualification. In the QCF, learners can accumulate credit in small steps by completing units, which can then build up into a full qualification. There are three sizes of qualification in the QCF: • Award (1 to 12 credits) • Certificate (13 to 36 credits) • Diploma (37 credits or more). What are the benefits of the QCF? For learners the QCF: • enables them to complete units at a pace and in a way that fits around their home and work lives • allows them to build up all their learning towards units and qualifications, and avoid repeating what they’ve already learnt • means they can use their previous learning and achievement towards recognised qualifications that meet industry needs • makes it easy to compare how hard each qualification is and how much work it involves • has smaller steps of learning that make it possible to take new paths to success, either by progressing further with a skill or by changing direction and putting the learning to a new use.
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Rules of Combination - Diabetes Level 3 Certificate in working with individuals with Diabetes Group A - Mandatory Units: Total of 14 credits Unit ref no DIB 201 DIB 202 DIB 203 DIB 302
Unit title
Level Credit 6 3
Unit ref number D/503/1839 J/503/1849
Awarding Organisation Ascentis Ascentis
Diabetes awareness Understand the risks associated with diabetes emergencies Diabetes prevention and early detection Understand conditions associated with diabetes
3 3 3 3
2 3
M/503/1862 A/503/1990
Ascentis Edexcel
Group B - Optional Units: Minimum of 6 credits from the optional units with a maximum of 4 credits from level 2 Unit ref no DIB 301
Unit title
Safe administration of medication and monitoring techniques for individuals with diabetes SS MU 2.1 Introductory awareness of sensory loss SS MU 3.1 Understand sensory loss DEM 201 Dementia awareness DEM 301 Understand the process and experience of dementia CMH 301 Understand mental well-being and mental health promotion CMH 302 Understand mental health problems
Level Credit Notes
Unit ref number T/503/1894
Awarding Organisation Edexcel
3
5
2
2
Barred combination F/601/3442 with SS MU 3.1
3
3
2
2
3
3
Barred combination M/601/3467 City & Guilds with SS MU 2.1 Barred combination J/601/2874 NCFE with DEM 301 Barred combination J/601/3538 City & Guilds with DEM 201
3
3
City & Guilds
Barred combination F/602/0097 with CMH 302
3
Barred combination J/602/0103 with CMH 301
City & Guilds
03
Unit ref no LD 201
HSC 3066
FSN 301
Unit title
Level Credit Notes
Understand the context of supporting individuals with learning disabilities Support positive risk taking for individuals Examine the feet of individuals with diabetes Provide agreed support for foot care Obesity and diabetes in exercise referral Promote nutrition and hydration in health and social care settings National diabetic retinopathy screening programmes, principles, processes and protocols
2
4
Unit ref Awarding number Organisation K/601/5315 OU
3
4
L/601/9549 Ascentis
3
4
Barred combination Y/602/4009 Edexcel with R/601/8063
2
3
3
2
Barred combination R/601/8063 Ascentis with Y/602/4009 T/602/0386 LAO
3
4
32
3
5
Overall Total: - 20 credits minimum - maximum of 4 credits from level 2 from Group B units
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T/503/2575 FSN 301
R/600/2560 City & Guilds
Learning outcomes Unit Ref DIB 202 Level 3 Credit value 3
The learner will 1. Understand the emergency treatments for hypoglycaemia 2. Know the process of recording and reporting emergency treatments for hypoglycaemia 3. Understand the risks associated with diabetes and intercurrent illness
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Diabetes Workbook Understand the risks associated with diabetes emergencies This section will give an understanding of the risks associated with diabetes emergencies; why it is important as a social care worker or a Health Care Assistant to have a basic knowledge of these diabetes emergencies and explore possible causes, identification of signs and symptoms, correct treatment and reporting and recording procedures. Diabetes is a growing health crisis and we need to see a reduction in the number of people dying prematurely, it is necessary to have a workforce with sufficient capacity and skills to deliver effective diabetes care. Increasingly diabetes care will need to be delivered in the community aimed at supporting people in their homes to maintain independence for as long as possible, or HCA’s will need to have an awareness of diabetes when working with individuals who may have other health care needs. It is recognised that many people require health and social care support because of the effects of long-term conditions. Different services will need to work together to promote self-care, preventative care and early intervention, minimising the need for hospital and residential care, or when admitted in to hospital receive the appropriate care. The identification of the possible short term complications such as hypoglycaemia and hyperglycaemia will enable health care professionals to make timely treatment changes that could improve the quality of life on an individual basis and help prevent costly admission to hospital. An understanding of the risks associated with diabetes and intercurrent illness will allow appropriate referral where prompt assessment can be made. This can help to make a real difference in the lives of people with diabetes through active promotion and maintenance of their health. Repeated hypoglycaemia has been indicated in an increase in cardiovascular causes of death and both hypoglycaemia and hyperglycaemia have a significant effect on morbidity in people with diabetes.
Diabetes is a growing health crisis and we n o ti c u d re a e e s to d e e n le p o e p f o r e b m u n e th in dying prematurely
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Pre Training Quiz 1. What is the normal range for blood glucose pre-meal? QQ 5-9mmols/L QQ 9-12 mmols/L QQ 4-7 mmols/L
5. If you found someone with diabetes unresponsive would you QQ E nsure airway was clear and call emergency services QQ Try and get them to drink a sugary drink QQ Ring GP for a house call
2. From the list below what are the common signs of hyperglycaemia QQ Thirst QQ Tiredness QQ Passing lots of urine QQ Repeated infections 3. How would you identify someone having a ‘hypo’?
6. A person with diabetes has blood glucose of 3.8mmols/L most mornings but feels well. Do you? QQ Ignore it they are well in themselves QQ Advise they have a good breakfast QQ Record and report to registered nurse 7. How would you treat a person who is having a hypoglycaemic episode?
QQ Testing their blood glucose level QQ Testing their urine QQ Observing them shaking QQ They would be very thirsty QQ They may be confused 4. If you identified a person’s blood glucose to be 22 mmols/L would you
8. In what type of diabetes would you need to test for ketones if the person was unwell? QQ Type 1
QQ Give them a drink of water
QQ Type 2
QQ Record and report to the district nurse / GP
QQ Gestational diabetes
QQ No idea QQ Advise them not to eat biscuits
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1. Hypoglycaemia Hypoglycaemia is a condition that occurs when there is an imbalance between circulating insulin levels, activity and carbohydrate intake. Glucose is an important energy source for the body. In someone without diabetes a drop in glucose levels stimulates the pancreas to produce certain hormones namely glucagon and adrenaline. These encourage the release of stored glucose from the liver. The pancreas also slows down the production and release of insulin. This allows the brain and vital organs to take up this extra glucose and normalises blood glucose levels. The person without diabetes is not usually aware of this series of events, but in someone with diabetes this process does not function as well as it should and coupled with certain medications can lead to a process of signs and symptoms that alert them to the need to treat. Hypoglycaemia occurs when the blood glucose level drops to 4mmols/L and below. Many people with diabetes are fearful of hypoglycaemia and this condition can be a real barrier to achieving good glycaemic control. Think about the imbalance between insulin, activity and carbohydrate intake. What could cause hypoglycaemia?
Name 5 common but inappropriate treatments for hypoglycaemia. Now name 5 correct treatments for hypoglycaemia and identify the difference in these treatments.
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2. Hyperglycaemia Hyperglycaemia can occur for a number of reasons. The occasional high blood glucose level could be due to an increased carbohydrate intake or a more sedentary day and does not usually lead to any symptoms or give rise for concern. However, if blood glucose levels are high for a period of time particularly in response to some intercurrent illness there is a risk of serious complications such as diabetic ketoacidosis (type 1 diabetes) or hyperosmolar hyperglycaemic syndrome (type 2). Intercurrent illness such as common colds, influenza, mouth abscess or urinary tract infections can prevent insulin from being utilised effectively in the body due to the production of other hormones used to fight infection such as cortisol, adrenaline and other catecholamine’s. During illness an increase in medication or insulin is required to prevent serious complications and ensure the patient does not suffer the kind of symptoms usually seen before diagnosis such as thirst, frequent urination and lethargy. High blood glucose levels make it more difficult to recover from infection.
de u l c n i s n Initial sig urination d e s a e r c n s i s e n d e r i t t, s r i h t d n a ce n e s e r p e and th n i s e n o t e of k ne i r u r o d bloo 09
Diabetic ketoacidosis (DKA) can occur when blood glucose levels are persistently above 14 mmols/L and usually occurs in those with type 1 diabetes. Initial signs include increased urination and thirst, tiredness and the presence of ketones in blood or urine. Ketones are toxic to the body and are a result of the body breaking down fat and protein to supply energy as there is insufficient insulin to enable normal energy production. DKA can occur rapidly (24 hours) so must be identified promptly, if allowed to progress nausea and vomiting may occur which precipitates dehydration, drowsiness and a strong smell of acetone on the breath – eventually the patient may lose consciousness. Hyperosmolar hyperglycaemic syndrome (HHS) occurs much more slowly and blood glucose levels can be extremely high 40mmol/L or more. Ketones are not usually produced as those with type 2 diabetes still produce small amount of insulin. The mortality rate in HHS can be as much as 40%. The symptoms are similar to DKA, but may be missed over the weeks of development, it is not uncommon to occur in those with no known history of diabetes, and the use of steroid is a common precipitator in those with known type 2 diabetes. List 3 similar signs and symptoms between DKA and HHS 1.
2.
3.
List 3 dissimilar signs and symptoms between DKA and HHS 1.
2.
3.
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3. Blood Glucose Monitoring We have described the need to confirm suspicions of either high or low blood glucose levels. The symptoms of high or low blood glucose levels are not sufficient to determine treatment or report accurately to a registered nurse or GP. The use of a blood glucose meter is required to gain the evidence that is needed to guide the next steps. There are also blood glucose meters that can now test for ketone levels, urine testing for ketones can still be used to determine risk of DKA. Name 5 reasons that could affect the accuracy of blood glucose result 1.
2.
3.
4.
5.
of s m o t p m y s The od o l b w o l r o high re a s l e v e l e s o gluc t to n e i c i f f u s t o n t n e m t a e r t e determin tely a r u c c a t r o or rep d e r e t s i g e r a to nurse or GP
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e s o c lu g d o lo b a f o e s u The in meter is required to ga d e d e e n is t a th e c n e id v the e to guide the next steps You have identified your client as having a blood glucose level of 15.2mmols/L. What could be the possible causes for that result?
Following identification of the cause – what is your next course of action?
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Reflections
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