Occupational Therapy: Diabetes Management

Occupational Therapy and Diabetes

• A lecture was given on January 29, 2025, by Jennifer Betts, an Occupational Therapist at Foothills Medical Centre.
• The lecture covered diabetes and its impact on individuals, alongside the occupational therapy role in managing that impact.

References and Considerations

• Valuable references included the Canadian Diabetes Association Clinical Practice Guidelines, the diabetes.ca website, Alberta Health Services' Diabetic Management information, and a specific page on their website (https://www.albertahealthservices.ca/info/Page7732.aspx).

Learning Objectives

• Understand diabetes, including its classifications, signs, symptoms, and risk factors.
• Understand the effects of diabetes on how people carry out their daily tasks (occupational performance).
• Learn the role of occupational therapists in supporting people with diabetes.
• Use a case study of a person with diabetes as part of the learning process.

Did You Know?

• One in five hospital patients has diabetes.
• Ninety percent of those patients have type 2 diabetes.
• Ten percent of hospitalised with diabetes have type 1 diabetes.
• Forty percent of patients with diabetes in hospital use insulin at home but might benefit from extra support within the hospital setting.

Impact of Diabetes

• People with diabetes are three times more likely to be hospitalized with cardiovascular disease.
• They are twelve times more likely to be hospitalized due to end-stage renal disease.
• They are over twenty times more likely to be hospitalized due to non-traumatic lower limb amputation compared to the general population.
• Diabetes is a leading cause of acquired blindness.

Normal Metabolism

• Carbohydrate breakdown is the primary source of glucose.
• Glucose intake into the bloodstream causes the pancreas to release insulin, a hormone created by beta cells.
• Insulin manages glucose uptake, utilisation, and storage through the body.
• The body regulates its insulin production to maintain stable glucose levels.
• Physical activity helps utilize stored glucose in the body.

Definitions

• Diabetes: An imbalance in glucose metabolism due to insufficient insulin production or effectiveness, leading to excess blood glucose levels.
• HbA1c: A blood test measuring average blood sugar levels over 90 days, giving an indication of diabetes management effectiveness.

Type 1 Diabetes

• It results from the body's destruction of insulin-producing cells, commonly due to an autoimmune response.
• The body does not produce much insulin in this situation.

Type 2 Diabetes

• It is a chronic disease with varying degrees of insulin resistance within the cells and difficulty with insulin production.
• Cells do not efficiently utilize insulin which leads to fluctuating blood sugar.

Potential Complications

• Microvascular: Retinopathy (eye disease), nephropathy (kidney disease), neuropathy (nerve damage)
• Macrovascular: Stroke, heart attack, circulatory disease
• Psychological: Anxiety, depression
• Cognitive: Changes in mental functioning.

Factors Influencing Blood Glucose in Hospital

• Patient activity levels
• Underlying illnesses in the patient
• Missing meals relating to hospital procedures
• Intake restriction status (like NPO)
• Changes in diabetic medications due to hospital care
• Changes to patient diet
• High-dose corticosteroids
• Sliding-scale insulin regimes.

Hyperglycemia

• Symptoms of Hyperglycemia include:
  • Excessive thirst
  • Frequent urination
  • Increased hunger
  • Blurred vision
  • Feeling tired
  • Unexpected weight loss
  • Dry mouth
  • Frequent infections

Signs & Symptoms of Hypoglycemia

• Neurogenic (autonomic): Shaking, rapid heartbeat, sweating, anxiety
• Neuroglycopenic (brain function): Hunger, difficulty concentrating, vision changes, speech issues, headaches, dizziness

Occupational Therapy Role in Diabetes

• Nutrition support
• Exercise guidance
• Mental health support
• Cognitive assessments
• Medication management
• Eye care and wound management
• Driving support

Functional Aspects of Diet and Nutrition

• Address barriers to eating healthily
• Develop meal preparation plans
• Grocery shopping strategies
• Kitchen adaptations

Glycemic Index (GI)

• A scale (1-100) ranking carbohydrate-rich foods based on their impact on blood glucose levels.
• High GI foods cause rapid rises in blood glucose.
• Low GI foods cause slower increases.
• Glycemic load considers portion size along with GI.

Functional Mobility, Exercise, and Activity

• Maintaining physical activity improves insulin resistance.
• Promotes healthy cholesterol levels (increase HDL/decrease LDL).
• Helps with decreasing triglycerides.
• Helps with decreasing blood pressure overall.

Chronic Disease Management

• Discussion of the impact of diabetes on patient well-being in the long-term.

Cognitive Assessment

• Questions to assess need for cognitive support
• Considering the impact of symptoms on cognition, potential reversibility.

Medication Management

• Methods of insulin delivery (syringes, pens, pumps)
• Other oral medications (for diabetes)
• Blood sugar testing practices.

Monitoring Blood Glucose Levels

• Traditional blood glucose monitors
• Continuous glucose monitors (CGM), which constantly measure glucose. Advanced CGMs can provide alerts, especially during sleep. Sensors measure glucose in cellular fluids.

Diabetic Retinopathy

• A painless eye disease of the retina caused by diabetes.
• Symptoms vary, but may include blurry vision, dark spots, and difficulty seeing well at night or in low light.

Diabetes & Vision - Functional Impact (Question)

• This section prompts questions about the vision challenges in people with diabetes.

Diabetes & Vision Pathway

• Pathway steps for eye health care in people with diabetes. This includes referrals based on level of diabetic retinopathy (or lack thereof).

Foot Care/Wound Management

• Utilizing the Alberta Diabetes Foot Care Clinical Pathway.
• Screening, assessment, treatment, and ongoing management of foot conditions that result from the complication from diabetes (e.g. ulcers, infection).

Diabetes Foot Screening Tool

• Clinical tool used for assessment of foot risks
• Different risk scores based on findings.

Diabetes Foot Risk Assessment Triage Referral

• Pathway/management approach based on risk level in foot assessment.
• Referral pathways based on urgency and need for follow up

Diabetes and Your Feet

• Importance of regular foot care.
• Foot complications related to diabetes.
• Urgency in checking for any wounds or changes in the feet.

Referral Pathway & Foot Care Poster

• Posters and guidelines available to assist with referring diabetic patients.
• Website (links) for guidelines.

Driving Considerations - Diabetes

• Fluctuating blood sugar levels significantly affect driving, require assessment of drivers with diabetes.
• Difficulty staying attentive, operating vehicles, and challenging situations like poor weather or night.
• Symptoms of possible hypoglycemia (lower blood sugar than normal) such as rapid heartbeat or shakiness can also be an issue.

Summary

• Occupational therapists play a key role in supporting patients with diabetes.
• Assessing their needs and functioning, and setting goals.
• Identifying barriers and complications.
• Recognizing impact on everyday living.

Case Study - New OT Referral

• A 75-year-old female with Type 2 diabetes experiencing hypoglycemia and confusion with significant need for further cognitive assessment with need for placement consideration.

This lesson covers diabetes and its impact on individuals' daily lives. It explores the role of occupational therapists in managing diabetes. Includes references to Canadian Diabetes Association guidelines and Alberta Health Services.