As we all know, aged care is a very different specialty area to other areas of dietetics and as such, our practices tend to run by different recommendations and guidelines. The management of residents with diabetes no different.
There are two main types of diabetes, in which either of the following occur;
TYPE 1 – The body does not producing any insulin as the beta cells of the pancreas have been attacked by the body’s own immune system. This is often referred to as Insulin Dependent Diabetes Mellitus (IDDM). It can only be treated by insulin and it makes up about 10% of all diabetes cases.
TYPE II - The insulin produced by the pancreas is not enough or the body is not sensitive enough to the effects of the insulin being produced. This can be treated in a number of ways including lifestyle management (diet & exercise), oral hypoglycaemic agents and/or insulin. This is often referred to as Non-Insulin Dependent Diabetes Mellitus (NIDDM). N.B. Once a person with type II requires insulin to manage their diabetes, they do NOT become type I.
One of the main effects of not having any or enough insulin is that our blood glucose levels (BGL) often end up extremely high.
Longer term elevated BGLs can damage large and small blood vessels. Damage to larger vessels can lead to heart attack, stroke and reduced blood flow to lower limbs. Damage to smaller vessels is often recognised when people present with eye damage and even blindness, kidney damage, nerve damage, dental & gum disease, increased risk of wounds and slow wound healing and decreased blood flow to extremities thus requiring amputation.
For residents in aged care facilities, who quite often will present with a plethora of other medical complications, these issues may present slightly differently. For example;
With a lot of residents in aged care having cognitive issues and complex medical backgrounds as well as limited health literacy financial support, life expectancy and often being solely reliant on the care provided by staff; the way we view diabetes and its management is very different to the rest of the population.
The primary aims of diabetes management in aged care is to manage diabetes so as to prevent discomfort associated with uncontrolled diabetes. As such, the ‘controls’ set for aged care residents tend to be looser than we would expect from the average population;
Recommendations suggest HbA1c should be monitored in all residents with diabetes every 6-12 months and BGLs should be monitored anywhere from once daily to three times daily pre-meals depending on the severity & management technique used for the diabetes and the health status of the resident.
NB these should all be determined on an individual level in consultation with the GP, Endocrinologist, Diabetes Educator and/or other specialist health professional.
There is more to BGL and diabetes management than just the numbers.