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Diabetes and Learning Difficulties

Diabetes and Learning Difficulties / Disabilities

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Introduction

Organisation and delivery of care for people who have a learning disability and diabetes should follow the same general principles as for others. However there may be particular difficulties with understanding and communication which lead to problems with effective management.

Degrees of disability vary widely but patients should be involved as much as possible in their own care and in decisions about their care.

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Aims of Care

Safety is paramount – targets for diabetes and other metabolic parameters should be the same but coexisting factors may indicate a need for a different approach

Avoid symptomatic hyperglycaemia and aim for best level of glycaemic control whilst preventing hypoglycaemia.

Manage coexisting diseases, reduce functional disability, and improve quality of life.

Engender a positive attitude to patients’ condition and carefully consider their ability to understand and participate in their care / treatment. Ensure a Mental Capacity Assessment is carried out if it is considered that the person may not fully understand their condition and a subsequent Best Interest discussion should take place with people who know the person well in order to plan care.

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Special Management Issues

Formulate a clearly written care plan. (see below)

Set realistic goals: overzealous application of clinical targets may compromise quality of life.

Consider limitations imposed by other factors:

 

Nature of disability

 

Mobility

 

Activities of daily living

 

Social support – home circumstances, carers etc.

Current medication – understanding and compliance with regular regimes, use of aids ie. a monitored dosage system (MDS)

Lifestyle choices - understanding and compliance with special diets, exercise and activities. (consider Mental Capacity Assessments)

Interrelationship with co-existing epilepsy (see below)

Liaise with Learning Disability Services if specialist support is required (Adult Learning Disability Teams, Health Facilitation Service, Sensory Impairment Service, Acute Liaison Nurses)

Review above issues on ongoing basis

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Individual Care Plan

A clearly written diabetes care plan needs to be drawn up for each patient. This may include information about the following:

Named diabetes lead.

Contact numbers for advice.

Medication type, dose and timing.

Type and frequency of home testing

Blood glucose targets

Action to be taken if home testing results are out of range

Where appropriate, treatment for hypoglycaemia

Action to be taken during sickness

When urgent action needs to be taken, eg. development of foot ulcer, diabetic ketoacidosis

When reviews are to be expected

This is not an exhaustive list but the care plan needs to be tailored to the needs and circumstances of each individual patient.

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Education and Resources

These should be appropriate to the individual - clarify needs with the individual and their supporting carers. Structured and ongoing training for staff teams who support the individual should be provided.

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Epilepsy and Diabetes

People with learning disabilities have a high prevalence of epilepsy; up to 20% with mild learning disabilities and up to 40% with severe learning disabilities.

Hypoglycaemia may mimic, precipitate or follow an epileptic seizure.

It is important to consider checking a blood glucose level when a fit occurs.

Extra carbohydrate may be required following an energy demanding Tonic Clonic seizure.

Frequent hypoglycaemia should necessitate a review of diabetes treatment

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Retinopathy Screening

Adults with a learning disability may require additional support to ensure they receive an eye health check.

The Sensory Impairment Service - Services for People with Learning Disabilities (SPLD)

Wherever possible adults who have learning disabilities should be and are supported to use mainstream services such as the Retinal Screening Service. If a person requires preparation, desensitisation, or specialist support, the Sensory Impairment Service can provide this (such as familiarisation with equipment, administration of drops, close body proximity etc.), and has done so for a number of people.

The Sensory Impairment Service offers a county wide service for Ophthalmic checks for adults who have learning disabilities, who find it difficult to access mainstream services due to their complex needs. Ophthalmology clinics are staffed by Associate Specialists in Ophthalmology at both Twinwoods, and Beech Close in Dunstable, an orthoptist, and members of the Sensory Impairment Service. They are commissioned as part of the block contract for Services for People who have a Learning Disability. The service screens for any eye health problem but also provides refraction, and has pathways into both acute hospitals for further investigation or surgical procedures. Assessments are carried out in a number of ways but would include full fundal examination with whichever piece of equipment is most suitable for the person’s needs e.g portable slit lamp, indirect ophthalmoscope etc. The people that attend these clinics would have been seen and supported for some time prior to the clinics to ensure that they receive as accurate assessment as possible, and will know what to expect when they attend for their appointment.

For further information regarding this Service contact: Ruth Cooper, Clinical Nurse Specialist, Specialist Services for People who have a Learning Disability, Clinical Resource Centre, Twinwoods Health Resource Centre, Milton Road, Clapham, Bedford MK41 6AT
Tel : 01234 310589
 

Supported Care

The principles of management of patients requiring supported care are very similar to those in who are housebound or in residential care. (See - Special Needs of Patients who are Housebound in Care Homes )

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Useful External Links & Resources
   
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