Foreword xv
Preface xvi
Acknowledgements xviii
List of Abbreviations and Symbols xix
1 Diagnosing and Classifying Diabetes 1
Key points 1
What is diabetes mellitus? 2
Prevalence of diabetes 2
Classification of diabetes 3
Overview of normal glucose homeostasis 4
The metabolic syndrome in children and adolescents 7
Type 1 and Type 2 diabetes 8
Type 2 diabetes in Indigenous children and adolescents 15
Gestational diabetes 15
Example Information Sheet: Preparation for an oral glucose
tolerance test 20
Screening for diabetes 21
Preventing Type 2 diabetes 22
Preventing Type 1 diabetes 25
Managing diabetes mellitus 25
Key points 25
Aims of management 27
Exercise/activity 29
Diabetes education 32
Complications of diabetes 33
Aim and objectives of nursing care of people with diabetes
34
Technology and diabetes management 36
A sobering final comment 38
References 38
2 Holistic Assessment, Nursing Diagnosis, and Documentation
44
Key points 44
Rationale 44
Holistic nursing 45
Care models 45
Characteristics of an holistic nursing history 47
Nursing history 49
Example Health Assessment Chart 50
Instruments to measure health status 54
Documenting and charting patient care 54
Care plans 55
Nursing responsibilities 56
Documentation by people with diabetes 57
References 58
3 Monitoring Diabetes Mellitus 60
Key points 60
Rationale 60
Introduction 61
Monitoring 1: Blood glucose 61
Key points 61
Blood glucose testing checklist 71
Monitoring 2: Urine glucose 73
Key points 73
Monitoring 3: Additional assessment 76
Self-care 80
The annual review 81
References 81
4 Nutrition, Obesity and Exercise 84
Key points 84
Rationale 84
The importance of good nutrition 85
Obesity 85
Overview of the pathogenesis of obesity 86
The significance of abdominal obesity 87
Nutrition, obesity and stress 88
Methods of measuring weight 88
Managing obesity and diabetes 90
Malnutrition and under-nutrition 90
Method of screening for dietary characteristics and problems
93
Principles of dietary management for people with diabetes 94
Goals of Dietary Management 97
Dietary management: obesity 98
Bariatric surgery 99
Complementary weight loss programmes 101
Factors associated with making dietary changes 101
Nursing responsibilities 102
References 107
5 Medicines Management 111
Key points 111
Introduction 112
Quality Use of Medicines (QUM) 112
Quality Use of Medicines and Diabetes 113
Oral Glucose-Lowering Medicines (GLM) 114
The incretin hormones 124
New medicines for type 2 diabetes 125
Medicine interactions 126
When should insulin be initiated in Type 2 diabetes? 128
Barriers to insulin therapy 132
Some strategies to overcome the barriers 132
Insulin therapy 133
Types of insulin available 134
Injection sites and administration 137
Mixing short- and intermediate-acting insulins 138
Commonly used insulin regimens 139
Interpreting morning hyperglycaemia 140
Continuous subcutaneous insulin infusion (CSII) 141
Continuous blood glucose sensors 142
Subcutaneous insulin sliding scales and top-up regimes 143
Uses of insulin infusions 145
Insulin allergy 147
Transplants 148
Stabilising diabetes 148
Stabilising diabetes in hospital 149
Community and outpatient stabilisation 150
Lipid-lowering agents 152
Monitoring lipid medicines 157
Antihypertensive agents 157
Antiplatelet agents 160
Medication safety, adherence and medication self-management
161
Enhancing medication self-care 163
Example protocol for outpatient stabilisation onto insulin
166
References 167
6 Hypoglycaemia 174
Key points 174
Rationale 174
Introduction 175
The counter-regulatory response 176
Definition of hypoglycaemia 178
Recognising hypoglycaemia 180
Counter-regulatory hormonal response to hypoglycaemia 181
Causes of hypoglycaemia 181
Preventing and managing hypoglycaemia 182
Hypoglycaemic unawareness 183
Prevalence of hypoglycaemic unawareness 183
Nocturnal hypoglycaemia 184
Relative hypoglycaemia 187
Medicine interactions 187
Objectives of care 188
Treatment 188
Prolonged hypoglycaemia 189
Patients most at risk of hypoglycaemia 190
Psychological effects of hypoglycaemia 191
Consequences of hypoglycaemia 192
Guidelines for administering glucagon 193
Adverse reactions 194
References 194
7 Hyperglycaemia, Acute Illness, Diabetic Ketoacidosis (DKA),
Hyperosmolar Hyperglycaemic States (HHS), and Lactic Acidosis
198
Key points 198
Rationale 199
Prevention: proactively managing intercurrent illness 199
Self-care during illness 201
Hyperglycaemia 201
Diabetic ketoacidosis (DKA) 203
Brittle diabetes and hyperglycaemia 210
Euglycaemic DKA 210
Hyperosmolar Hyperglycaemic States 211
Presenting signs and symptoms 212
Lactic acidosis 213
Lactic acidosis associated with Metformin 215
References 216
8 Long-Term Complications of Diabetes 218
Key points 218
Introduction 219
Pathophysiology of diabetes complications 219
Cardiovascular disease and diabetes 221
Key points 221
Rationale 222
Medicines and cardiovascular disease 223
Complementary medicines (CAM) 226
Other management considerations 227
Mental health and cardiovascular disease 228
Nursing responsibilities 229
Telephone coaching 233
Cerebrovascular disease 233
Signs and symptoms 234
Diabetes and eye disease 235
Key points 235
Rationale 235
Introduction 235
Risk factors for retinopathy 236
Diabetes and renal disease 241
Key points 241
Introduction 241
Stages of chronic kidney disease 241
Risk factors for renal disease 242
Renal failure 243
Renal disease and anaemia 245
Diet and renal disease 245
Renal disease and older people 247
Kidney biopsy 247
Renal dialysis 247
Objectives of care 249
Nursing responsibilities 250
Commencing CAPD in patients on insulin 250
Educating the patient about CAPD 251
Supportive care 252
Renal disease and herbal medicine (see also Chapter 19) 252
Peripheral and autonomic neuropathy 253
Key points 253
Introduction 253
Vascular changes 254
Infection 255
Diabetes-related peripheral neuropathy 257
Other pain management strategies 258
Stages of peripheral neuropathy 259
Risk factors for developing foot problems 259
Objectives of care 260
Nursing responsibilities 260
Classification of foot ulcers 262
Wound management 262
Wound management techniques under study 264
Rehabilitation 264
Autonomic neuropathy 265
Key points 265
Introduction 265
Diagnosis and management 267
Nursing care 268
References 269
9 Management During Surgical and Investigative Procedures
277
Surgical procedures 277
Key points 277
Rationale 277
Introduction 278
Children with diabetes undergoing surgical procedures 279
Older people with diabetes and surgical procedures 280
Aims of management 280
Preoperative nursing care 281
Major procedures 284
Postoperative nursing responsibilities 286
Minor procedures 287
Insulin pump therapy in patients undergoing surgery 288
Emergency procedures 289
Bariatric surgery 290
Investigative procedures 290
Key points 290
Rationale 290
The objectives of care 291
General nursing management 291
Eye procedures 292
Complementary therapies and surgery and investigative
procedures
295
Preoperative phase 295
Postoperative phase 296
Implications for nursing care 297
References 297
Example Instruction Sheet 2(a): Instructions for people with
diabetes on oral glucose-lowering medicines having procedures
as
outpatients under sedation of general anaesthesia 298
Example Instruction Sheet 2(b): Instructions for people with
diabetes on insulin having procedures as outpatients under
sedation
or general anaesthesia 299
10 Conditions Associated with Diabetes 300
Key points 300
Introduction 300
Enteral and parenteral nutrition 301
Aims of therapy 301
Routes of administration 302
Choice of formula 304
Nursing responsibilities 304
Diabetes and cancer 306
Management 307
Objectives of care 308
Nursing responsibilities 309
Managing corticosteroids in people with cancer 310
Complementary therapies and cancer 311
Smoking, alcohol, and illegal drug use 312
Smoking 312
Nicotine addiction 314
Assisting the person to stop smoking 315
Medicines to support smoking cessation 317
Alcohol addiction 317
Illegal drug use 319
Effects on diabetes 321
Interactions with medicines 322
Management issues 322
Brittle diabetes 323
Introduction 323
Causes of brittle diabetes 324
Management 324
Oral health and diabetes 325
Introduction 325
Causal mechanisms 326
Management 326
Diabetes and liver disease 327
Introduction 327
Managing people with diabetes and liver disease 328
CAM medicines 329
Haemochromatosis 329
Iron overload 330
Management 330
Diabetic mastopathy 330
Diagnosis 330
Management 331
Diabetes and coeliac disease 331
Signs and symptoms 332
Diagnosis 332
Management 333
Cystic fibrosis-related diabetes 333
Diagnosis 334
Signs and symptoms 335
Management 335
Sleep disturbance and diabetes 335
Diagnosis 336
Management 337
Diabetes and tuberculosis 337
Management 337
Diabetes and HIV/AIDS 338
Management 338
Diabetes and hearing loss 339
Causes of hearing loss 339
Management 340
Diabetes and musculoskeletal diseases 341
Management 342
Corticosteroid and antipsychotic medications and diabetes
342
Key points 342
Introduction 342
Management 344
Antipsychotic medicines 345
Diabetes and driving 346
Prevalence of and risk factors for driving crashes 346
Diabetes-related effects on driving 349
Hypoglycaemia effects on driving 352
Strategies to enhance driving safety 353
Information for people with diabetes to help them drive safely
354
Diabetes and fasting for religious observances 355
Education and counselling 356
References 356
11 Diabetes and Sexual and Reproductive Health 365
Key points 365
Rationale 365
Sexual health 366
Sexual development 367
Sexual problems 367
Possible causes of sexual difficulties and dysfunction 368
Sexuality and older people 369
Women 369
Men 370
Investigation and management 371
Medication management for ED 372
Non-pharmacological therapy 372
Complementary medicines for sexual problems (CAM) 373
Involving partners in ED management 374
Sexual counselling 374
The PLISSIT model 376
Role of the nurse 377
References 377
12 Diabetes in Older People 379
Key points 379
Rationale 380
Introduction 380
Determining functional status 386
Geriatric syndromes 388
Cognitive functioning 388
Depression and older people with diabetes 394
Dementia 394
Managing diabetes in older people 395
Management aims 395
Factors that affect management decisions 396
Guidelines for administering diabetes medicines with enteral
feeds 401
Education approaches 402
Self-care 403
Factors that can affect metabolic control 404
References 414
13 Diabetes in Children and Adolescents 422
Key points 422
Rationale 422
Introduction 423
Managing children and adolescents with diabetes 425
Aspects of care that apply to both Type 1 and Type 2 diabetes
in
children and adolescents 425
Managing Type 1 diabetes 427
Managing childhood Type 2 diabetes 430
Medication self-management 431
Other conditions associated with diabetes 431
Complementary therapy use in children 432
Strategies for enhancing adherence during adolescence 433
Ketoacidosis in children 434
References 434
14 Women, Pregnancy, and Gestational Diabetes 438
Key points 438
Rationale 438
Polycystic ovarian syndrome 439
Pregnancy 442
Complications of pregnancy 446
Effects of diabetes on the baby 447
Longer term effects of maternal hyperglycaemia on the child
448
Gestational diabetes 448
Risk factors for gestational diabetes? 449
Managing gestational diabetes 450
Type 1 diabetes 451
Type 2 diabetes 452
Menopause and diabetes 452
Signs and symptoms of menopause 453
Managing the menopause 453
Contraception options for women with diabetes 454
Complementary approaches to managing the menopause 456
References 458
15 Psychological and Quality of Life Issues Related to Having
Diabetes 463
Key points 463
Rationale 464
Introduction 464
Depression 469
Symptoms of depression 470
Maintaining mental health and managing depression 470
Screening for psychological distress and depression 472
Antipsychotic medicines and diabetes 473
Type 1 diabetes 473
Type 2 diabetes 474
Compliance/adherence/concordance 475
Psychological distress and cardiovascular disease 476
Quality of life 478
References 479
16 Diabetes Education 483
Key points 483
Rationale 484
Introduction 484
Learning styles 486
Education and other theories/models 489
Communication ? the central element of effective teaching
and learning 492
Teaching: an art and a process 494
Health literacy 495
Survival skills 498
Sample diabetes education record chart 499
Empowerment 501
Special issues 502
The nurses? role in diabetes education 502
Insulin administration 504
Guidelines for teaching people about insulin delivery systems
504
Documenting diabetes education 505
Examples instruction sheets 505
Example Instruction Sheet 3: How to draw up insulin from one
bottle 505
Example Instruction Sheet 4: How to draw up insulin from two
bottles
(usually a short/rapid acting and an intermediate acting
insulin) 506
Example Instruction Sheet 5: How to give an insulin injection
using syringes or insulin pens 506
Example Instruction Sheet 6a: Managing your diabetes when you
are ill: patients with Type 1 diabetes 506
Example Instruction Sheet 6b: Managing your diabetes when you
are ill: patients with Type 2 diabetes 508
Evaluating diabetes education 509
References 511
17 Nursing Care in the Emergency, Intensive Care, Outpatient
Departments, Community and Home-Based Care and Discharge
Planning
516
Key points 516
Community, practice and home care nurses are in an ideal
position to deliver preventative health care education 516
Rationale 516
The emergency department 517
Intensive Care (ICU) 519
The outpatient department 519
Community, Practice Nursing, and Home-Based Care 520
Introduction 520
How to obtain advice 521
General points 521
Disposing of sharps in the home situation 527
Storing insulin 528
Practice nurses 528
Discharge Planning 529
Key points 529
References 530
18 Managing Diabetes at the End of Life 532
Key points 532
Introduction 533
Palliative care and diabetes 534
Key issues in palliative and end of life care 534
The end of life process 538
Key management considerations for managing diabetes at the end
of life 540
Glycaemic targets 541
Blood glucose monitoring 541
Hyperglycaemia 542
Hypoglycaemia 542
Medicine management 543
Type 1 diabetes 543
Type 2 diabetes 544
Nutrition and hydration 545
Diabetogenetic medicines 546
Managing corticosteroid-induced diabetes in palliative care
patients 547
Antipsychotic medicines 547
Supporting family/carers 548
Withdrawing treatment 548
Diabetes education 549
References 549
19 Complementary and Alternative Therapies 552
Key points 552
Rationale 552
Introduction 553
CAM philosophy 555
Integrating complementary and conventional care 556
Can complementary therapies benefit people with diabetes?
558
Spirituality 561
CAM and surgery 561
Herb/medicine interactions 567
How can complementary therapies be used safely? 568
Nursing responsibilities 569
Identifying quality health information on the Internet 570
References 572
Index 575
Professor Trisha Dunning is Inaugural Chair in Nursing atDeakin University and Barwon Health, Australia. She is anhonorary Life Member of the Australian Diabetes EducatorsAssociation, a Vice President of the International DiabetesFederation and a distinguished Life Fellow of the Royal College ofNursing, Australia.
Care of People with Diabetes is an essential guide to thecare and management of people with diabetes mellitus, withparticular emphasis on the acute care setting. Written by anexperienced clinical nurse specialist with extensive knowledge ofevidence-based diabetes care, this fully updated fourth editionserves as an essential companion to clinical practice for nursesand healthcare professionals. (Newbooks.lib, 9September 2014) However, whilst the book is a nursing manual, it would bea useful resource for any health professional involved in the careof people with diabetes. (Journal of DiabetesNursing, 1 June 2014)
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