What are the joys and pains of being a nurse?
What are the facts and what are the myths that surround nursing?
What is nursing really like?
And is it worth it to choose nursing as the career of your choice?
So, what are the real truths, myths and stereotypes about nursing?
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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
Genetic and Environmental Factors
Immunological Damage
Clinical Diagnosis
Long-Term Implications
✾ 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 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:
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:
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:
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:
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 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 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.
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.
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?
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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.
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.
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.
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.
Before you give a subcutaneous injection, you need to gather the following equipment:
A syringe with a needle that is suitable for subcutaneous injection. The needle size depends on how big or small your patient is and how much fat they have under their skin. Generally, subcutaneous needles range from 25-31 gauge.
A bottle or ampoule of medication that is prescribed for subcutaneous injection. Some injectable medications come pre-packed which means that you can skip all the hassle, but make sure to check the rights of medication before using it.
For throwing away used needles and syringes. And carrying the sharps bin with you isn't always the best option, so at least locate it before you start.
For protecting your hands from germs and adhering to infection control protocol.
The steps for giving a subcutaneous injection are as follows:
✾ The common spots for subcutaneous injection are:
✾ 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!
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!
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.
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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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?
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.”
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.
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:
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.
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.
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.
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:
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.
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:
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:
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.
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:
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.
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.
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.
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.
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.
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
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.
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.
Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.
What are some of the latest trends and innovations in diabetes care that you find exciting or useful?
How do you educate and empower patients with diabetes to take an active role in their care and prevent complications?
What are some of the best practices and resources that you use to provide effective and person-centred care for patients with diabetes?
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You don’t need to be a nurse or healthcare professional to have even the smallest amount of knowledge about diabetes.
Over 4 million people in the UK are affected by diabetes.
Now, times that by a hundred and you start getting closer to what the worldwide statistics for diabetes are looking like.
(And that’s only the people who have had confirmed diagnoses).
So, with those numbers, the chances are highly likely that you know someone or have come across a patient with diabetes already.
But how much can you say that you really know about diabetes?
And as a healthcare professional, are you confident that if a student nurse, colleague, patient or their relative asked you the following questions that you would be able to give them the most basic answers:
Diabetes is a metabolism disorder that affects how your body uses sugar – glucose – for energy.
Glucose is essential for your health as it fuels your cells and organs.
But too much or too little glucose can cause problems.
Normally, your pancreas produces a hormone called insulin which helps glucose move from your blood into your cells.
But if you have diabetes, either your pancreas cannot make enough insulin, or your cells cannot use it properly.
This leads to high blood sugar levels which can damage your heart, blood vessels, eyes, kidneys and nerves.
✾ The term “Diabetes” derives from a Greek word meaning “to pass through” which refers to the excessive urination of uncontrolled diabetes.
✾ “Mellitus” is a Latin word for “sweet” or “honey” which was added when it was discovered that the urine from people with diabetes contains glucose by curious doctors who tasted the pee and found out it was sweet!
People often forget to differentiate between the types of diabetes, including the varying causes and treatments.
However, it is vital that anybody in charge of the care of someone with diabetes can understand the difference.
The most common types of diabetes are:
Type 1 Diabetes
This is an autoimmune disease where the immune system attacks and destroys the cells in the pancreas that make insulin.
For this type of diabetes, the person will need to take insulin injections or use an insulin pump to manage their blood sugar levels.
Type 1 diabetes usually develops in childhood or adolescence, but it can occur at any age.
Type 2 Diabetes
This is a metabolic disorder where the body becomes resistant to the effects of insulin, or the pancreas cannot produce enough of it.
A type 2 diabetic may need to take medication, such as tablets or injections, to lower their blood sugar levels.
Type 2 diabetes is more common in adults, especially those who are overweight or obese, have a family history of diabetes or have an overall unhealthy lifestyle.
Non-diabetic Hyperglycaemia (or Pre-Diabetes)
This is where the patient’s blood sugar levels are higher than normal, but not high enough to be diagnosed as having diabetes.
This is a warning sign that they are at risk of developing type 2 diabetes in the future, but they can still prevent it by making some lifestyle changes.
Gestational Diabetes
This is a temporary condition that occurs during pregnancy, when the hormones affect how the body uses insulin.
It usually goes away after the woman gives birth, but it can increase their risk of developing type 2 diabetes later in life.
Monitoring of blood sugar levels and following a healthy diet and exercise plan may be needed to manage their condition.
Steroid Induced Diabetes
Steroids, also known as corticosteroids, are artificial versions of hormones that are naturally produced by your body.
They are used to reduce inflammation and can help to treat a wide range of conditions, including severe asthma, cystic fibrosis, arthritis, inflammatory bowel disease and some types of cancers.
However, a side effect of steroids is the impact it can have on blood sugar levels.
They can make your body produce more glucose, prevent glucose from being used by your cells, and make your insulin less effective.
This leads to too much glucose in your blood which can cause damage to your body over time.
Most people will only have steroid-induced diabetes while they are taking steroids. Their blood sugar level usually goes back to normal when they stop.
But others may have steroid-induced diabetes even after they stop their treatment, especially if they have some risk factors for type 2 diabetes.
The World Health Organisation (WHO) classifies diabetes into four categories:
✾ Type 1 is an autoimmune disorder that destroys insulin-producing cells.
✾ Type 2 is a condition of insulin resistance or deficiency, often linked to obesity and inactivity.
✾ Gestational diabetes occurs during pregnancy and usually resolves after delivery.
✾ Other specific types are rare forms of diabetes caused by various factors.
Type 1 Diabetes
The exact trigger for this autoimmune response is still a mystery, but it can be said to be:
Genetic
OR
Related to their environment – Dietary habits, exposure to vitamin D, obesity, early exposure to islet inflammation-causing viruses.
Type 2 Diabetes
This is a common and preventable type of diabetes where the patient’s lifestyle choices affect how their body uses insulin.
There are a number of factors that can raise the risk of developing type 2 diabetes:
✾ It’s important to note that while these factors can increase the risk of developing diabetes, they do not guarantee that an individual will develop the condition.
✾ The good news is that a person can also change these factors to improve their health and prevent complications.
Polyuria (Increased Urination)
The kidneys are responsible for filtering the blood and removing any waste products, such as excess glucose.
When someone’s blood sugar levels are too high, the kidneys have to work harder to get rid of the extra glucose.
This means that they draw more water from the diabetic body, which makes the urine more diluted, producing even more urine and therefore increasing the frequency of needing to go toilet.
Polydipsia (Increased Thirst) and Having a Dry Mouth
The brain is constantly monitoring fluid levels and sending signals to the body to maintain a balance.
When a person loses fluid from their urine, the brain detects that they are dehydrated and tells them to drink more water.
This is why a diabetic person would feel thirsty and have a dry mouth.
Feeling Tired and Weak
The body normally uses insulin to help glucose move from the blood into the cells.
But if someone has diabetes, either their pancreas cannot make enough insulin, or their cells cannot use it properly.
This means that glucose stays in your blood and your cells do not get enough of it.
As the cells are not functioning properly, due to the lack of glucose, and as it is not producing energy as it should, it leads to fatigue.
Unexplained Weight Loss, but Experiencing Hyperphagia (Constant Hunger)
When the cells do not get enough glucose, they start to break down other sources of energy, such as fat and muscle, leading to unplanned weight loss and a constant feeling of hunger.
Blurry Vision
The eyes have a clear lens that helps to focus on what you see.
But when the blood sugar levels are too high, it can cause fluid to move in and out of different parts of the eye.
This can make your lens swell and change its shape, which affects how well it can focus light onto the retina (part of the eye that converts light into signals that the brain can understand), which leads to the vision becoming blurry and distorted.
Also, high blood sugar levels can damage the blood vessels that supply the retina itself with oxygen and nutrients.
This can cause bleeding, swelling or scarring of the retina, which can affect the vision and even lead to blindness.
Numbness or Tingling in the Hands or Feet
The nerves are like wires that carry messages from the brain to the body, and from the body to the brain.
But with high blood sugar levels caused by diabetes, it can damage the nerves and affect their ability to send and receive signals.
This can cause pain, numbness, tingling or weakness in the hands and feet.
Slow Healing Sores or Cuts
The blood vessels carry oxygen and nutrients to the tissues, and waste products away from them.
But the blood vessels can become damaged from diabetes and make them narrow or clogged and reduce blood flow.
Along with the poor circulation, there is the added issue of nerve damage and a weakened immune system which all contribute to the interference of the body’s ability to heal wounds, especially in the feet and legs.
This can cause ulcers, which are open sores that do not heal easily.
Ulcers can be painful, get infected, or can even lead to amputation if not treated properly.
Itching or Thrush in the Genitals
The genitals have a natural balance of bacteria and fungi, such as yeast, that keep them healthy and clean.
But when the blood sugar levels are too high, it can cause excess glucose to spill into your urine and onto your genitals.
This can create an ideal environment for yeast to grow and multiply, upsetting the natural balance.
These symptoms can affect anyone, regardless of their age or gender. But some of them are more common in people with type 1 diabetes, and they can appear very quickly.
✾ These symptoms are entirely dependent on the person and that not everyone with diabetes will experience these symptoms.
You know exactly what to look for, so if you experience any signs and symptoms, look after yourself and go see your GP. Healthcare professionals aren’t immune to diabetes.
Heart Disease
Diabetes can damage the blood vessels and make them narrow or clogged. This can reduce the blood flow to the heart and brain and increases the risk of having a heart attack or stroke.
Nephropathy (Kidney disease)
Diabetes can damage the kidneys and make them less able to filter the blood and remove excess fluid and waste. This can cause swelling, high blood pressure and kidney failure.
Retinopathy (Eye Problems)
Diabetes can damage the eyes and affect the vision. This can cause blurry vision, cataracts, glaucoma or diabetic retinopathy, which is a serious eye disease that can lead to blindness.
Neuropathy (Nerve Damage)
Diabetes can damage the nerves and affect how a person feels and moves. This can cause pain, numbness, tingling or weakness in the hands and feet. It can also affect the digestion, bladder and sexual function.
Foot Problems
Diabetes can damage your feet and make them more prone to infections and ulcers.
This can be caused by nerve damage, poor circulation or high blood pressure.
If left untreated, foot problems can lead to amputation.
Gum Disease and Other Mouth Problems
Diabetes can affect a person’s oral health and make their mouth more susceptible to bacteria and plaque. This can cause gum disease, tooth decay, bad breath or a dry mouth.
Sexual Problems
Diabetes can affect sexual health by making it harder to enjoy sex. This can be caused by nerve damage, blood vessel damage or hormonal changes.
It can affect both men and women, and cause problems such as erectile dysfunction, vaginal dryness or low libido.
Coeliac Disease, Thyroid Disease, and Haemochromatosis
These are some of the other conditions that can be linked to diabetes. They are caused by problems with the immune system, hormones or iron levels. They can affect the digestion, metabolism or blood cells.
✾ Necrobiosis lipoidica diabeticorum is a rare dermatological condition that manifests as red or brown lesions on the legs, often triggered by diabetes.
You should now be able to confidently give information to anybody who asks you about the different types of diabetes, why people get it, the sign and symptoms, and even some of the most common conditions caused by diabetes.
Read the questions and if you have the answers, flaunt your knowledge and share your thoughts and experiences in the comment section below.
How confident are you that you can answer a student nurse, colleague, patient or relative about a diabetes-related question now?
Without searching or scrolling up, can you list all the signs and symptoms of diabetes that you can remember?
Do you have any memorable stories about a patient or someone you know with diabetes? (Make sure to maintain confidentiality or if you want to keep it anonymous, then share it to ‘Nursing Tales’).
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Let’s start by acknowledging that staying fit and healthy as a registered nurse is hard.
However, although it can be challenging, without a doubt it is not impossible.
We constantly advise our patients, our colleagues and our family and friends on how to better their health, but how much do we follow our own advice?
And of course, you always want to put your patients and others first, which is admirable. But you also need to look after your own health and happiness, because your wellbeing also matters.
So, how can you stay fit and healthy as a registered nurse?
If you’re looking for a quick miracle solution, then apologies because the truth is that you won’t find that anywhere.
However, what can be provided is information that takes into consideration the difficulties that come with working as a nurse, when trying to maintain a lifestyle that will keep you energised and ready to take on each new day.
Have you ever gotten home from a long, strenuous shift feeling hungry but too tired to cook? You look in your fridge, and then your freezer but there is nothing to eat. Horror.
At that point you have two options: Power through and go to bed hungry OR open that very convenient food app and order something that wouldn’t exactly be considered healthy.
As something that doesn’t happen to often, this isn’t too much of an issue. But when it becomes the norm then we know it’s time to make some urgent changes.
✾ Eating a balanced diet can help you keep your energy levels up, boost your immune system, prevent diseases and improve your overall mood.
✾ It can also help you avoid overeating or binge eating, which can make you gain weight and cause other health problems.
Pick lean proteins and whole grains
Lean proteins, like chicken, fish, eggs, and beans, can help you build and repair your muscles and tissues.
Whole grains, like oats, brown rice and quinoa, can give you complex carbs that can keep you going throughout the day. They’re also good for your heart and brain.
Eat more fruits and veg
“An apple a day keeps the doctor away.”
Well, hopefully not for too long, we have lives to save!
Fruits and veg are packed with antioxidants, fibre and water, which can help you feel full and hydrated.
They also have vitamins and minerals that can protect you from infections and diseases.
Cut down on saturated fats and sugars
Saturated fats, like butter, cheese and red meat, can raise your cholesterol levels and increase your risk of heart disease.
Sugars, like candy, soda and pastries, can spike your blood sugar levels and cause cravings and mood swings.
They may taste good, but they’re not good for you. Trust me, your body will thank you later.
Plan your meals ahead of time
Meal prep is a game changer.
Preparing your meal in advance lets you choose fresh and nutritious ingredients, portion them wisely and avoid junk food temptations.
You can relax and not waste extra time overanalysing what you want to eat.
Meal prep undeniably takes away the stress and hassle of deciding what to eat every day.
Make your meals healthy, not tasteless
Does eating healthy mean chewing on a piece of unseasoned broccoli as a meal or bowls of plain salad for the rest of your life?
Certainly not.
Your meals can be full of luscious flavours and still be healthy.
So, don’t hold out on adding spices such as rosemary, cayenne pepper and cumin.
Just don’t overdo it, because too much of a good thing can still be bad for you.
Either way don’t make yourself suffer.
Because if you aren’t enjoying your food, it’s only a matter of time before you turn back to foods that WILL momentarily make you happy, healthy or not.
Don’t sacrifice your cultural foods, just make them healthier
Nurses come from many different backgrounds and cultures.
But when it comes to cultural foods it can be harder to determine the nutritional value, which leads to conventional foods being the default choice whilst trying to be healthy.
Rather than giving up on your favourite foods, a better long-term solution would be to adapt the recipes and at least have an estimate of its nutritional value.
It’s no secret that exercise is good for you.
And as much as we want to count the numerous hours that we already spend on our feet during shifts as our ‘exercise for the day’, the unfortunate truth is that it’s simply not enough.
✾ Exercising regularly can help you burn calories, strengthen your muscles and bones, improve your heart health and reduce stress.
✾ It can also help you prevent or manage common health issues that affect nurses, like back pain, obesity and depression.
Know What You Want – Set realistic and specific goals
If you have ever been to a gym, you may have noticed the people that tend to half-heartedly complete a few reps on a machine or piece of equipment, and then move on aimlessly to the next one that catches their eye.
These people are called ‘Wanderers’.
Wanderers usually have a vague idea of what they want, but without guidance and a clear goal the end result is usually a loss of motivation.
So, set some goals. But don’t just set any random goals.
Make them SMART (Specific, Measurable, Achievable, Realistic, Time-Bound).
So, instead of saying “I want to lose weight”, say:
“I will do a 30-minute HIIT (high-intensity interval training) workout at the gym or at home, three times a week for the next twelve weeks, to improve my cardiovascular fitness, burn calories and lose at least five kilograms.”
Whatever you set as your goal, just don’t compare yourself to others, because everyone is different.
Know Yourself – Find an exercise routine that fits your schedule and preferences
There is no point in convincing yourself that you will go to the gym straight after every shift, when you know that you will be making a beeline straight home instead.
This ties in with setting a SMART goal that is realistic.
Be honest with yourself and think about what workout routine you can keep up with, so you can stay fit and healthy.
Make exercise fun and enjoyable
Exercising doesn’t have to be dull or tedious.
You can make exercise fun and enjoyable by picking activities that you like and won’t bore you back into an unhealthy lifestyle.
This could mean joining a dance class, playing a sport or exercising with a friend (but make sure they are as motivated as you).
You could even consider spicing things up with some music, games or challenges?
For example, games like Just Dance weren’t made to be played sitting down.
Go ahead, be creative!
It doesn’t make sense for a sick person to look after another sick person, so look after your health for your sake and for your patients.
Yeah, don’t worry, nurses everywhere around the world are laughing at this point too.
For the majority of registered nurses, having a normal sleep schedule is not in our vocabulary.
In between an unpredictable mixture of day shifts, night shifts and sometimes even late shifts, you might find it unfathomable to create a consistent sleep plan that works for you.
But even though it may not seem like it, getting a good night’s rest is far from impossible.
✾ Sleep can help you recharge your energy, repair your body, store your memory, and balance your hormones.
✾ Sleep can also help you cope with stress, improve your mood, boost your creativity, and strengthen your immune system.
Try to keep a consistent sleep schedule as much as possible, even on your days off
This can help your body adjust to your irregular shifts and maintain a healthy circadian rhythm.
Avoid caffeine, alcohol, nicotine, and other stimulants or depressants before bedtime
These substances can interfere with your sleep quality and make it harder to fall asleep or stay asleep.
Create a comfortable and dark sleeping environment
Use curtains, blinds, or an eye mask to block out any daylight or artificial light. Use earplugs or a fan to mask any noise.
(If these don’t work for you, do the opposite and try a galaxy light projector or a white noise machine).
Set your room temperature to a comfortable level and use cosy bedding and pillows.
Follow a relaxing bedtime routine
Do some gentle stretches, read a book, listen to soothing music, meditate or practice breathing exercises before bed.
And it might be hard, but avoid using your phone, computer, TV or other devices that emit blue light and stimulate your brain.
(If you know that some of these activities usually help you sleep instead, like watching a specific type of video, then continue but be cautious of how long you are spending on it. It’s easy to lose track of time, so don’t let it affect your sleep).
Stress is unavoidable for registered nurses.
(As much as you want to believe that you don’t really get stressed.)
Some of the unavoidable perks of being a nurse is having to deal with demanding patients, difficult colleagues, heavy workloads and emotional situations.
You would have to be a robot not to get stressed sometimes.
Being stressed is not a weakness, so don’t let denial stop you from handling stress the right way.
✾ Stress affects your physical and mental health, causing headaches, anxiety, fatigue and insomnia.
✾ It can affect your overall health as a registered nurse, and your performance as a registered nurse.
Identify the sources of your stress
Figure out the different causes of your stress, and uncover which one stresses you out the most.
(You can try to make a list from most to least stressful to help you visualise and prioritise).
Avoid or reduce the sources of your stress
You can do this by setting boundaries, saying no, delegating tasks, or changing your perspective.
This won’t change things overnight, but as long as you start – even if it’s just the little things – you’ll be able to get your peace back, one step at a time.
Manage your emotions
Express your feelings (in a healthy way), seek support, practice gratitude and use positive affirmations.
Because sometimes all you need is somewhere or someone to rant to, and get things off your chest.
Relax your body and mind
Try deep breathing exercises, progressive muscle relaxation, guided imagery or aromatherapy.
We have access to such a wide range of resources, such as ‘Mind’. It would be a shame not to use them.
And I know that some people see meditation and think that it’s nonsensical mumbo jumbo, but between a lifetime of stress or just trying something new, I know which one I would choose.
Count the amount of times you have told your patients to stay hydrated, when you were on the verge of dehydration yourself.
If it’s more than you can count, then we clearly have a problem.
✾ Staying hydrated can help you keep your body temperature stable, lubricate your joints, flush out toxins, transport nutrients, and prevent infections.
✾ Staying hydrated can also help you improve your brain function, mood, skin health, and digestion.
Drink enough water (obviously)
The general recommendation is to drink at least eight glasses of water a day (between 1.5 and 2.5 litres).
But this may vary depending on your age, weight, activity level and climate.
You can use a water bottle or a handy hydration app to keep track of your water intake.
And I know how easy it is to lose track of time whilst working, so use a task that needs to be completed in regular intervals (e.g. vital sign observations) to associate with and remind yourself to drink water.
Drink other fluids
Water is not the only source of hydration.
You can also drink other fluids, like milk, juice or tea. Even soup counts.
But avoid drinking too much caffeine, alcohol or sugary drinks as they can dehydrate you instead.
And don’t use this as an excuse to completely replace water either, because drinking water is the healthiest and easiest way to stay hydrated.
(If you’re not a fan of plain water, try adding something to give it a bit more flavour).
Eat hydrating foods
Foods that have a lot of water can also help you stay hydrated. Some examples of hydrating foods are: cucumbers, watermelon, strawberries, lettuce and yoghurt.
Staying fit and healthy as a registered nurse is not easy, but it is possible.
By following these tips, you can improve your physical and mental health, as well as your performance and productivity as a nurse!
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 have other methods to stay fit and healthy that have worked for you?
How did you motivate yourself to begin the process and better your health?
How have you handled stressful situations, good or bad, in the past?
