Supporting a client with diabetes through meals, medication prompts, hypos and foot care

Diabetes UK says type 2 affects 90% of people living with diabetes and type 1 affects 8%, so a client with diabetes is far more likely to have type 2. The NHS says type 2 is treated first with changes to eating and activity, then with tablets, and for some people with insulin. A client with type 1 has been taught by their diabetes team to manage their own insulin, and may want little more from you than meals on time and somebody who notices if they are unwell. Diabetes UK's page on the differences between type 1 and type 2 explains the causes in more depth.

The first thing to find out, before or at the first visit, is which type your client has and what they take for it. Ask to see their medicines, and ask whether they have a written plan from their diabetes team, including what to do when they are ill and what to do in a hypo. The NHS says the team teaches people with type 1 how and when to check their blood sugar and what their targets are, so the client or their family will usually know. If there is no written plan, suggest the family ask for one at the next review.

What families are told about the condition is on what is diabetes?, which is useful for knowing what a family may already have read. The carer resources hub has the rest of the guides on working with clients, pay and tax.

On meals, the question is timing and regularity rather than a special menu. A client who takes insulin, or a tablet such as gliclazide, is more likely to have a hypo if a meal is missed or late, or if they are more active than usual without eating more. If you are cooking, keep to the usual pattern your client and the family describe, and have a snack in the house for when a meal is delayed. Any specific eating plan should come from the GP or a dietitian. Food and nutrition as a carer covers planning meals, weight loss and poor appetite, and Diabetes UK's guidance on eating is the source to show a family who asks.

On tablets, the rules are the same as for any other medicine. Reminding your client that a dose is due, and opening a pack for them, keeps your client in charge of the medicine. Selecting the dose and giving it is administering, which needs clear written directions and training first. Helping with medication as a carer sets out prompting, assisting and administering, the record to keep, and what to do after a missed or wrong dose. Read it before you take on any diabetes medicines.

On insulin, the same guide explains how a task is delegated to you, who trains you and who signs you off, including why the paperwork has to come to you directly when you are self-employed. Delegated healthcare tasks is what families are told about the same process, and it is worth sharing with a family who has not been through it. Many clients with type 1 inject their own insulin, and reminding them is prompting. Giving the injection yourself is not, and nor is changing a dose because a reading looks high or low.

Blood sugar checks by finger-prick or sensor are part of the plan the diabetes team sets. If your client or the family wants you to help with them, ask the diabetes team to show you and to write down what they want you to do with a reading. Your contract with each client on PrimeCarers says you will not take on work you feel unqualified to do and will tell the client, so alternative arrangements can be made, and it says the client must not pressure you into a task you feel unable to do safely.

The NHS says the signs of a hyper usually develop gradually, and it needs the client's medicine and their team. A hypo needs treating straight away with something sugary. Diabetes UK notes that some people have no warning signs of a hypo at all, which is called hypo unawareness, so a client who suddenly seems muddled or unlike themselves is worth treating as a possible hypo if they take insulin or gliclazide. If they test their blood sugar, a reading below 4mmol/L confirms it.

Know before you need it where your client keeps their hypo treatment, whether they have a glucagon kit, and whether anybody has been trained to use it. Glucagon is an injection, so it falls under the same rules as insulin: use it only if a clinician has trained you on it. If there is no glucagon, or it has not worked within 10 minutes, the NHS says to ring 999. The same applies if they have been drinking alcohol.

Being unwell is one of the common causes of a hyper, the NHS says. Diabetes UK's sick day guidance says to keep taking diabetes medicine even if your client does not feel like eating, unless their team says otherwise, to drink plenty of unsweetened fluids, and to check blood sugar more often, at least every four hours, if they test. It also says some tablets may need to be reduced or stopped for a while during illness, and insulin doses can need changing. Those decisions belong to the diabetes team, so if your client is unwell, help them ring the team or the GP. If they cannot keep any fluids down, they need medical help as soon as possible.

The NHS pages on low blood sugar and high blood sugar are the source for the panels above. Under your contract you may share what you know about a client where it is needed for emergency medical care, so tell the paramedics or the hospital what you saw, what you gave and when.

The checklist comes from Diabetes UK's page on how to look after your feet. If you see something new, such as a cut, a blister or red skin around it, Diabetes UK says to contact the GP or the local foot protection team straight away, and to call NHS 111 for advice if you cannot get through. Tell your client and the family what you saw, and write it down with the date. If your client does not want you to look, respect it, record it and mention it to the family. Mental capacity in care covers what to do if you doubt they can make that decision.

Everyone with diabetes should have a foot check at their review at least once a year, or every two years if there were no problems last time, according to Diabetes UK. The check sorts people into low, moderate or high risk, and a client at moderate or high risk is referred to a podiatrist. Ask which group your client is in, because it tells you how closely to watch.

The eyes are the other part of the yearly care. Diabetes can damage the back of the eye, called diabetic retinopathy, and the NHS says it does not usually cause symptoms at first. That is why everyone with diabetes aged 12 or over is invited to diabetic eye screening every 1 or 2 years. The NHS says the drops used make sight blurry for a few hours afterwards, so your client cannot drive home. If you are taking them, allow for it, and agree any mileage with the client in writing before the day. Visual impairment and blindness covers working with a client whose sight has already changed.

The best time to settle all of this is before the first visit. Ask your client and the family for the name of their GP practice and diabetes team, the plan for a hypo and for sick days, where the hypo treatment and any glucagon are kept, who gives insulin if it is used, and which family member to ring. Put what you agree in a message on PrimeCarers, so there is a written note of it for both of you. For a live-in placement, what to agree before a live-in placement covers the rest of the list.

Tell the family whenever you have made one of these calls, even if it ended well. If you ever think your client is being harmed because their diabetes is being neglected, for example medicine withheld or food not provided between your visits, that is a safeguarding concern. Safeguarding for self-employed carers explains how to report it to the council.

If you have experience with clients with diabetes, including any delegated tasks you have been trained and signed off to do, you can register as a carer on PrimeCarers and describe it on your profile in your own words, or see the carer jobs open near you. Writing your profile covers how to set out experience clearly.