Managing the Care of a Diabetes Patient in the Home Care Setting

Introduction

Diabetes is a life-long disease. It can cause many serious health complications. But it is possible to manage diabetes through the right treatment and lifestyle changes. Keeping the blood glucose level in check will also help prevent complications of the eye, kidney, and nerves, and prevent heart disease.

Home care may be provided to a person with diabetes by family members, caregivers, or home care nurses in association with the health care team, or by the patient himself.

The aim of diabetes care in the home setting is to:

• Improve the knowledge and skills required for taking care of the patient at home
• Empower people with diabetes to take control of their condition independently
• Integrate self-management into everyday life

MANAGING CARE AT HOME

To take care of a person with diabetes at home, you will need to know the treatment goals and how to monitor glucose levels at home. You may need to manage the diet and weight of the person and also look for signs and symptoms that may need a visit to the doctor.

Taking medicines on time

Whether the person with diabetes is on insulin or oral blood glucose-lowering drugs, taking medicines on time must be a top priority.
Taking medicines as directed by your provider is the first step towards keeping your diabetes in check.

Personal hygiene and grooming

• People with diabetes are prone to infections. Follow these tips to prevent infections:
• Brush teeth regularly to keep the mouth clean and gums healthy.
• Avoid harsh brushing.
• Keep toenails trimmed.
• Take a bath with warm water and dry the body completely.
• Keep a check on any callus formation or any minor cuts or wounds.

Medical nutrition therapy

People with diabetes need to make changes to their diet to keep blood glucose levels in check. A registered dietitian (RD) can check the nutritional status of the patient and help create an individualized diet plan.

Carbohydrate counting is important for people with type 1 diabetes or anyone taking insulin. The glycemic index, which measures how quickly a carbohydrate-containing food raises blood sugar levels, may be a helpful addition to carbohydrate counting for some people.

The American Diabetes Association (ADA) has made some dietary recommendations for people with diabetes. Following these recommendations can help you take care of your nutrition:

• Choose carbohydrates that come from vegetables, whole grains, fruits, beans (legumes), and dairy products. Avoid carbohydrates that contain excess added fats, sugar, or sodium.
• Choose “good” fats over “bad” ones. Avoid unhealthy saturated fats (red meat and other animal proteins, butter, lard) and trans fats (hydrogenated fat found in snack foods, fried foods, commercially baked goods).
• Choose protein sources that are low in saturated fat. Fish, poultry, legumes, and soy are better protein choices than red meat. Prepare these foods with healthier cooking methods that do not add excess fat, such as baking, broiling, steaming, or grilling instead of frying. If frying, use healthy oils like olive or canola oil.
• Try to eat fatty fish, which are high in the omega-3 fatty acids DHA and EPA, at least twice a week. Salmon, herring, trout, and sardines are some of the best sources of DHA.
• Limit intake of sugar-sweetened beverages such as soda, juice, sports drinks. These contain fructose corn syrup or sucrose and are high in sugar.
• Sodium (salt) intake should be limited to 2,300 mg/day or less. People with diabetes and high blood pressure may need to restrict sodium even further. Reducing sodium can lower blood pressure, protect kidneys, and decrease the risk of heart disease and heart failure.

Weight management

Being overweight or obese raises the risk for poor heart health and stroke. A person with diabetes who
is obese or overweight needs a daily calorie deficit of 500 to 700 kcal. This must be achieved through
behavioral modification, dietary changes, and physical activity.
High abdominal fat (high waist circumference) is linked to high insulin resistance.
You are obese if you have a:

• BMI >25 kg/m2 (for Asians)
• Waist circumference > 102 cm (men) and >88 cm (women)

Type 2 diabetes cannot be reversed, but weight loss and physical activity can both help with diabetes
management.

Footcare

Diabetes can damage the nerves and blood vessels in the feet. People with diabetes have an increased
risk of developing foot sores, or ulcers also called diabetic ulcers.
Do the following on a daily basis:

• Keep the area between the toes and nails clean and dry to prevent fungal growth.
• Check feet daily for redness, blisters, and calluses, discoloration, clawing of toes, or loss
  of the plantar arch.
• Always wear socks. Check socks and shoes for rough spots.

Inform your provider right away if you notice have warmth, swelling, or redness across the top of your
foot or your ankle.

Managing sleep

Restful uninterrupted sleep is necessary for normal glucose metabolism. Disrupted sleep raises the risk
of diabetes and obesity.
Follow the tips below to get a healthy sleep:

• Avoid caffeine six hours before sleep time.
• Avoid exercise 2-3 hours before bedtime.
• Take a warm bath to induce relaxed sleep.
• Avoid using smartphones, laptops, tablets, and other electronic devices at bedtime as they
  hinder sleep.
• Avoid heavy meals and alcohol just before bedtime.

Staying active at home

For people with diabetes, it is recommended to do no less than 150 minutes of aerobic exercise and resistance training spread over at least 3 days a week.
One of the best things is to get up and start moving. Any activity is better than no activity.

These are a few ways to stay active:

• Clean the house.
• Walk around when on the phone.
• Take frequent short breaks at least every 30 minutes to get up and walk around when using
  the computer.
• Do household chores, such as gardening, raking leaves or washing the car.
• Play with kids or grandchildren.
• Take the dog for a walk.
• Do not sit for more than 30 minutes at a time.
• Find a hobby such as swimming, dance, or any activity you enjoy.

Blood glucose monitoring at home

New drugs and smart devices have made it possible to monitor blood sugar levels at home and maintain
them near to the normal range in most people.
In type 2 diabetes, you may not be asked to check your blood glucose level daily unless you are on
insulin or sulphonylurea drugs. However, self-assessment of blood glucose level can be used for selfeducation
at home to understand how exercise affects blood sugar and how to manage blood sugar
during sickness.

The following levels show a good control on diabetes:

• Fasting blood glucose: 90-126mg/dL
• Pre-meal: 72-126 mg/dL
• Postprandial: 72-144 mg/dL

If you are on insulin, you should know how to monitor your blood sugar using a glucometer. Learn how to manage your insulin doses according to your activity levels and during sickness.

Self-management and lifestyle changes at home

The importance of lifestyle changes such as daily physical activity, a healthy diet, and reduction of
alcohol intake should not be undermined in keeping diabetes in check.

• Stop smoking and lead a tobacco-free life.
• Alcohol can be taken in moderation, keeping within the recommended levels.

Understand the high-calorie value of some types of alcohols and their effect on your body weight.

When to see the doctor

A person with diabetes must visit their provider every 3 months, or as often as instructed. At these visits,
the provider may:

• Ask the patient about their blood sugar level (always bring the meter if one is checking blood
  sugar at home)
• Check blood pressure
• Check the feeling in the feet
• Check the skin and bones of the feet and legs
• Examine the back of the eyes

The provider will also order blood and urine tests to make sure that:

• Kidneys are working well (every year)
• Cholesterol and triglyceride levels are healthy (every year)
• Glycosylated hemoglobin (HbA1C) level is in a good range (every 6 months if diabetes is well
  controlled or every 3 months if it is not)

References :

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  S72; DOI: 10.2337/dc21-S005
• Ghosh S, Collier A. Management of diabetes. In: Ghosh S, Collier A, eds. Churchill’s Pocketbook of
  Diabetes. 12th ed. Philadelphia, PA: Elsevier; 2012:chap 3.
• Krishnan V, Patel SR. Consequences of sleep disruption. In: Broaddus VC, Ernst JD, King TE, et al,
  eds. Murray and Nadel’s Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier;
  2022:chap 118.
• Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes—
  2021. American Diabetes Association. Diabetes Care Jan 2021, 44 (Supplement 1) S100-S110; DOI:
  10.2337/dc21-S008