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

2. 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

3. 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

4. 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
150mls of non diet fizzy drink or 200ml orange juice
Re check blood glucose in 15-20mins
Have a snack containing carbohydrate eg.2 plain biscuits or fruit or meal if due

5. 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

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

7. 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.

8. 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

9. 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

10. 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

11. 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

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