Subcutaneous Injection: The Basics

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Ward nurses. Community nurses. Student nurses. Most other nurses you can think of.

If you have ever been part of a patient’s direct clinical care then you are, without a doubt, no stranger to subcutaneous injections.

So, how can you be sure that you are carrying out this common skill correctly?

Subcutaneous injections are not just about poking a needle into someone’s skin.

There is a risk to your patient if not done correctly, so you need to be sure that you know all you need to know.

Table of Contents

What is a Subcutaneous Injection?

A subcutaneous injection is a way of delivering medication directly to the fat layer under the skin.

This layer is called the subcutaneous tissue, and it’s where you store all your extra calories and energy.

Subcutaneous injections are different from other types of injections, such as intramuscular (into the muscle) or intravenous (into the vein).

Subcutaneous injections are slower and gentler, because they don’t need to go through the muscle or the bloodstream.

✾ The term “subcutaneous” comes from Latin words ‘sub’ meaning “under” and ‘cutis’ meaning “skin,” hence subcutaneous injections are administered into the layer of skin directly below the dermis and epidermis, also known as the subcutis or the hypodermis.

Why are Subcutaneous Injections Necessary?

Some medications work best when they are injected into the fat layer because they need to be absorbed at a steady pace.

For example, insulin is a hormone that helps control blood sugar levels, and it needs to be injected into the fat layer to mimic the natural release of insulin from the pancreas.

Other medications that are given subcutaneously include growth hormone, octreotide, glucagon, and epinephrine.

Subcutaneous injections can also be helpful for patients who have trouble swallowing pills, or who have problems with absorbing or metabolising oral medications.

This form of injections can also reduce the risk of infection or irritation that may happen with other routes of medication.

✾ Subcutaneous injections are generally safer than intravenous and intramuscular routes. They are less likely to cause complications such as infections, nerve damage or injection into a blood vessel.

When to Perform a Subcutaneous Injection?

The timing and frequency of subcutaneous injections depend on the medication, the patient’s condition and the doctor’s prescription.

Some medications need to be given every day, while others may be given once a week or once a month.

And some need to be given at specific times of the day, such as before meals or at bedtime.

There are also medications that need to be given in relation to blood tests or other monitoring procedures.

It is very important to follow the instructions on the medication label and the prescription carefully, and to ask the doctor or pharmacist if you have any questions or doubts.

✾ Timing can be crucial when it comes to subcutaneous injections. For instance, insulin injections are often timed around meals, with the exact timing depending on the type of insulin and the individual’s specific needs.

✾ It’s also recommended to administer these injections at the same time each day to help keep blood sugar levels stable.

Step-By-Step: How to Perform a Subcutaneous Injection

Before you give a subcutaneous injection, you need to gather the following equipment:

The steps for giving a subcutaneous injection are as follows:

Wash your hands with soap and water or use an alcohol-based hand rub.
Put on gloves, in adherence to infection control and local policy.
Check the patient’s name and date of birth using two identifiers.
Explain what you are going to do to the patient and get their consent.
Choose a suitable spot for injection on the patient’s body.
Cleanse the skin at the injection spot with an alcohol wipe or swab using a circular motion from inside to outside. Let it dry completely before injecting.
Take off the needle cap and hold the syringe like a pencil or a dart in your main hand.
Pinch up a fold of skin at the injection spot with your other hand. Put in the needle quickly and firmly at a 45° angle.
Inject the medication slowly and smoothly by pushing the plunger all the way down.
Pull out the needle swiftly and apply gentle pressure to the injection spot with some gauze. Do not rub or massage the area as this may cause discomfort or affect the absorption of the medication.
Throw away the used needle and syringe in a sharps bin right away after use. Do not put back or bend the needle, as this may cause a sharps injury.
Take off your gloves and wash or gel your hands.
Complete your documentation, including the date, time, area, medication name, dose, route, as well as any side effects or problems.

✾ The common spots for subcutaneous injection are:

The stomach (except for 2 inches around the belly button)
The upper arms (on the outer back side)
The thighs (on the front outer side)
The bum (on the upper outer corner)

✾ You should change the spots regularly to avoid hurting or irritating the same area repeatedly.

Rapid breathing? Sweating? Anxiety? These are all signs a person who has a needle phobia might display. So rather than waving a needle around, maybe try some distraction techniques instead!

What Happens When a Subcutaneous Injection is Not Done Correctly?

Although subcutaneous injections are a great way to deliver medications that need a steady and slow absorption into the bloodstream, whilst avoiding unwanted complications, it needs to be done accurately and with care.

Here are some of the things that could go wrong if you don’t follow the proper technique:

Pain

Nobody likes to feel pain, especially your patients. That’s why you should insert the needle gently and correctly, avoiding the sensitive nerve endings in the skin that can trigger a painful response.

Incorrect Absorption of Medication

The whole point of a subcutaneous injection is to ensure that the medication is absorbed at the right rate and amount. If you inject the medication too fast, too deep, or in the wrong place, you could compromise its effectiveness and put your patient at risk.

Infection or Irritation at the Injection Site

You should always clean the injection site with an alcohol pad and wait for it to dry before inserting the needle. You should also rotate the injection sites to prevent overuse and irritation of the same area.

Damage to Tissues

Subcutaneous injections are meant to go into the fatty layer under the skin, not into the muscle. If you insert the needle too deeply, you could damage the muscle tissues and cause bleeding, bruising, or inflammation.

✾ To prevent these complications, you should follow the steps above and use the correct technique when giving a subcutaneous injection. It’s as simple as that!

So there you have it.

Subcutaneous injections are a key skill for nurses, as they can give medications that are effective and convenient for patients.

They need careful preparation, technique and documentation to ensure safety and quality of care.

Question Time

Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.

Do you remember giving your first subcutaneous injection? Or have you ever received a subcutaneous injection? What was your experience?

How do you cope with needle phobia or anxiety when giving or receiving subcutaneous injections?

What are some of the tips or tricks that you use to make subcutaneous injections easier or more comfortable?

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The Basic Biology of Diabetes

March 8, 2024 (updated April 28, 2024) Published by intunursing

Connecting Nurses Worldwide

The Basic Biology of Diabetes

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Diabetes Mellitus is a complex, chronic illness that affects millions worldwide and is characterised by high levels of sugar in the blood.

But what exactly causes these elevated levels?

In this post, we’ll delve into the biological mechanisms behind diabetes, exploring the role of the pancreas, insulin and glucose in the body.

Whether you’re a student, a healthcare professional or simply curious about this widespread condition, here’s hoping this post will shed light on the intricate biology of diabetes.

Let’s dive right in!

Table of Contents

Type 1 Diabetes

Type 1 diabetes is a chronic condition characterised by the autoimmune destruction of the insulin-producing β-cells within the islets of Langerhans in the pancreas.

Insulin Production and Destruction

In normal circumstances, insulin is synthesised by the β-cells in response to glucose levels

However, in Type 1 diabetes, these very β-cells become targets of the immune system

Mistakenly identified as foreign, they face an autoimmune attack, leading to their destruction

Consequently, an absolute deficiency of insulin occurs, necessitating lifelong reliance on external insulin sources

Genetic and Environmental Factors

The onset of Type 1 diabetes involves a complex combination of genetic and environmental factors

Genetic predisposition plays a significant role, with a strong association to specific HLA haplotypes and immune system genes

Additionally, an infective or environmental trigger (such as a viral infection) may initiate the autoimmune response in genetically susceptible individuals

Immunological Damage

The development of Type 1 diabetes is gradual and characterised by progressive immunological damage

Insulitis occurs—an invasion of pancreatic islets by T-lymphocytes which ultimately leads to β-cell destruction

Over time, this process results in insulin deficiency

Clinical Diagnosis

Clinically, Type 1 diabetes is often diagnosed based on specific criteria:

Capillary blood glucose levels greater than 11 mmol/L

A history of classic osmotic symptoms (polyuria and polydipsia)

Weight loss

Assessment for the presence of ketones in the blood or urine

Long-Term Implications

Insulin administration is crucial for maintaining blood glucose control

Optimising overall glycaemic control helps prevent micro and macrovascular complications

Elevated blood glucose levels in Type 1 diabetes can lead to premature morbidity and mortality

✾ β-cells: These are special cells in the pancreas that produce insulin, a hormone necessary for regulating blood sugar levels.

✾ Autoimmune: When the immune system mistakenly attacks healthy cells in the body, thinking they are harmful invaders.

✾ HLA haplotypes: These are specific genetic markers related to the immune system. They play a role in determining susceptibility to certain diseases.

✾ Insulitis: Refers to inflammation of the insulin-producing cells (β-cells) in the pancreas.

✾ Micro and macrovascular complications: These are health issues related to small blood vessels (microvascular) and large blood vessels (macrovascular). In diabetes, these complications can affect organs like the eyes, kidneys, and heart.

Type 2 Diabetes

Type 2 diabetes is a metabolic disorder where the body either becomes resistant to the effects of insulin or the pancreas cannot produce enough of it.

Insulin Resistance

Insulin resistance is when the cells in the body do not respond well to insulin.

Even though there is enough insulin in the blood, the cells do not take in enough sugar, leaving too much of that sugar in the blood.

This can happen because of several factors, such as:

Changes in the cell membrane, which affect the transport of sugar and insulin across the membrane

Alterations in the insulin receptor, which reduce the binding and signalling of insulin to the cell

Dysregulation of the intracellular pathways, which impair the glucose uptake and metabolism by the cell

Production of inflammatory cytokines, which interfere with the insulin action and induce insulin resistance

The gut microbiota, which is the collection of microorganisms that live in the digestive tract, can also influence the insulin resistance by affecting the inflammation, immunity and metabolism of the host.

Increased Glucose Production

Increased glucose production is when the liver makes too much sugar, even when the blood sugar levels are already high.

This adds more sugar to the blood and makes it harder to control.

This can happen because of several factors, such as:

Activation of the gluconeogenesis, which is the process of making new sugar from non-carbohydrate sources, such as amino acids, lactate or glycerol

Suppression of the glycogenolysis, which is the process of breaking down the stored sugar (glycogen) in the liver and releasing it into the blood

Stimulation of the glucagon, which is a hormone that increases the blood sugar levels by activating the gluconeogenesis and glycogenolysis

Inhibition of the insulin, which is a hormone that lowers the blood sugar levels by suppressing the gluconeogenesis and glycogenolysis.

The gut microbiota can also affect the glucose production by producing different metabolites, such as short-chain fatty acids (SCFAs), bile acids, and amino acids.

These can influence the glucose metabolism and the secretion of hormones, such as insulin and glucagon-like peptide-1 (GLP-1) that regulate the blood glucose levels.

Beta-Cell Dysfunction

Beta-cell dysfunction is when the cells in the pancreas that make insulin become damaged and stop working overtime.

This leads to less insulin in the blood and more sugar in the blood.

This can happen because of several factors:

Exposure to high levels of sugar, which can cause oxidative stress and inflammation in the beta cells, leading to their death or dysfunction

Exposure to high levels of fatty acids, which can cause lipotoxicity and apoptosis in the beta cells, leading to their death or dysfunction.

Exposure to high levels of inflammatory cytokines, which can cause immune-mediated damage and dysfunction in the beta cells, leading to their death or dysfunction.

Exposure to high levels of amyloid, which is a protein that can accumulate and form toxic aggregates in the beta cells, leading to their death or dysfunction.

The gut microbiota can also affect the beta-cell function by modulating the immune and inflammatory responses, and by producing certain metabolites, such as SCFAs, that can protect or enhance the beta-cell survival and function.

Inflammation and Fat Accumulation

Inflammation and fat accumulation are when the body has too much fat, especially around the belly, which can cause inflammation and release certain proteins that interfere with insulin action.

This makes the cells more resistant to insulin, and can happen because of several factors:

Excess intake of calories, which can lead to weight gain and obesity, which are major risk factors for type 2 diabetes

Imbalance in the adipokines, which are proteins that are produced by the fat cells and that can affect the insulin sensitivity and glucose metabolism of the body

Accumulation of ectopic fat, which is fat that is stored in or around the organs, such as the liver and the pancreas, and that can impair their function and induce insulin resistance

Activation of the innate immune system, which can trigger the production of inflammatory cytokines and reactive oxygen species, which can damage the cells and tissues and induce insulin resistance

The gut microbiota can also influence the inflammation and fat accumulation by affecting the energy balance, the fat storage, the adipokine secretion and the immune activation of the host.

✾ Inflammatory Cytokines: Proteins that are secreted by immune cells and other cell types to promote inflammation, which is a protective response to infection or injury.

✾ Gut Microbiota: The collection of microorganisms that live in the digestive tract

✾ Gluconeogenesis: The process of making new sugar from non-carbohydrate sources, such as amino acids, lactate or glycerol

✾ Glycogenolysis: The process of breaking down the stored sugar (glycogen) in the liver and releasing it into the blood

✾ Short Chain Fatty Acids (SCFAs): Fatty acids with fewer than six carbon atoms. They are produced by the bacteria in the gut when they ferment fibre. SCFAs are important for colon health as they provide energy to the cells lining the colon. SCFAs also have various benefits for metabolism, inflammation, immune system and blood sugar control.

✾ Lipotoxicity: A metabolic syndrome that occurs when excess lipids, such as fatty acids, accumulate in non-adipose tissues, such as the liver, heart or pancreas leading to cellular dysfunction and even cell death

✾ Adipokines: Proteins that are produced by the fat cells and that can affect the insulin sensitivity and glucose metabolism of the body

Gestational Diabetes

Gestational diabetes mellitus (GDM) is a condition that affects some pregnant women, who develop high blood sugar levels due to impaired glucose metabolism.

It is one of the most common complications of pregnancy, and its prevalence is increasing worldwide.

GDM is the result of two major metabolic disorders that occur during pregnancy:

Chronic Insulin Resistance

This is when the cells of the body become less responsive to insulin, the hormone that regulates glucose uptake from the bloodstream.

This leads to hyperglycaemia, or elevated blood glucose levels.

Insulin resistance is a normal physiological adaptation of pregnancy, as it allows more glucose to be available for the growing foetus.

However, in some women, the insulin resistance becomes too severe and exceeds the compensatory increase in insulin secretion by the pancreas.

β-cell Dysfunction

This is when the β-cells of the pancreas, which produce and secrete insulin, fail to function properly.

This impairs the ability of the pancreas to produce enough insulin to overcome the insulin resistance.

β-cell dysfunction is a key factor in the development of both GDM and Type 2 diabetes mellitus (T2DM).

Several risk factors, such as advanced maternal age, overweight, obesity, westernised diet, ethnicity, intrauterine environment, hypertension, family history of GDM or T2DM, and personal history of GDM or polycystic ovarian syndrome, can affect the β-cell function and/or insulin sensitivity, either directly or indirectly.

Therefore, GDM can be seen as a transient manifestation of underlying metabolic abnormalities that may predispose women to develop T2DM later in life.

(In short, GDM is basically a sneak peek of what could happen to your metabolism later in life).

✾ Gestational Diabetes Mellitus is influenced by both genetic and environmental factors, and it can have short-term and long-term consequences for both the mother and the offspring.

You won’t be expected to know everything immediately, so start with the basic biology, particularly the endocrine system, as it is crucial for understanding diabetes.

Steroid Induced Diabetes

Steroid-induced diabetes is caused by two main problems in your metabolism.

Steroids make your muscle and fat cells resist insulin, which means they don’t take up glucose from your blood.

It makes your liver resist insulin, which means it keeps making more glucose (gluconeogenesis and glycogenolysis) even when you don’t need it.

Steroids also make your pancreas produce and release less insulin, which means you can’t lower your blood sugar level.

Glucocorticoid Receptor (GR) Activation

Steroids, especially the ones called glucocorticoids, stick to special proteins called glucocorticoid receptors (GRs) in different parts of your body, like your liver, muscle, and fat tissue.

When GRs are activated by steroids, they change the way your genes work, affecting how your body handles sugar.

In your liver, GR activation makes your genes produce more enzymes that make glucose from scratch (gluconeogenesis).

In your muscle and fat tissue, GR activation makes your genes produce less proteins that help your cells take up glucose from your blood (such as GLUT4).

Insulin Resistance

Steroids make your body ignore insulin, the hormone that tells your cells to take up sugar from your blood.

GR activation stops a molecule called insulin receptor substrate-1 (IRS-1) from working properly, breaking the chain of signals that insulin sends to your cells.

When IRS-1 doesn’t work, your cells can’t take up glucose or store it as glycogen (a form of sugar storage).

Hepatic Gluconeogenesis and Glycogenolysis

Steroids make your liver produce more glucose.

GR activation makes your genes produce more enzymes that make glucose from scratch (gluconeogenesis) or from glycogen (glycogenolysis).

Glycogenolysis is when your liver breaks down glycogen, the stored form of sugar, into glucose.

Beta-Cell Dysfunction

Steroids make your pancreas produce and release less insulin.

GR activation makes your genes produce less insulin and release less insulin.

Your pancreas cells may die (apoptosis) if you take steroids for too long.

Adipokines and Inflammation

Steroids change the way your fat tissue releases hormones called adipokines.

Some adipokines are bad for you, like TNF-alpha and IL-6, because they cause inflammation and make your body resist insulin.

Your fat tissue may also get inflamed, which makes your blood sugar level worse.

Alterations in Gut Microbiota

There is some evidence that steroids may affect the bacteria in your gut (gut microbiota).

Having a balanced gut microbiota is important for your health, but steroids may cause an imbalance (dysbiosis).

A dysbiotic gut microbiota may make your body resist insulin and cause inflammation.

Individual Variability

✾ Not everyone who takes steroids gets steroid-induced diabetes.

✾ Your genes, how long you take steroids, your overall health, and other factors can affect your risk of getting steroid-induced diabetes.

So there you have it.

The biology of Type 1, Type 2, gestational and Steroid induced diabetes.

Going through your biology will always bring you one step closer to understanding what is going on and why, allowing you to provide the most effective care.

Question Time

Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.

How would you explain the concept of insulin resistance to someone learning about diabetes for the first time?

If you could invent a new treatment for diabetes based on its biology, what would it be?

What is one aspect of diabetes biology that you find most intriguing and why?

Latest Blog Posts

Subcutaneous Injection: The Basics

The Basic Biology of Diabetes

A Basic Care Plan for Diabetes

The Basics of Diabetes Mellitus

What to Expect as a Nurse | Truths, Myths and Stereotypes

How to Stay Fit and Healthy as a Registered Nurse

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A Basic Care Plan for Diabetes

February 18, 2024 (updated April 28, 2024) Published by intunursing

Connecting Nurses Worldwide

A Basic Care Plan for Diabetes

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We’ve looked at the causes and the risk factors of diabetes.

We’ve even gone through the signs, symptoms and conditions associated with diabetes.

But as a nurse, how would you apply this knowledge to the short-term, and long-term care of your patients?

Table of Contents

What is the Expected Nursing Outcome for Diabetes?

One of the first things you need to ask yourself when thinking of a care plan for your patient is ‘What is the Expected Outcome?’

What is the goal that needs to be set to deal with the presenting condition?

For diabetes, the ultimate outcome will always be to:

“Achieve and maintain glycaemic control within the correctly identified ranges and continuous blood glucose monitoring.”

Nursing Assessment

The main, and most basic, nursing assessment that should be done for a diabetic patient should be to monitor their blood glucose levels.

You can use a blood glucose meter to check their levels before and after meals, at bedtime, and whenever they feel unwell.

This should be done in regular intervals (usually just before a meal), and even more often if your patient is on a Variable Rate Intravenous Insulin Infusion (VRIII) – previously known as a sliding scale.

And in the case of a patient with Diabetic Ketoacidosis (DKA), as part of the nursing assessment, you will also need be monitoring their ketone levels.

Document these blood glucose levels, as well as your patient’s medication adherence according to local policy.

✾ A nursing assessment that may sometimes be missed is to carry out a regular assessment of your patient’s skin.

This will especially contribute towards the nursing care of a diabetic patient with neuropathy, as these patients are prone to unrecognised injuries on their feet.

Nursing Interventions

Looking back at the main nursing outcome for a diabetic care plan creates the question of ‘How?’.

Most people can carry out the necessary assessments, but how do you apply this to your patients care the proper way?

It can be brought down to a few points:

Prevent hyperglycaemia (high blood glucose) and hypoglycaemia (low blood glucose):

Hypoglycaemia is when the blood glucose level is too low, usually below 4 mmol/L. It can cause symptoms such as sweating, shaking, dizziness, confusion and even loss of consciousness.

Hyperglycaemia is when the blood glucose level is too high, usually above 11 mmol/L. It can cause symptoms such as thirst, dry mouth, frequent urination, blurred vision, fatigue, headache, nausea or fruity breath.

Preventing and treating complications and conditions related to diabetes:

Although the main outcome for diabetes, as a whole, is focused on maintaining glycaemic control, there are additional nursing aspects of care that consider a much wider range of factors.

This includes the prevention and treatment of complications that are acute and life-threatening, such as diabetic ketoacidosis (DKA), which is a condition where the body produces too many ketones, which are acidic substances that can poison the blood and organs.

Other complications are chronic and progressive, such as cardiovascular diseases, diabetic retinopathy, chronic kidney disease, infection and neuropathies, which can damage the heart, blood vessels, eyes, kidneys, skin and nerves.

These can cause problems such as heart attack, stroke, blindness, kidney failure, amputation and disability.

To manage these key points, and take charge of your plan, you will need to focus on the following:

Insulin Therapy

Assess your patients’ blood glucose levels regularly and escalate any concerns when necessary.

You should aim to keep their blood glucose levels within the target range recommended by their doctor or diabetes care team.

Learn about the different types of insulin and how to use them safely and effectively.

Know the benefits and risks of each type of insulin, such as rapid-acting, short-acting, intermediate-acting, long-acting and mixed insulins.

Know how to store, prepare and inject insulin correctly using the appropriate devices and techniques, such as syringes, pens or pumps.

It is important to rotate your patient’s injection sites, such as the abdomen, thighs or arms to prevent problems such as lipohypertrophy, which is characterised by stiff, lumpy skin and can result in inconsistent absorption of the insulin.

Administering Oral Antidiabetic Agents

Oral antidiabetic agents are pills that help lower blood glucose levels in people with type 2 diabetes who still produce some insulin.

They work by different mechanisms, such as stimulating the pancreas to produce more insulin, reducing the liver’s glucose production, improving the cells’ insulin sensitivity or slowing down the digestion of carbohydrates.

As a nurse, you should help them follow their medication regimen as prescribed and encourage them not to refuse doses.

By having the knowledge and being able to explain the benefits of your patient taking their antihyperglycaemic medication (and the risks of not taking it), it will give your patient confidence in your nursing care.

You may need to manage the possible side effects of oral antidiabetic agents.

This includes stomach upset, weight gain or hypoglycaemia.

Help your patients manage these side effects by giving them some tips, such as eating small and frequent meals and drinking plenty of water.

Restoring Fluid, Electrolyte, and Acid-Base Balance

Patients with diabetes can lose a lot of fluid and minerals from their body due to high blood sugar levels that make them urinate and drink more often.

This can affect their fluid, electrolyte, and acid-base balance, which is important for the normal functioning of their cells and organs.

If this balance is disturbed, it can cause problems such as weakness, confusion, irregular heartbeat and can even lead to a coma.

Therefore, you should monitor and record the patient’s fluid balance, address any concerns you have to the medical team and give them fluids or electrolytes as prescribed.

Managing Pain and Discomfort

Patients with diabetes may experience pain and discomfort due to various causes, such as neuropathy, foot ulcers or infection.

Pain and discomfort can affect the patient’s mood, sleep, appetite and overall quality of life.

Therefore, nurses should assess the patient’s pain and discomfort level and provide appropriate relief and comfort measures. Some of the ways to manage pain and discomfort include:

Using a pain scale, such as the numerical rating scale (NRS) or the faces pain scale (FPS), to measure the intensity and location of the pain and discomfort.

Giving the patient analgesics as prescribed.

Applying non-pharmacological methods, such as heat, cold or distraction to reduce the pain and discomfort.

Encouraging the patient to report any changes or problems with their pain and discomfort.

Diabetes Foot Care

People with diabetes are more likely to develop foot problems, such as ulcers or infections (which may lead to amputations), because of the damage that high blood glucose levels can cause to the nerves and blood vessels in the feet.

Nursing care should include:

Inspect your patients’ feet every shift for any problems, such as cracks, sores, corns, calluses or nail problems.

Help your patients wash their feet with warm water and soap. Dry them gently, especially between the toes.

Apply a thin layer of moisturizer to keep the skin soft and prevent cracking BUT avoid putting moisturizer between the toes as this can cause fungal infection.

You can also advise your patients to trim their toenails (straight across and file the edges with a nail file, whilst avoiding cutting the nails too short or digging into the corners, as this can cause ingrown toenails or infection).

If they have trouble cutting their nails, or you do not feel confident to do it correctly, then you can and should make a referral to a podiatrist as they will have much more training in this area.

Encourage your patients to wear comfortable, well-fitting shoes and socks that protect their feet and allow them to breathe.

Shoes that are too tight, too loose, or have seams or rough edges can rub or cause blisters, and should be avoided.

They should avoid wearing sandals, flip-flops and walking around with their bare feet, as these can expose their feet to injury or infection.

Their shoes and socks should be checked for any objects, such as stones, nails or pins, that can hurt their feet.

If possible, you should ask a patient’s relatives to bring this suitable footwear in.

Promoting Wound Healing and Prevention

Patients with diabetes are more prone to developing wounds, especially in the feet, due to the damage that high blood glucose levels can cause to the nerves and blood vessels.

Wounds can impair the patient’s mobility and increase the risk of infection and amputation.

Therefore, nurses should promote wound healing and prevention by doing these things:

Inspecting the patient’s feet and other areas of the body for any signs of wounds, such as cuts, blisters, sores or ulcers and escalating when necessary.

Cleaning and dressing the wounds properly and regularly, using aseptic technique and the appropriate dressings.

Monitoring the wound healing process and looking for any signs of infection, such as redness, swelling, pain, or pus and treating them promptly with antibiotics or other medications as prescribed.

Educating the patient and the family about the importance of wound care and prevention, and how to do it at home, such as by keeping the wounds clean and dry, changing the dressings as instructed, and avoiding pressure or friction on the wounds.

Providing Emotional Support Through Effective Coping

People with diabetes may experience various emotions and stress related to their condition, such as anger, sadness, fear, guilt or frustration.

These can affect their mood, self-esteem and well-being, which could make it harder for them to manage their diabetes for themselves.

You can help your patients with diabetes cope with their emotions and stress by providing them with emotional support:

Listen to your patients and empathize with their feelings

Avoid judging, criticizing, or blaming them for their condition or their actions. Instead, offer them encouragement, praise and positive feedback for their efforts and achievements

Teach your patients how to cope with stress and relax. Stress can worsen their blood glucose control and affect their physical and mental health.

Help them recognize the sources and signs of stress in their life and find ways to reduce or manage their stress, such as planning, prioritizing, delegating or simply by saying no.

Teach them relaxation techniques, such as breathing, meditation or yoga.

Encourage them to do something they enjoy, such as reading, gardening or playing games.

Support your patients in building and maintaining a strong social network.

Having a good support system can help them cope with their diabetes and improve their well-being.

Help them involve their family, friends and even co-workers in their diabetes care, such as by educating them about their condition or asking for their help.

Help them find and access community resources, such as diabetes educators, counsellors, or social workers.

Collaborating with Primary Care and Specialist Teams

Patients with diabetes need a team approach to get the best care possible.

You should work closely with the primary care providers and specialists who are involved in the patient’s diabetes care, such as the diabetic nurse, doctors, dietitians, pharmacists or podiatrists.

You should communicate with them regularly, share information, and coordinate care plans.

This way, you can ensure that the patient gets comprehensive and consistent care for their diabetes and any related conditions.

✾ Humulin, the first insulin made from human cells, was invented by scientists in 1978. This insulin has the same structure as the insulin that the human body makes.

Things to Consider When Caring for a Diabetic Patient

Each patient’s situation will be different, so it would be your job to tailor the diabetic care plan to suit each individual.

Here are some of the things you may need to consider:

For a Diabetic Patient Requiring Nasogastric (NG) or Percutaneous Endoscopic Gastronomy (PEG) Feeding

Make sure you are well-trained and educated on how to provide adequate nutrition to patients with diabetes who need NG or PEG feeding.

You should know the type, amount and timing of the feed, as well as how to monitor and adjust it according to the patient’s blood glucose levels and needs.

Prevent and treat any infections that may affect the patient’s nutrition and glucose control, such as gastroenteritis, by following the infection prevention and control guidelines, such as washing your hands, wearing gloves and aprons, and cleaning and disinfecting the equipment and the environment.

You should also monitor the patient for any signs and symptoms of infection, such as fever, diarrhoea, vomiting, or abdominal pain and escalate if necessary.

For a diabetic patient who is nil by mouth (NBM)

Chances are that if you have a diabetic patient who is NBM, they will be put on the variable rate intravenous insulin infusion (VRIII) protocol.

This protocol is used to maintain the patient’s blood glucose levels within the target range of 5-10 mmol/L, by giving them a continuous infusion of insulin and glucose.

You should follow the protocol carefully and adjust the insulin and glucose rates according to the patient’s blood glucose levels, which will usually be checked hourly.

Caring for a Diabetic Patient who is Confused

When caring for a confused diabetic patient, regular mental status assessments are crucial.

Providing a safe environment and having strategies to manage behavioural disturbances are also important. Effective communication with the healthcare team and family members is key.

Caring for a Diabetic Patient When there is a Language Barrier

For patients with a language barrier, it’s helpful to use simple, non-medical language and visual aids to communicate with your patient about their diabetes.

Translation services can be utilized if available, and cultural differences should be considered.

Caring for a Diabetic Patient who is Non-Compliant

In the case of a non-compliant patient, it’s important to identify and address barriers to compliance (which usually is related to a lack of understanding).

Education about the importance of medication compliance and the consequences of noncompliance can definitely be beneficial.

Providing support and resources to help the patient overcome barriers to compliance, along with regular follow-up to monitor progress can also be helpful.

If you come across a patient who has a complex care plan, don’t stress in silence. When in doubt, ask someone to help you out.

Patient Education in Diabetes Management

Diabetes management is a lifelong process that requires the involvement and commitment of the person with diabetes and their care team.

If a patient can only rely on others to provide care for their diabetes, then the long-term risk of mismanagement and future complications increases significantly.

As a nurse, you can help your patients with diabetes manage their condition by providing them with patient education on diabetes management.

What Should Your Patients Be Taught About Diabetes?

Nurses need to know the basics about a wide range of conditions, but a patient will only really need to know about their own.

This means that everything you should know, they should know too.

Take each aspect of your diabetic nursing care plan and find a way to transform it into a suitable piece of learning that your patient can take away with them.

For example, whilst administering insulin injections for your patient, you can explain them step-by-step what you are doing and even test their knowledge (such as asking them about the rotation of injection sites).

Even better, you should use your own judgement and could allow your patient to self-administer the insulin injection.

This promotes independence and gives them the confidence to carry this task out by themselves, without having to rely on others.

This form of educating your patients can apply to many aspects of diabetic care including medication management, self-hygiene, wound care, nutritional balance and weight management.

Addressing Challenges in Self-Management

Your Patient’s Attitude Towards Learning:

You should always assess your patient’s motivation to learn and tailor your education to their needs, preferences and goals.

Doing this helps your patient to retain the information they are taught, rather than you both going through a never-ending cycle of confusion and frustration.

You can use various tools and methods to assess their readiness to learn, such as asking open-ended questions or using motivational language.

Try use different formats and materials to deliver your education, such as verbal, written, visual or interactive.

You can also involve your patients in setting their own goals and action plans and provide them with feedback and reinforcement.

Your Patient’s Ability to Learn:

Consider the specific needs and challenges of different age groups, such as children and older adults.

Children and older adults with diabetes may have different learning styles, cognitive abilities, physical limitations, emotional issues and social support than other age groups.

You can adapt your education to their developmental stage, functional status, mental capacity and cultural background.

You can also involve their family, caregivers or peers in their education and care.

Some patients may find it hard to manage their condition, especially if they are older or have other conditions that affect their memory, mobility or mood.

You should provide support and resources to help these patients manage their diabetes effectively.

This could be done by teaching them how to use devices, apps or reminders, involving their family or caregivers or referring them to support groups or programs.

✾ You will undoubtedly come across a few patients who will refuse their medication or neglect their own care.

✾ It might be frustrating at the time, but usually there is a reason. So, be patient and maybe even try to find out why.

So there you have it.

The nursing assessments and interventions that can be included in a care plan for your patient with diabetes, including a way that helps to promote their independence.

With this, you should be able to come across a diabetic patient and create a care plan that is perfect for them.