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Diabetes Winter Pressures Jola Turowska, Community Diabetes Specialist Nurse Diabetes Winter Pressures Jola Turowska, Community Diabetes Specialist Nurse

The Facts There are currently over 3 million people with diabetes in the UK The Facts There are currently over 3 million people with diabetes in the UK with type 2 diabetes. More than half a million people with diabetes who have the condition and are unaware they have it (Diabetes UK). The Population of Lewisham is 275, 698. The estimated (diagnosed and undiagnosed) diabetes prevalence in 2012/13 was 6. 0% of people aged 16 years and older in London Borough of Lewisham

The Facts • People with diabetes are at risk of developing acute or long The Facts • People with diabetes are at risk of developing acute or long term complications: • CHD, Stroke, Kidney Disease, Blindness and amputation, Hypoglycaemia, Diabetic Ketoacidosis, Hyperglycaemia and Coma. • Winter Pressures can increase these risks

Look out for Potential Problems Low blood glucose levels/ less than 4 = Hypoglycaemia Look out for Potential Problems Low blood glucose levels/ less than 4 = Hypoglycaemia Sweating Dizziness Trembling Tingling hands, feet, lips or tongue • Hunger • Anxiety • • Action to be taken : 5 -6 glucose tablets 4 large jelly babies 150 mls of non diet fizzy drink or 200 ml orange juice Re check blood glucose in 15 -20 mins Have a snack containing carbohydrate eg. 2 plain biscuits or fruit or meal if due

Look out for Potential Problems Raised blood glucose levels= Hyperglycaemia • • • Feeling Look out for Potential Problems Raised blood glucose levels= Hyperglycaemia • • • Feeling thirsty Increased urination Abdominal pain Dry Mouth Ketones in Urine Lethargy/ Drowsy Seek urgent/emergency medical advice if: • • • Vomiting Unable to eat Unable to take medication Altered breathing Abdominal pain

Possible Outcomes Of Poor Diabetes Control • • • Admission Infections Falls Hypothermia Trauma/injury Possible Outcomes Of Poor Diabetes Control • • • Admission Infections Falls Hypothermia Trauma/injury Acute Illness /complications

Preventing Potential Problems? • Adequate discharge planning • Does the patient have food in Preventing Potential Problems? • Adequate discharge planning • Does the patient have food in the house/can they prepare a meal or snack • Supplies – medication, needles, testing strips, sharps container. Has an adequate supply at home and knows how that supply will be continued.

Preventing Potential Problems • Timing of medication in relation to meals/ weather may delay Preventing Potential Problems • Timing of medication in relation to meals/ weather may delay visits by nurses • Temperature of medication-Storage/Administration • Ability to collect prescriptions

Top 5 Things To Remember • Increased risk of infections. Remember flu vaccination • Top 5 Things To Remember • Increased risk of infections. Remember flu vaccination • Inter current illness needs prompt attention • Extremes of temperature can effect action of medication. • Foot injury from heat sources. • Plan for adequate supplies of medication/food

Know who to contact • Discuss Hypoglycaemia/Hyperglycaemia with GP and or Diabetes team. • Know who to contact • Discuss Hypoglycaemia/Hyperglycaemia with GP and or Diabetes team. • Is the patient already known to District Nurses/Social care? • Is anyone else involved with the patient – relatives, carers? • Multidisciplinary communication is key

Community Diabetes Team • What can we do? Support, advice, education, dose adjustment, clinic Community Diabetes Team • What can we do? Support, advice, education, dose adjustment, clinic appointments/home visits • Where do we go? We can visit any patient registered with a Lewisham GP

How to contact us Telephone 020 3192 6540 (voicemail) Community DSNs: • Anita Koelmel How to contact us Telephone 020 3192 6540 (voicemail) Community DSNs: • Anita Koelmel • Siobhan Ewing • Jola Turowska Acute Foot Health Services (home visits) 020 3049 1860