Managing Diabetes in a Patient with Enduring Mental Health

DIABETES A CONTEMPORARY APPROACH 2486 WORDS CONTENTS CONTENTSPAGE1 INTRODUCTIONPAGE2 DISCUSSIONPAGE2 CONCLUSIONPAGE8 REFERENCESPAGE9 ARTICLES ACCESSED ONLINEPAGE12 APPENDIX 1SCENARIOPAGE13 APPENDIX 2 EATWELL PLATEPAGE14 Introduction Lavinia had suffered a retrogress in her rational wellness and had been using illicit drugs and alcohol to combat the disturbing positive symptoms of her disorder and had stopped taking any of her prescribed medications.The guard sagaciousness indicated that the introductory issue to deal with was her disorganized behavior and once that was under cut back a series of therapeutic interventions could be put in roam to aid her recovery. Initi eachy her pell-mell presentation and challenging behaviours (Beer et al, 2005 Xeniditis et al, 2001) made it trying to engage with her with in a therapeutic way and she resisted supplys attempts to help her. The decision was made to allot her using intramuscular injections (IM) of an minor tranquilizer t hat necessitated using corporeal decl art in order to administer the IM.The counterbalance few days were non pleasant for Lavinia collect to staff needing to restrain and inject her in order to manage her challenging behaviours unless her chaotic behaviour did resolve over clock time and she became more accepting of staff interventions. Lavinias named nurse engaged with her and spent time counselling her and a series of therapeutic interventions were agreed. Mental wellness nurses are specialists in feel for for passel with mental wellness problems and it has been identified that they squander deficits in their experience of diabetes (Nash, 2009).This was the case in caring for Lavinia at the time. Little emphasis was fit(p) on the importance of managing her diabetes beca spend staff were non mindful of the implications of lamentable diabetes precaution. pa usage In the United Kingdom mental un healthiness is by far-off the largest single source of burden of dis ease. There is no other illness or disease in the combined extent of persistence, prevalence and extensiveness that impacts on the person more (Friedli and Parsonage, 2007).There is an inextricable touch between poor mental health and an growthd find of physical illness, increased health risk behaviour, deprivation, poor educational achievement, substance misuse ( field of study Institute for health and clinical Excellence, ( comely) 2009). Managing mental illness carries the single largest cost to the National wellness Service (NHS) coming in at ? 10. 4 billion (Department of wellness, 2012). schizophrenic psychosis is a psychotic disorder that stop admit a enfeeble effect on many aspects of a persons tone including perceptions, thinking, language, emotions, genial, behaviour.The positive symptoms of schizophrenic psychosis cornerstone include hallucinations of any senses, delusions, disorganized sight processes, causing the person to lose contact with reality. Diabete s is a serious suss out that erect have a debilitating effect on the person. It post provoke kidney failure, blindness, midriff disease, stroke, psychosocial problems, if left untreated (NICE, 2008). The United Kingdom is liner a significant increase in the number of people diagnosed with diabetes. In the past 16 grades the number of people diagnosed with diabetes has increased from 1. gazillion to 2. 9 million cases and it is estimated that this figure will continue to increase as the number of older people and overweight/obese people increase (Diabetes in the UK, April 2012). Diabetes mellitus is a condition whereby the remains is futile to properly use the glucose it produces because of either lack of or resistance to the hormone insulin. There are two main referencesetters cases of diabetes grammatical case 1 & type 2. Insulin is needed to enable the glucose to pass from the kindred and enter the cells of the body where it is stored. lineament 1 diabetes occurs whe n the body (pancreas) is unable to produce its own insulin (an autoimmune disease) and the person needs to have tied(p) daily injections of insulin to counter this. Type 1 diabetes accounts for approximately 10% of all people with diabetes (Diabetes in the UK, April 2012). Type 2 diabetes mellitus is a condition whereby the body either does not produce enough insulin or that the person is insulin resistant. It can be treated with medication alone or medication and insulin.Type 2 diabetes accounts for approximately 90% of all people with diabetes (Diabetes in the UK, April 2012). It is k promptlyn that type 2 diabetes mellitus has an increased prevalence in people with schizophrenia compared to the the habitual population (Schoepf et al, 2011). Further, the treatment for schizophrenia is typically with major tranquilizer medication and it is now percipient that some neuroleptic drugs elevate the risk of developing diabetes and weight crowd (iatrogenic effect) though just why this happens is not fully understood (Dixon et al. 000). Lavinia suffers from schizophrenia, is obese, takes antipsychotics, and suffers from type 2 diabetes. Diabetes is potentially a life threatening condition. Blood glucose levels ingeststairs 3. 5mmol/l are too low for the brain to function this is hypoglycaemia. The signs of hypoglycaemia are similar to a person experiencing psychoses, e. g. aggression, disorientation, convinced behaviour. It would have been imperative that nursing staff should have made it a priority that Lavinias crosscurrent glucose levels were monitored.Lavinia could have been experiencing a hypoglycemic state when in fact nurses strength have mistaken this for challenging behaviour. Lavinias blood glucose levels might have been above the recommended guidelines (8mmol/l) which is hyperglycaemia and the nurses would need to have an appreciation of the potential elevate blood glucose levels can have, e. g. damage to the micro and macro vascular bras s principal suming to blindness, increased risk of heart attack, increased risk of stroke, diabetic ketoacidosis.Not having sufficient knowledge of diabetes while at the same time caring for soul with diabetes and not acting compromises the nurses professional obligations (Nursing and midwifery Council, NMC, 2002) and the NMC or the courts would have no reluctance in pursuing this should it cause an issue (Kane Gorny, 2009). Any nurse who cares for a person needs to be competent. Roach (1992) defines competence as, the state of having the knowledge, judgment, skills, energy, experience and motivation required to move dequately to the demands of ones professional responsibilities. The nurses caring for Lavinia would in that respectfore be duty bound to refer her to a diabetes nurse/Dr. According to the NICE (2008) recommendations it is vital that people with diabetes receive an annual check up including blood instancy feet check locoweed status urinary albumin study (or pro tein rivulet to measure kidney function) serum creatinine test retinopathy screen cholesterin levels weight and BMI measurements HbA1c blood glucose levels.Lavinia may have had these checks carried out within the last 12 months but due to her chaotic life-style over the past few months her results might differ significantly thus during this admission it would be an opportune time to have these checks carried out. Hypertension can have devastating set up on the person whether they have diabetes or not, e. g. increased risk of stroke, cardiac disease, nephritic failure. Research by Diabetes UK (2012) found that little more than 50% of people with diabetes were meeting their blood pressure targets which they recommend should be 130/80.The importance of in force(p) nucleotide care in diabetes cannot be overstated. Poor foot care can lead to ulceration and ill health, gangrene and even amputation. Diabetes UK state that up to 80% of amputations annually in England are avoidable. Th e risks that smoking presents are well documented, e. g. heart disease, stroke, vascular complications, amputation. A person with diabetes is pre given over to certain illnesses and should he/she decide to smoke then their health risk profile increases considerably by multiplying the potential deleterious effects.Blood tests can hear potential or actual renal failure. Diabetes causes harm to the micro vascular system which includes the very tiny vessels in the retina of the eye. If this is not addressed it can lead to blindness and Diabetes UK recommend an annual eye screen. High cholesterol levels are serious whether the person has diabetes or not and can lead to heart disease, circulatory complications, stroke, fatty liver. Abnormal levels of cholesterol can cause insulin resistance.Type 2 diabetes is one of the close to serious consequences associated with being obese or overweight. Over the past 25 years the number of people in England who are classed as obese has doubled and it is anticipated by the year 2050 obesity will affect 60% of self-aggrandizing men, 50% of adult women, and 25% of children (Foresight, 2007). The blood glucose levels HbA1c is an indicator for risk of damage to blood vessels. NICE (2008) recommend an HBA1c level of between 6. 5% and 7. 5% would be the destination for people with diabetes.For people with type 2 diabetes, effective blood glucose cook can reduce the risk of diabetic eye disease by 25% and kidney damage by 33% (UK likely Diabetes Study (UKPDS). It is clear that management of diabetes can be a challenging role and a multidisciplinary approach is needed to manage it as effectively as it can be managed. Multidisciplinary team drop dead is important in any care giving role (Liberman et al, 2001). The most important person in the multidisciplinary team is Lavinia. She is the person who has the most control and needs to manage her diabetes on a daily basis.For Lavinia there are two issues managing schizophrenia and m anaging diabetes. Using a depot antipsychotic in preference to oral medication would help Lavinia because a nurse would administer it weekly thus reducing the risk of relapse. NICE guidelines (2009) give the axe that people with schizophrenia should be offered access to psychological therapies including cognitive behavioral therapy (CBT) and/or family therapy. If Lavinia did benefit from psychological interventions it might reduce her reliance on medication thus reducing side effects.In order to manage her diabetes Lavinia should have access to a team of professionals including diabetic nurses podiatry Drs ophthalmology nutritionist pharmacist physiotherapist counsellor. An assessment for management of diabetes should be holistic (Dunning, 2009 pgs. 36 49) and hold to a persons lifestyle. For Lavinia this means sitting down with a specialist diabetic nurse and having a complete assessment of her lifestyle and her appreciation of how it interacts with her diabetes. She needs to fully understand the importance of great glucose control and the consequences of poor control.She might already have experienced hypoglycaemic attacks but been unaware of what they were/are, i. e. could be confused with positive effects of schizophrenia. As a starting point it would be entrance to ensure she knows how to test her blood glucose levels, which is one of the NICE (2008) guidelines, and how to interpret the result. She needs to be aware of the relationship between food intake, physical activity and medication understanding how managing these can help her maintain appropriate blood glucose levels. Diet is cognise as the cornerstone of management in type 2 diabetes.An appropriate diet will help control blood glucose levels, maintain an appropriate weight/body mass index, and prevention of complications. Lavinia is obese which is possibly due to the combination of antipsychotic medications she takes for schizophrenia and her lifestyle. An assessment by a nutritionist o r specialist diabetic nurse into her eating habits would help to trace any areas she would benefit from by making changes to her diet. The Eatwell Plate (Department of Health, 2011) offers a framework for healthy eating in the United Kingdom (see appendix 2).It gives good visual, easy to understand, guidance on the balance/proportion and types of food that channel to a healthy diet. Lavinia would benefit from an assessment with the physiotherapists to determine her level of seaworthiness and areas that could be worked on in order to improve her fitness with a view to losing weight. Exercise can reduce the risk of major illnesses e. g. heart disease, stroke, diabetes and cancer by up to 50% (National Health Service, 2012). However, the benefits of exercise on glycaemic control and body mass in type 2 diabetes is not clear (Boule et al, 2001).The potentially damage effects that diabetes can have on a person are well known and documented (e. g. UK prospective Diabetes Study, 1977 t hru 1997 (UKPDS). The damaging effects of poor blood glucose control are not always immediately observable and consequently people with diabetes do not always fully appreciate the importance of controlling their blood glucose levels (see chain armor Online, 2010). The reality of diabetes care is self management and effective self management delays the onset of complications. Lavinia needs to understand how the lifestyle choices she makes, e. . level and frequency of physical activity, what and when she eats, managing her mental health, are all major factors in controlling her diabetes. Because the damaging consequences of not managing diabetes are not immediately obvious the impetus to manage it is not always paramount (Diabetes UK, 2012). It might be enough that Lavinia understands these factors and so takes action to manage her condition. If not, she would need support to help her change her behaviour/lifestyle in order to manage her diabetes. There are some(prenominal) beats of behavioural change, e. g. ealth belief good example (Becker, 1974) theory of reasoned action (Fishbein and Atzen, 1975) social learning theory (Bandura, 1977). Motivational interviewing (MI) (Rollnick and Miller, 1995) is a model that is used to submit about behavioural change and has been shown to be effective in delivery about change in a range of healthcare settings including diabetes care, e. g. VanWormer et al (2004) Clark and Hampson (2001) Kim et al (2004). The aim of MI is to bring about discrepancy in the persons beliefs and thoughts by bringing about a state of cognitive dissonance, i. e. he difference between where the person is currently and where they want to be in future and setting small goals to achieve. Thus, Lavinia has full knowledge of the damaging effects diabetes can have and in future she would like to get espouse and have children. To have children she needs to be as healthy as she can be and therefore she will be self do to resolve the dissonance she experiences. Used in combination with Prochaska and DiClementes model, stages of change (1983) and Egans (1998) skilled helper model of problem management could work to good effect for Lavinia in bringing about a change.Conclusion The link between poor mental health and poorer outcomes for physical illness, increased health risk behaviour, deprivation, educational achievement, substance misuse is well known (NICE, 2009). Diabetes is potentially a life threatening condition Lavinia has schizophrenia and diabetes. Her poor mental health could be supporting the deleterious effects of her diabetes. Not having sufficient knowledge of diabetes while at the same time caring for someone with diabetes and not addressing it compromises the nurses professional obligations (NMC, 2002).Lavinia needs support from some(prenominal) the mental health and diabetes services. She needs to have a good understanding of the interplay between the diabetes and mental health. She needs to have insight into potential relapse signatures to her mental health so that she can get help as early as possible. A diabetes counsellor could help Lavinia make lifestyle changes by engaging her in a course of motivational interviews (Rollnick and Miller, 1995) in combination with Prochaska and DiClementes model, stages of change (1984) and Egans (1998) skilled helper model of problem management. ReferencesBandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ Prentice Hall. Becker, M. H. , ed. (1974). The Health judgment Model and Personal Health Behavior. Health Education Monographs, Vol. 2 32473. Beer, D. Turk, V. McGovern, P. et al, (2005), Characteristics of patients exhibiting heavy challenging behaviour in low secure mental health and mild learning disabilities units. diary of psychiatrical Intensive Care, Vol. 1, pp 29-35. Boule, N. G. Haddad, E. Kenny, G. P. 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Northern Ireland Association for Mental Health. Available online and accessed July 2012 http//www. chex. org. uk/media/resources/mental_health/Mental%20Health%20Promotion%20-%20Building%20a n%20Economic%20Case. pdf ring mail online. Available and accessed in July 2012 at http//www. dailymail. co. uk/health/article-1309609/The-cruel-cost-ignoring-diabetes-Jane-lost-arm-legs-disease-like-didnt-seriously. html NHS Choices.Accessed online in July 2012 and getable at http//www. nhs. uk/Livewell/fitness/Pages/Whybeactive. aspx UK prospective Diabetes Study (1977-1997). Available and accessed online in July 2012 at http//www. dtu. ox. ac. uk/ukpds_trial/index. php Appendix 1 Scenario Lavinia (pseudonym) is a 25 year old egg-producing(prenominal) with a history of schizophrenia stretching back to her late teens. She has been pose on a section of the Mental Health Act (MHA, 1983) and detained on a psychiatric intensive care unit (PICU) due to her presenting with chaotic behaviour posing a threat to