Diab HD3 Help individuals with Type 2 diabetes to continue insulin therapy

Overview

This standard covers supporting a person with Type 2 diabetes who has recently taken responsibility for their own insulin therapy, including reviewing and evaluating the effectiveness of the therapy, in partnership with the individual and carer. 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. of 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. assess the individual’s need for support, through discussion with the individual and carer, and through gathering information from the healthcare team
2. ensure the individual and carer know who to contact for support and advice, for routine and for emergency needs
3. help individuals solve any emerging problems with injection techniques, and with safety, storage and disposal of equipment 
4. review and agree with the individual and carer
1. targets for well-being, HbA1c and, if available, home glucose test levels including urine
2. titration of dosage, based on blood/glucose monitoring
3. guidelines for diet, physical activity, and managing illness
5. provide information and support to help the individual and carer understand how to adjust their own dosage as appropriate
6. assess and reinforce the individual’s and carer’s understanding of the causes of hypoglycaemia and how to prevent and manage it
7. identify and agree how to meet any additional education needs appropriate to the individual and carer
8. provide support to help individuals and carers develop coping strategies for their fears and anxieties
9. record the progress that has been made with the therapy in a form that can be followed by other members of the care team and the individual and carer
10. review the outcomes of the therapy in partnership with individuals and carers, in a way that encourages them to express their interests and concerns
11. review the physical effects of insulin therapy at appropriate intervals through examination, measurement of HbA1c levels, and discussion with individual and carer
12. listen to the individual and carer describe how the insulin therapy is fitting into their lifestyle and discuss what changes might be made to manage any difficulties
13. review the individual’s and carer’s knowledge and understanding of the individual’s diabetes and their care plan, and offer appropriate information to help them learn more
14. agree changes that might be made to the insulin therapy to resolve problems, taking into account 
1. the wishes of the individual and carer
2. the risks and benefits that are involved
15. review targets and agree new target levels for blood glucose where appropriate
16. record the outcomes of the review in a form that can be followed by other members of the care team, 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