Amber Nielsen 281 East 900 North Bountiful, Utah 84010 (801) 647-4906 December 4, 2009 David Webster,

Jr. Legacy House of Bountiful 79 East Center Street Bountiful, Utah 84010 Dear Mr. Webster Attached is a report that analyzes the disease process of Diabetes and the effects that it has on the elderly population that we care for at Legacy House. This report offers a brief overview of the disease process, managing Diabetes and gives recommendations on how to train the staff of Legacy House of Bountiful to better care for residents with this disease. About twenty three percent of the population over the age 60 has diabetes and twenty five percent of the residents at Legacy House are currently living with diabetes. Many of these residents live at the Legacy House so that they can receive help with their diabetic care. This report gives recommendations of how to educate all staff in recognizing signs and symptoms of Diabetes and how to better care for residents who have Diabetes. Thank You, Mr. Webster, for allowing me to present this information to you. If you have any questions or would like to discuss the reports findings you may reach me at the above address, at 801-647-4906 or at ahnielsen02@hotmail.com. I would be happy to hear from you. Sincerely, Amber Nielsen

Caring for Elderly Diabetic Patients at the Legacy House in Bountiful

Research Report

By

Amber Nielsen December 4, 2009

Table of Contents
Executive Summary ............................................................................................................... ii Information ........................................................................................................................... 1 Methodology......................................................................................................................... 2 Results .................................................................................................................................. 2 Conclusions ........................................................................................................................... 3 Recommendations ................................................................................................................ 3 Bibliography .......................................................................................................................... 5 Glossary ................................................................................................................................ 6

Executive Summary
The purpose of this report is to inform the administrator of the Legacy House of Bountiful about diabetes and its effects on the residents that live in the Legacy House. It is important to educate the Legacy House of Bountiful staff about Diabetes because it is common in the population over 60 years. Early detection of the disease makes it easier for those that have the disease to manage its symptoms and often slow the disease process. Also, early recognition of the symptoms of diabetes reduces that chance of the patient ending up in a diabetic coma or death. This report provides a brief overview of the disease, its complications, and gives recommendations of ways to educate staff members about Diabetes and how to care for residents with the disease.

Information
Diabetes Overview There is currently no cure for diabetes, but any type of diabetes can generally be controlled by diet, medication, or insulin. Symptoms of Diabetes include: Frequent urination Unusual thirst Extreme hunger Unusual weight loss Extreme fatigue Irritability Frequent infection Blurred vision Cuts or bruises that are slow to heal Tingling or numbness in the hands or feet Recurring skin, gum, or bladder infection

Diabetes occurs when the pancreas is no longer able to make insulin or the insulin that it does make doesnt function properly to control blood sugar. Without insulin the body cannot control the blood sugar levels in the body. When this occurs blood sugar levels fluctuate wildly, which can cause complications or death. Fluctuations of blood sugars can either be high or low. High blood sugar is known as hyperglycemia, and low blood sugar is known as hypoglycemia. Many of the symptoms are the same for both hyperglycemia and hypoglycemia, so the only way to know which the patient is suffering from is to test the blood sugar with a blood sugar monitor. Symptoms for both high and low blood sugars are: Shakiness Fast heartbeat Sweating Dizzy Anxious Hungry Blurry vision Weakness or fatigue Headache Irritability

There are three types of diabetes: type 1 type 2 and gestational. Type 1: In type 1 Diabetes the body cannot make its own insulin and requires insulin injections to control blood sugars. The bodys inability to make insulin occurs when the bodys immune system mistakes the cells in the pancreas that make and release insulin for antibodies and destroys them. This is often called insulin dependent Diabetes. Because the body isnt able to make insulin to control the blood sugar levels in the body, insulin injections are needed to control the bodys blood sugar levels. Type 2: In adults, type 2 Diabetes accounts for about 90% to 95% of all diagnosed cases of Diabetes. Being overweight and inactive increase the chances of developing type 2 Diabetes Typically, with type 2 Diabetes, the body still makes insulin, but its cells can't use it. This is often called insulin resistant Diabetes. Over time, high levels of sugar build up in the bloodstream because the insulin that the body produces is ineffective at controlling the blood

sugar level. Diabetic diet, exercise and oral medications help the bodys insulin with controlling the bodys blood sugar level. Generally, over time, type 2 Diabetes will develop into type 1 Diabetes. If properly cared for and monitored, the process of developing type 1 Diabetes can be slowed. Gestational Diabetes: This type of diabetes occurs in some pregnant women. It can cause problems during pregnancy, labor, and delivery. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 510 years. The Elderly and diabetes The American Diabetes Association(ADA) estimates that 23.1 % of the population over the age of 60 has either type 1 or type 2 diabetes. The ADA also estimates that 50% of all diabetes cases that are digonosised are digonosised in people aged 55 or older. The majority of diabetic cases that are digonosised in the over 55 population are because as the body ages the pancreass ability to produce insulin decreases. As well as the pancreass decreased ability to produce insulin, the over 60 population often have other health problems that contribute to the risk of developing Diabetes including hypertension, high cholesterol, obesity, and certain medications.

Methodology
Research was gathered from the American Diabetes Associations website, Dorlands Medical Dictionary, and WebMD.com. Research was also gathered from firsthand experience caring for diabetic residents of Legacy House.

Results
While there is no cure for diabetes, proper management is essential to maintain appropriate blood sugar levels and maintain health. Proper control of diabetes includes: monitoring blood sugar levels, taking medication or insulin at the appropriate times, exercise and diet. Blood sugar control is very important because uncontrolled blood sugar levels can lead to hyperglycemia, hypoglycemia, Diabetic ketoacidosis, and cause damage to the bodys organs. It is normal for blood sugars to fluctuate throughout the day, but controlling the valleys and peaks of those fluctuations can help reduce these complications. Below is a comparison of ideal Diabetic and non Diabetic blood sugars through out the day. Often with out proper control of Diabetes, such the correct diet or taking medication or insulin before a meal, can cause the blood sugar levels to

drop below 70 mg/dl before a meal, causing hypoglycemia. And can cause a blood sugar to spike above 180 mg/dl after a meal causing hyperglycemia.

Table of Blood Sugars

Diabetic NonDiabetic Fasting/ Before a Meal 70-130 mg/dl 70- 110 mg/ dl After a meal Less than 180 mg/ dl Less than 140 mg/ dl

Early recognition of symptoms of diabetes, hypoglycemia, and hyperglycemia is important because early treatment of the symptoms minimizes damage that is caused by diabetes such as Diabetic coma or even death.

Conclusions
While there is no cure for Diabetes, with proper care symptoms can be managed and the disease process can be slowed. Controlling diabetes through proper management is important to insure the health of the diabetic patient. Many elderly people that have diabetes often move to assisted living facilities, like Legacy House, because they need help with diabetic cares. Raising awareness among staff about diabetes can improve the care that these residents receive. It can also help attract potential residents if Legacy House can claim that it provides diabetic friendly care. The recommendation section gives example of what Legacy House can do to set up a diabetic care program.

Recommendations
The first recommendation is that all of the staff is educated about diabetes, and the symptoms of Diabetes, hyperglycemia, and hypoglycemia. Holding a training session that will educate the staff about diabetes and its symptoms will help the staff recognize when a resident is experiencing problems of the disease. This can reduce complications from the disease that cause serious health problems or death. The second recommendation is to hold further training for the nursing staff because they provide cares for the residents on a much more personal level than any other member of the staff and will be the only staff that will notice certain symptoms of Diabetes. Those symptoms include problems with the skin such as slow healing cuts, bruises, and sores; and nerve damage that causes numbness or tingling of the hands or feet. When the CNAs are providing cares such as dressing or bathing and notice these problems, they will know that they could be signs of Diabetes and will be able to report to the nurse about their findings and concerns. This could help

with diagnosing residents with Diabetes sooner and getting them the care that they need. Because Diabetes causes nerve damage in the feet and hands, CNAs should also be trained to check Diabetic residents hand and feet for sores or cuts that could become inflected. Because of slow healing when sores on a diabetic residents hand or foot becomes infected it will almost always need to be amputated. If the CNAs are aware of this and catch these sores early and provide care to keep them clean, it reduces the chances that amputation will be needed. The third recommendation is to further train the med techs that are responsible for handling medications for residents to administer insulin in emergent situations. When a residents blood sugar is dangerously high it is important to lower it as soon as possible. Currently med techs cannot administer insulin, but teaching them how to read a sliding scale, which gives the amount of insulin needed based on blood sugar, draw insulin and administer it to the resident to lower blood sugar quickly. Currently because med techs are not trained to do this they must wait for a nurse, which isnt always readily available, or call the EMTs to administer insulin, waiting for a nurse or the EMTs can increase problems that are caused by the complications that occur from a high blood sugar. The fourth and finally recommendation is to invest glucotabs and glucopens. Both are used to raise a low blood sugar. Some diabetic residents currently have glucotabs but it would be helpful to have a house stock of these tabs to use in an emergency.

Bibliography
American Diabetes Association. 27 November 2009. American Diabetes Association. 1 December 2009. <hppt://www.diabetes.org> Diabetes Dorlands Pocket Medical Dictionary. 27th ed. 2004. WebMD. May 2009. WebMD, LLC. 1 December 2009. <webmd.com>

Glossary
Blood Sugar: The main sugar that the body makes from food in the diet. Blood Sugar is carried through the blood stream to provide energy to all cells in the body. Cells cannot use blood sugar without the help of insulin. Diabetic Ketoacidosis: A complication of diabetes, usually occurring in type 1 diabetic patients, but it can occur in type 2 diabetic patients. It occurs when the body cannot use sugar as a fuel source because there is little or no insulin in the body. The body will then breakdown fat for fuel. This causes ketones, a byproduct of fat break down, to build up in the body causing problems. Hyperglycemia: High blood sugar. Blood sugar is considered high when it is over 180 mg/ dl in diabetics and 140 in non diabetics Hypoglycemia: Low blood sugar. Blood sugar is considered low when it falls below 70 mg/ dl in both diabetics and non diabetics. Mg/dl: Milligrams per deciliter. The unit of measurement used for blood sugar.