Diab HA11 Assess the need for an individual to start insulin therapy

Overview

This standard covers helping a person with Type 2 diabetes to begin insulin therapy, through a planned and managed introduction. It will be followed by the activities which cover providing the information and support an individual needs to start insulin therapy, and by helping the individual to continue with insulin therapy. The activities should be agreed with the individual, and with their carer(s) if the individual chooses to involve them. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. the NSF for diabetes
2. the NICE guidelines on diabetes monitoring, management and education
3. causes of diabetes
4. signs and symptoms of diabetes
5. normal and abnormal blood glucose and HbA1c values
6. how to monitor glucose levels, HbA1c, blood pressure
7. typical progressive patterns of diabetes
8. the importance and effects of patient education and self management
9. the psychological impact of diabetes, at diagnosis and in the long term
10. how to gather information from patients about their health
11. how to work in partnership with patients and carers
12. psychological reactions to injecting insulin
13. the social, cultural and economic background of the patient/carer group and relevant attitudes towards injecting insulin
14. the impact of nutrition and physical exercise
15. the effects of smoking, alcohol and illicit drugs
16. the effects of, and how to manage, intercurrent illness
17. the medications used to manage diabetes
18. the effects of insulin on diabetes
19. types of insulin
20. how to obtain and store insulin
21. insulin delivery and blood testing systems
22. the range of delivery devices that are used in the UK
23. local sharps disposal procedure
24. how to avoid and how to manage hypoglycaemia
25. the long term complications of diabetes and when they are likely to occur
26. how to examine feet and assess risk status
27. how to monitor cardiovascular risk
28. how to monitor for renal disease
29. how to monitor for diabetic retinopathy
30. the law and good practice guidelines on consent
31. legal aspects of transporting insulin and hypodermic needles
32. the staff member’s role in the healthcare team and the role of others
33. local guidelines on diabetes healthcare
34. local referral pathways
35. local systems for recording patient information
36. quality assurance systems
37. the process of notification for legal and insurance purposes
38. sources of practitioner and patient information on diabetes
39. contact details of local and national support groups
40. how individuals can access local facilities for exercise and physical activity, education and community activities

Performance Criteria

You must be able to do the following:

1. accept the individual and carer as equal partners in the decision and encourage them to express their interests and concerns
2. assess the effectiveness of current medication and lifestyle therapies in managing the individual’s diabetes
3. assess the medical case for the individual to start insulin therapy, compared with adjusting current medication and lifestyle therapies
4. help an individual with diabetes and their carer understand the choices, issues, benefits and risks relating to commencing insulin therapy
5. support the individual and carer who choose not to start insulin therapy to manage the individual’s diabetes
6. where the individual chooses to start insulin therapy, assess the potential difficulties they may encounter in doing so, and consider how these difficulties might be addressed
7. help the individual and carer make informed choices about options available when commencing insulin therapy
8. agree the use of other medication with insulin, clarifying what will be continued and what will no longer be required
9. discuss and plan testing and monitoring of glucose levels
10. agree the appropriate forum for starting insulin, and agree what support the individual and carer will receive in the following days and weeks
11. record the decisions that have been agreed in a form that can be followed by other members of the care team and the individual and carer

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004) Dimension: HWB6 Assessment and treatment planning