The prevalence of Diabetes is rising rapidly as people are living longer. Ten out of every 100 people over the age of 65 in Ireland have diabetes. 95 % of these have Type 2 diabetes.
Diabetes mellitus is a condition in which there is too much glucose in the blood. Glucose is needed for energy and comes from the digestion of carbohydrates for example sugars and starches.
Sugar and starchy foods are broken down and absorbed into the blood stream as glucose. Some older people do not produce enough insulin to move glucose from the blood into the body cells where it is needed for heat and energy. Glucose builds up in the blood and spills out into the urine. Being overweight or not being active makes it more difficult for the cells to take in glucose and increases the risk of type 2 diabetes.
Older people are more likely to get type 2 diabetes because of a certain number of pre-disposing factors
• Age related decreased insulin secretion
• Age related insulin resistance
• Obesity
• Decreased physical activity
• Drugs
• Genetics
• Co-existing illness
Symptoms of Diabetes
The main symptoms of untreated diabetes or high blood sugars in older people are dry mouth, incontinence, sleepiness after main meals, blurring of vision and recurrent infections. However, for many people the onset is so gradual that there are no noticeable symptoms. Every person over 65 years of age should be tested annually for diabetes. A capillary blood sample may be used as a screening tool with normal levels being less than 6mmols fasting and 7 mmols after eating. If the levels are higher, a fasting blood glucose should be carried out by the GP.
Types of Diabetes
Type 1 diabetes develops when there is an absolute lack (>80%) of insulin in the body. This type of diabetes usually appears in people of normal weight under the age of 40 years.
Type 2 diabetes develops when the body produces some but not sufficient insulin to meet the demands of the body. This may be due to individual factors or a combination of factors:
• A pancreas that cannot produce sufficient insulin
• A liver that releases glucose inappropriately
• Muscle cells not effectively taking in glucose.
Treatment of diabetes
Treatment of diabetes is to keep blood sugars near normal levels. High blood sugars in the short period can induce incontinence and infections and over a long period can lead to eye disease, heart problems, foot ulcers and high blood pressure. The life-threatening nature of diabetes results from complications such as kidney failure, heart attacks and stroke rather than the condition itself. Everyone with diabetes can reduce their risk of future ill-health by living healthily, controlling blood glucose levels and taking the medication prescribed for them at the correct times.
The treatment of type 2 diabetes is primarily taking a healthy eating diet, exercising as much as feasible, taking medications as prescribed and for approximately one third of people with type 2 diabetes insulin therapy.
Healthy Diet
The diet for a person with diabetes is the same as the ideal healthy balanced diet for all.
· Eat regular meals
· Base each meal on a starchy carbohydrate food such as bread, cereal, potato, rice or pasta (eat the appropriate portion)
· Limit your intake of sweet and sugary foods
· Reduce your fat intake and change the type of fat you eat
· Eat fruit and vegetables regularly, a total of 5 portions between fruit and vegetables every day
· Eat fish twice a week- white fish once a week and oily fish once a week.
· Avoid adding salt to food and cut down on processed foods
· If you drink alcohol, drink sensibly.
Diabetic foods are not necessary, are expensive and can cause loose bowel motions if taken in excess. Instead, use reduced sugar jams and marmalades, sugar free jellies and squashes and ‘diet’ or ‘healthy options’ in other products. Always use the reduced or low-fat varieties of dairy products if the person is overweight.
Check out the booklet Healthy eating for people with Type 2 Diabetes for more information. This can be downloaded from the Diabetes Federation of Ireland website on www.diabetes.ie.
Exercise
The FAST (Fitness Arthritis and Seniors Trial) study showed that any form of exercise i.e. aerobic exercise, strength training, balance and flexibility is beneficial to health. Few contraindications to exercise exist, and almost all older persons can benefit from additional physical activity. Professionals and professional carers play a key role in motivating older patients and advising them regarding their physical limitations. Almost any movement done voluntarily uses energy and maintains flexibility, so encourage people to move more.
Medications
Medications may include oral hypoglycaemic, antihypertensive and lipid lowering agents. Oral hypoglycaemic agents (OHA’s) include:
• Sulfonylurea’s to stimulate the beta cells of the pancreas to release more insulin (E.g. Diamicron
• Biguanides to decrease the amount of glucose produced by the liver ( E.g. Glucophage),
• Meglitinides to increase insulin production but of shorter duration than sulfonylurea’s ( E.g. Starlix)
• Alpha-glucosidase inhibitors to block the absorption of sugar and starches ( E.g. Glucobay)
• DPP-4 Inhibitors to prevent the breakdown of a naturally occurring compound GLP-1, that prolongs the effectiveness of insulin (E.g. Januvia).
All persons with diabetes, regardless of who is responsible for their health should receive a level of diabetes care appropriate to their needs. A named person should take responsibility for the daily diabetes needs. This will involve providing a healthy diet, monitoring of blood sugar control and getting medical assistance when necessary. In order to carry this out properly, the person should be instructed in the individualised care of the person with diabetes by that person’s diabetes team. If the carer is a qualified healthcare professional, they should meet with the person’s diabetes team and take part in the annual review process. In residential care situations, the named person is accountable for their own diabetes education and passing on their diabetes knowledge to other healthcare workers responsible for the care of the patient with diabetes when they are not present.
The diet may need to be adjusted and the community dietitian should be involved in making a detailed diet plan. Nutritional plans should take into account the nutritional state of the person, budgetary constraints, available cooking facilities, ability of carer to oversee cooking and serving of suitable meals, likes and dislikes of the person with diabetes. The plan should make provision for days when complete meals are not taken.
As people get frailer, they tend to be less thirsty but the body still needs the same amount of fluids. For people with diabetes, lack of fluids can cause dehydration which artificially raises the blood sugar level by concentrating it. High blood sugar levels in frail people can lead to incontinence in addition to increasing the risk of urinary infections. It is important that people drink 6 to 8 cups of fluid every day including water, tea and sugar free or diet drinks.
Monitoring of blood sugar should be discussed with the community or hospital based diabetes nurse specialist. If home blood glucose monitoring is necessary, targets should be set for fasting and post meal readings and appropriate guidelines written for when targets are not reached.
The aim of diabetes care for the person who is no longer able to look after their own health is to maintain the highest degree of quality of life and well-being without subjecting the person to unnecessary actions. For many individuals, it may be appropriate to aim for blood sugar control which avoids the malaise, lethargy and urinary frequency of high blood sugars, whilst permitting the highest level of physical and mental function to be attained.
Annual Check-up
Each Person with diabetes should have at minimum an annual Diabetes Review. This should include
· A review of their general health
· Review of nutritional status and dietary recommendations
· An opportunity to discuss any problems
· Discussion on current blood glucose results and new targets set. When a person has diabetes, normal levels of blood glucose levels are generally not used. It is better to discuss the appropriate target levels which are based on ability, physical health and general circumstances.
· Recording of weight, height and blood pressure
Attendance and Punctuality
This is vital within homecare. Clients you attend to can be quite vulnerable and some may live alone or have no family to support. You’re our home care visits can be the most important visit they have each day so please aim to honour your roster and arrive on time. Any difficulties in attending shifts must be communicated to your local homecare team. This is preferably via a phone call to one of our team members who can assist with you further.
Patient identification
This is vital within homecare. Clients you attend to can be quite vulnerable and some may live alone or have no family to support. You’re our home care visits can be the most important visit they have each day so please aim to honour your roster and arrive on time. Any difficulties in attending shifts must be communicated to your local homecare team. This is preferably via a phone call to one of our team members who can assist with you further.
Our Core Values 💙
Core values are what support the vision, shape the culture and reflect what a company values. They are the essence of the company’s identity – the principles, beliefs or philosophy of values. What are our Core Values?
· Customer First – We never compromise on quality – we deliver services to world class standards, nothing less ever.
· Accountable – We represent our clients and customers with dignity and honesty. Our stakeholders trust us.
· Responsible – It is about seeing the whole job through to the end. It is not done until it is all done.
· Empower – Our leaders within the business are encouraged to problem solve, innovate and use the latest technology to support others.
· Effective Communication – Clarity, openness and a willingness to listen characterises our approach to interacting with others.
· Respect – Integrity, fairness, equality, diversity, cooperation, responsiveness and perceptiveness in how we treat others.
Coronavirus ~ COVID-19 🦠
All the information you need regarding COVID-19.
As current Covid 19 cases are increasing this winter please ensure you are kept up to date on the most recent guidance from the HSE & HSPC websites. Remember:
• All staff must wear gloves, apron and surgical mask for all visits in a clients home. Correct donning and doffing of PPE must be completed on entering and leaving the home. Change of PPE if needed between tasks such as personal case is permitted once clean PPE is put on.
• Handwashing must be completed on entering the home and leaving. In between tasks carried out
• All carers are to wear enhanced PPE (surgical face mask, goggles/visors, full gowns, gloves) when working with a client who is Covid positive. Please contact your local client care manager/nurse manager so this can be provided to you. If you are made aware a client is awaiting a test result or is symptomatic we can provide full PPE in the interim. If negative result basic PPE then will resume.
• All your clothes should be washed daily using a minimum 60 degree cycle. If possible, leave your work shoes outside or in the car.
Please remember to self-monitor for COVID symptoms minimum twice daily as per guidelines. If you have a sore throat, blocked/runny nose, cough, aches/pain, tiredness/fatigue, loss of taste/smell, severe headache or any other unusual symptom please contact your GP and Myhomecare immediately for advice before continuing your client calls.
You must inform the office if you are displaying any symptoms of Covid-19, are a close contact or have received a positive antigen test. If you are awaiting a PCR test you cannot return to work until result has come back and it is negative.
Some helpful links are outlined below with guidance and video resources available
Stress Management Tips for Healthcare Workers during COVID-19
If you are a healthcare worker, you may be exposed to additional sources of stress because of different reasons:
• You may be working extended shifts or seeing more patients, while trying to stay up to date with evolving COVID-19 treatments and protocols.
• Your intense work schedule could make it much harder for you to practice self-care and connect with your social support network.
• You may be experiencing stress in your personal life due to the crisis - or other unrelated issues – as you attempt to maintain standards of care for vulnerable patients.
• You may feel tired of and restricted by protective equipment. It could take a physical toll on you, and it may become harder to provide the level of comfort you usually offer to distressed patients in your care.
• If you have children and are required to work full shifts, it could be challenging to find someone to look after them.
• You may experience stigma due to your increased exposure to the virus, which could cause you to feel isolated and lonely.
• You may be concerned about your health and the potential health risk to your family members.
• You may face an increase in difficult or distressing situations and decisions.
• You may have to quickly adjust to new colleagues and guidelines, with no time to reflect and adapt.
• You may have to practice social distancing or isolate entirely from your family and children.
• Being vulnerable to high levels of stress can increase your chances of becoming overwhelmed. You need to be aware of how you are feeling before you can find ways to cope with your new circumstances.
• So, if you are experiencing more stress, what can you do to mind yourself in the middle of working on the frontline of a pandemic?
Top tips for healthcare workers:
Pay attention to and notice how you are feeling:
1. Be aware of your stress levels: stress can accumulate and become overwhelming and chronic unless managed. Keep an eye and monitor how you’re doing.
2. Remind yourself that feeling stressed is normal under the exceptional circumstances we are living through. It is okay not to be okay.
3. You may feel like you are not doing enough and that you’re not up to the task. Remember that becoming stressed or overwhelmed simply shows you are human and is in no way a reflection of your
abilities.
4. Some stress is helpful in energizing you to keep going in the current situation, but it is important to manage it so that it does not become excessive and overwhelms you.
5. You may also experience a range of unpleasant and unwelcome emotions, maybe also towards patients, on top of dealing with a lot of uncertainty on a daily basis. You may feel anger for non-compliance with social distancing restrictions, you may feel powerless at times and you may find it hard to feel compassionate towards patients at other times. This is normal and to be expected. However, it is important that you reach out for support if these feelings start becoming unsettling.
Once you recognize that things are impacting on you, you can find new ways to cope with your situation. Remember, even doing something small to look after yourself can make a big difference to your stress levels.
What you need to do:
• Self-care is hardest when you need it most. You may not feel like it is a priority when you have so much to do, but it is and cannot be negotiable at this time. You need to make sure you look after your basic physical and mental health needs or you won’t be able to look after others.
• Eat well and look after your body - Make sure you get enough exercise as it is the single most helpful tool to help you manage your mental health. Don’t skip meals or breaks, no matter how busy you are. Stretching or simply getting some fresh air can be a simple and quick way to mind yourself.
• Beware of unhelpful coping strategies - (Alcohol, tobacco etc), which can easily become automatic ways to try and make ourselves feel better at times of stress. However, these can have a negative impact on your mental health, so it is a good idea to try and keep an eye on them.
• Get enough sleep – Sleep can be a challenge at this time, but it is essential to your ability to make sound decisions.
• Find ways to care for yourself - What are the things that help you care for yourself? You may need to get a little creative at this time as some of your self-care tools may not be options due to current restrictions.
• Connect - You may find yourself somewhat excluded and isolated at this time because of work, restrictions, etc. Try to keep in touch with important people in your life as much as possible (without overdoing it!).
• Keep healthy boundaries - Beware of the temptation to overwork and skip breaks because things are so busy. These are essential times for you to recharge to be able to give some more.
• Watch out for excessive stress, fatigue, and sudden exhaustion - Look out for your stress levels worsening, feeling overwhelmed, feeling disconnected from your work and start finding looking after yourself harder as time goes on. Working on adrenaline for extended periods of time can also lead to a sudden onset of exhaustion. Do not blame yourself, as it is not your fault, rather reach out to your line manager/lead to get the support you need to get back on track.
• Values - Reconnecting to your values can be a helpful way to refocus on why you are doing what you are doing and how you want to do it. Taking a moment to reflect on what these are and how your life and what you are doing every day is matching up against these can help keep focus.
Finally, how about you take a moment to reflect each day: remind yourself of what you have achieved, how maybe you supported or connected with someone, or perhaps you did something to self-care. No matter how big or small, it’s important to celebrate your gains to help you stay well and hopeful about the future.
One Touch Health
It is important that you record your tasks and care provided in the notes section daily for each client. If you have any issues using the system, please contact your local team who will be happy to help!
