'Managing Diabetes in a Patient with Enduring Mental Health\r'

'DIABETES; A CONTEMPORARY draw near 2486 WORDS CONTENTS CONTENTSPAGE1 INTRODUCTIONPAGE2 DISCUSSIONPAGE2 CONCLUSIONPAGE8 REFERENCESPAGE9 ARTICLES ACCESSED ONLINEPAGE12 concomitant 1SCENARIOPAGE13 APPENDIX 2 ‘EATWELL PLATE’PAGE14 Introduction Lavinia had suffered a relapse in her affable health and had been using illicit drugs and alcohol to contend the disturbing positive symptoms of her illness and had halt taking any of her prescribed medications.The nanny legal opinion indicated that the for the first time issue to overcompensate with was her chaotic behaviour and once that was at a humiliateder ramble halt a series of remediation interjections could be put in place to aid her recovery. Initi every last(predicate)y her chaotic insertion and repugn behaviours (Beer et al, 2005; Xeniditis et al, 2001) made it difficult to take up with her with in a therapeutic style and she resisted module’s attempts to aid her. The conclusiveness was m ade to permit it off her using intramuscular get intoions (IM) of an anxiolytic that necessitated using physical restriction in localise to administer the IM.The first few days were non lovable for Lavinia due to staff needing to restrain and inject her in revise to manage her con testing behaviours but her chaotic behaviour did unthaw over time and she became more(prenominal) pass judgment of staff interventions. Lavinia’s named treat employed with her and spent time ‘counselling’ her and a series of therapeutic interventions were agreed. psychical health nurses ar specialists in care for batch with m oral exam health problems and it has been identified that they score deficits in their knowledge of diabetes (Nash, 2009).This was the case in caring for Lavinia at the time. Little ferocity was primed(p) on the greatness of managing her diabetes be reach staff were not aw argon of the implications of execrable diabetes focusing. banter I n the join body politic mental illness is by far the largest angiotensin-converting enzyme source of burden of malady. There is no other illness or disease in the combined extent of persistence, preponderance and breadth that impacts on the individual more (Friedli and Parsonage, 2007).There is an inextricable link in the midst of lamentable mental health and an increase en previse of physical illness, increased health adventure behaviour, deprivation, poor educational achievement, shopping mall sophisticate ( internal Institute for health and clinical Excellence, ( handsome) 2009). Managing mental illness carries the single largest cost to the case wellness Service (NHS) coming in at ? 10. 4 billion ( discussion section of health, 2012). dementia praecox is a psychotic disorder that chiffonier absorb a enfeeble pith on many aspects of a person’s life including perceptions, thinking, language, emotions, social, behaviour.The positive symptoms of schizophren ic disorder heap include hallucinations of any senses, delusions, disorganise thought processes, causing the person to brook contact with humankind. Diabetes is a full full term that keister require a debilitating effect on the person. It tail end progress to kidney failure, blindness, heart disease, stroke, psychosocial problems, if left untreated ( adept, 2008). The United Kingdom is facing a epoch- devising increase in the matter of spate diagnosed with diabetes. In the past 16 days the rate of hatful diagnosed with diabetes has increased from 1. wiz thousand thousand to 2. 9 million cases and it is estimated that this figure bequeath continue to increase as the number of experienceder flock and over tip/ corpulent populate increase (Diabetes in the UK, April 2012). Diabetes mellitus is a gibe whereby the organic structure is unable to right use the glucose it cause ons because of either lack of or resistance to the hormone insulin. There are deuce main types of diabetes; type 1 & axerophthol; type 2. Insulin is take to modify the glucose to pass from the channel and enter the cells of the physical structure where it is stored. place 1 diabetes occurs when the body (pancreas) is unable to produce its own insulin (an autoimmune disease) and the person take to give birth regular daily injections of insulin to counter this. guinea pig 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 fitting insulin or that the person is insulin resistant. It back 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 know that type 2 diabetes mellitus has an increased preponderance in people with dementia praecox compared to the the general population (Schoepf et al, 2011). Further, the tre atment for schizophrenia is typically with major tranquillizer medication and it is now fade that some antipsychotics elevate the peril of create diabetes and weight gain (iatrogenic effect) though respectable why this happens is not fully mum (Dixon et al. 000). Lavinia suffers from schizophrenia, is grave, takes antipsychotics, and suffers from type 2 diabetes. Diabetes is potentially a life threatening condition. Blood glucose levels beneath 3. 5mmol/l are too low gear for the brain to function; this is hypoglycaemia. The signs of hypoglycaemia are similar to a person experiencing psychoses, e. g. aggression, disorientation, convertd behaviour. It would puddle been imperative that nursing staff should collect made it a priority that Lavinia’s blood glucose levels were monitored.Lavinia could piddle been experiencing a hypoglycaemic conjure when in fact nurses readiness beget mistaken this for challenging behaviour. Lavinia’s blood glucose levels talent break been supra the proposeed guidelines (>8mmol/l) which is hyperglycaemia and the nurses would need to fuck off an sagaciousness of the potential elevated blood glucose levels can have, e. g. damage to the micro and macro vascular system filming to blindness, increased luck of heart attack, increased find of stroke, diabetic ketoacidosis.Not having sufficient knowledge of diabetes patch at the same time caring for someone with diabetes and not acting compromises the nurse’s professional obligations ( nursing and obstetrics Council, NMC, 2002) and the NMC or the courts would have no reluctance in act this should it become an issue (Kane Gorny, 2009). Any nurse who cares for a person needs to be competent. Roach (1992) defines competence as, â€Å"the state of having the knowledge, judgment, skills, energy, meet and motivation required to respond dequately to the demands of one’s professional responsibilities”. The nurses caring for Lavinia would so be duty bound to consult her to a diabetes nurse/Dr. According to the NICE (2008) urgeations it is vital that people with diabetes receive an annual check up including; blood pressure level; feet check; pot status; urinary albumin test (or protein test to quantify 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 modus vivendi over the past few months her results might differ significantly thus during this opening it would be an opportune time to have these checks carried out. Hypertension can have destroy effectuate on the person whether they have diabetes or not, e. g. increased fortune of stroke, cardiac disease, renal failure. Research by Diabetes UK (2012) undercoat that little more than 50% of people with diabetes were meeting their blood pressure targets which they recom mend should be 130/80.The importance of honest foot care in diabetes cannot be overstated. Poor foot care can lead to ulceration and ill health, crucify and even amputation. Diabetes UK state that up to 80% of amputations annually in England are avoidable. The risks that smoking presents are well documented, e. g. heart disease, stroke, vascular complications, amputation. A person with diabetes is pre disposed to original illnesses and should he/she decide to smoke whence their health risk profile increases substantially by multiplying the potential deleterious effectuate.Blood tests can rank potential or factual renal failure. Diabetes causes harm to the micro vascular system which includes the very tiny vessels in the retina of the heart. If this is not addressed it can lead to blindness and Diabetes UK recommend an annual eye screen. High cholesterol levels are honest whether the person has diabetes or not and can lead to heart disease, circulatory complications, stroke, fertile liver. Abnormal levels of cholesterol can cause insulin resistance.Type 2 diabetes is one of the most serious consequences associated with being obese or overweight. oer 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 meet 60% of handsome 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 amidst 6. 5% and 7. 5% would be the goal for people with diabetes.For people with type 2 diabetes, hard-hitting blood glucose picture can reduce the risk of diabetic eye disease by 25% and kidney damage by 33% (UK prospective Diabetes Study (UKPDS). It is clear that counseling of diabetes can be a challenging role and a multidisciplinary plan of attack is needed to manage it as effectively as it can be managed. Multidisciplinary teamwork is impor tant 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 enclose and needs to manage her diabetes on a daily basis.For Lavinia there are two issues; managing schizophrenia and managing diabetes. Using a storage antipsychotic in preference to oral medication would jock Lavinia because a nurse would administer it weekly thus trim back the risk of relapse. NICE guidelines (2009) advise that people with schizophrenia should be offered access to psychological therapies including cognitive behavioral therapy (CBT) and/or family therapy. If Lavinia did advantage from psychological interventions it might reduce her faith on medication thus diminution side set up.In order to manage her diabetes Lavinia should have access to a team of professionals including diabetic nurses; podiatry; Dr’s; ophthalmology; dietician; pharmacist; physiotherapist; counsellor. An assessment for mana gement of diabetes should be holistic (Dunning, 2009 pgs. 36 †49) and withdraw to a person’s lifestyle. For Lavinia this means posing down with a specialist diabetic nurse and having a complete assessment of her lifestyle and her understanding of how it interacts with her diabetes. She needs to fully understand the importance of keen glucose control and the consequences of poor control.She might already have experienced hypoglycaemic attacks but been unconscious(predicate) of what they were/are, i. e. could be confused with positive cause of schizophrenia. As a starting decimal point it would be appropriate to ensure she knows how to test her blood glucose levels, which is one of the NICE (2008) guidelines, and how to check the result. She needs to be aware of the relationship between regimen intake, physical natural action and medication understanding how managing these can help her maintain appropriate blood glucose levels. dieting is know as the cornerstone of management in type 2 diabetes.An appropriate diet will help control blood glucose levels, maintain an appropriate weight/body quid index, and prevention of complications. Lavinia is obese which is possibly due to the conclave of antipsychotic medications she takes for schizophrenia and her lifestyle. An assessment by a dietician or specialist diabetic nurse into her eating habits would help to identify any areas she would improvement from by making interpolates to her diet. The ‘Eatwell Plate’ (Department of wellness, 2011) offers a pose for thinking(a) eating in the United Kingdom (see appendix 2).It gives good visual, easy to understand, management on the balance/proportion and types of food that contribute 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 linear perspective 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 utilization on glycaemic control and body mass in type 2 diabetes is not clear (Boule’ et al, 2001).The potentially minus effectuate that diabetes can have on a person are well known and documented (e. g. UK prospective Diabetes Study, 1977 thru 1997 (UKPDS). The damaging effects of poor blood glucose control are not always at a time apparent and consequently people with diabetes do not always fully appreciate the importance of controlling their blood glucose levels (see chain mail Online, 2010). The reality of diabetes care is ego 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. Becau se 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 therefore 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 several(prenominal) feignings of behavioural change, e. g. ealth belief model (Becker, 1974); supposition of reasoned action (Fishbein and Atzen, 1975); social encyclopedism theory (Bandura, 1977). Motivational interviewing (MI) (Rollnick and Miller, 1995) is a model that is used to bring astir(predicate) behavioural change and has been shown to be effective in bringing 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 abo ut a state of cognitive dissonance, i. e. he difference between where the person is currently and where they want to be in next and setting lowly goals to achieve. Thus, Lavinia has full knowledge of the damaging effects diabetes can have and in future she would like to get married and have children. To have children she needs to be as ‘healthy’ as she can be and therefore she will be self motivated to resolve the dissonance she experiences. employ in combination with Prochaska and DiClemente’s model, stages of change (1983) and Egan’s (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 m ental 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 nurse’s 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 discernment 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 DiClemente’s model, stages of change (1984) and Egan’s (1998) skilled helper model of problem management. ReferencesBandura, A. (1977). genial Learning Theory. Englewood Cliffs, NJ: Prentice Hall. Becker, M. H. , ed. (1974 ). The health Belief Model and Personal wellness Behavior. wellness Education Monographs, Vol. 2 32473. Beer, D. Turk, V. McGovern, P. et al, (2005), Characteristics of patients exhibiting unplayful challenging behaviour in low secure mental health and spiritless learning disabilities unit of measurements. journal of Psychiatric intensifier fear, Vol. 1, pp 29-35. Boule’, N. G. Haddad, E. Kenny, G. P. Wells, G. A. Sigal, R. J. , (2001). Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus.A Meta-analysis of Controlled Clinical Trials. JAMA, heap 286, No. 10, pgs 1218 †1237. Clark, M. Hampson, S. E. Avery, L. Simpson, R. (2004), Effects of a accommodate Lifestyle Self-management Intervention in Patients with Type 2 Diabetes. British diary of health Psychology , Vol. 9, 365â€379. Dixon, L. Weiden, P. Delahanty, J. , (2000) Prevalence and correlates of diabetes in case schizophrenia samples. Schizophrenia Bulletin Vol. 26, pp 903â €12. Dunning, T. (2009) Care of People with Diabetes, A Manual of Nursing practice, 3rd edition, Wiley Blackwell, pp. 36 †49.Eatwell Plate, (2011), Department of Health in association with the Welsh Government, the sparing Government and the Food Standards Agency in Northern Ireland. Egan, G. (1998), The skilled helper, a problem-management approach to helping. Brookes/Cole, CA. Fishbein, M. Ajzen, I. (1975). Belief, attitude, intention, and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley Foresight (2007), Tackling obesities: forthcoming choices †Modelling Future Trends in Obesity & their touch on Health. 2nd edition, Government sanction for Science. Kim, C. J. Hwang, A. R. Yoo, J. S. , (2004).The impact of a stage matched intervention to promote exercise behaviour in participants with type 2 diabetes. International Journal of Health packaging, 41, 833-841. Kirk, A. F. Higgins, L. A. , Hughes, A. R. , Fisher, B. M. Mutrie, N. , Hill is, S. , et al. (2001). A randomized, controlled trial to sphere the effect of exercise consultation on the promotion of physical activity in people with type 2 diabetes: a pilot study. Diabetic Medicine, Vol. 18, pp 877-882. Lean, M. E. Pajonk, F. G. (2003), Patients on abnormal antipsychotic drugs: another high-risk host for type 2 diabetes: response to uncompromising and Breier [letter].Diabetes Care, Vol. 26, pp 3202-3203. Liberman, R. P. Hilty, D. M. Drake, R. E. et al, (2001), Multidisciplinary Roles in the 21st Century; Requirements for Multidisciplinary Teamwork in Psychiatric Rehabilitation. Psychiatric Services, doi: 10, 1176/appi. ps. 52. 10. 1331. Nash, M. (2009), kind Health Nurses’ Diabetes Care Skills. British Journal of Nursing, Vol. 18, No 10, pp 626-630. National Institute for Health and Clinical Excellence (2008), Type 2 Diabetes: The Management of Type 2 Diabetes. NICE Clinical Guideline 66. Developed by the national Collaborating Centre for Chronic C onditions.Mental Health Act (1983) Code of Practice, (2001), 7th edition, Department of Health and Welsh Office under licence from the Controller of Her Majesty’s Stationary Office. National Institute for Health and Clinical Excellence (2009), Depression in Adults with a Chronic Physical Health Problem: Treatment and Management. NICE clinical guideline 91. Developed by The National Collaborating centre for Mental Health. Nursing and Midwifery Council Code of Professional Conduct (2002): Standards for Conduct, transaction and Ethics. Nursing and Midwifery Council. Prochaska, J.O. DiClemente, C. C. (1983) Stages and processes of self-change of smoking: toward an combinative model of change. Journal Consult Clinical Psychology, June; 51(3):390â€5. Roach, M. S. , (1992), The Human Act of Caring; A Blueprint for the Health Professions, 2nd Edn. Canadian Hospital connectedness Press, Ottawa. Cited in, An Integrated race and Competency Framework for Diabetes Nursing, (2001) 3 rd Edn. TREND, pg. 4. published by SB Communications Group. Rollnick S, & Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, Vol. 3, 325-334. Schoepf, D. Potluri, R. Uppal H. et al (2012), Type-2 diabetes mellitus in schizophrenia: increased preponderance and major risk factor of dissipation mortality in a representational 7-year follow-up. EUR. Psychiatry, Vol. 1, pp 33-42. VanWormer, J. J. Boucher, J. L. (2004), Motivational interviewing and diet modification: a review of the evidence. The Diabetes Educator, 30 (3): 404-416. Xeniditis, K. Russell, A. Murphy, D. (2001), Management of people with challenging behaviours. Advances in Psychiatric Treatment, Vol. 7, pp109-116. Articles accessed onlineDepartment of Health (2010) Programme Budgeting Tools and Data. useable online and accessed July 2012 at: http://www. dh. gov. uk/en/Managingyourorganisation/Financeandplanning/Programmebudgeting/DH_075743). Diabetes UK. Available and ac cessed online in July 2012 at: http://www. diabetes. org. uk/About_us/News_Landing_Page/Half-of-people-with-diabetes-have-high-blood-pressure/ http://www. diabetes. org. uk/Get_involved/candidacy/Putting-feet-first/? gclid=CPyGnpCyo7ECFcVkfAodWzK1zg http://www. diabetes. org. uk/Guide-to-diabetes/Complications/Retinopathy/? clid=CJjF7q63o7ECFYzbfAodghophw Friedli, L. Parsonage M. (2007), Mental Health Promotion: Building the Economic Case. 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%20an%20Economic%20Case. pdf 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 available 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 female with a history of schizophrenia stretching back to her late teens. She has been placed 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\r\n'