Clinical update

Diabetes and care homes: how nurses can manage risk related to COVID-19

Advice on effective management of hyperglycaemia, as well as end of life care and foot care

Managing diabetes well is an important aspect of life in nursing homes and residential care homes Picture: iStock

Essential info

Residents of nursing homes and residential care homes are a population with a high number of co-morbidities who are particularly vulnerable to COVID-19 infection.

One quarter of these residents have diabetes and two thirds may have frailty, which is a better predictor of intensive care unit outcomes than age or other factors.

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What’s new

Guidance to help protect people in nursing homes and residential care homes with diabetes from becoming seriously unwell and dying from COVID-19 has been published.

The guidance, by expert stakeholders including Diabetes UK, Diabetes Frail and the Association of British Clinical Diabetologists, stresses that homes must be aware that residents with diabetes are at very high risk of catching the virus.

Those at the highest risk of poor outcomes from COVID-19 are those who have frailty, several existing medical conditions such as cardiovascular disease or respiratory disease, diabetes complications, treatment with steroids and a life expectancy of less than six months.

COVID-19 can cause a serious acute illness in residents with diabetes by increasing the risk of a rapid worsening of diabetes control. This can lead to life-threatening conditions, increasing susceptibility to other infections, including pneumonia, chest and foot infections and sepsis, and worsen symptoms and signs in those with frailty, kidney disease and cardiovascular disease.

The guidance sets out detailed information on how to manage hyperglycaemia in residents with COVID-19, and advice on end of life care and foot care.

Home managers are advised to equip the home with sufficient capillary blood glucose strips with a meter, and strips for ketones, if possible.

Homes need to have a hypoglycaemia treatment kit plus intramuscular (IM) glucagon, and should replenish this every time it is has been used.

Managers should ensure good communication with local diabetes specialist nurses, the community nursing service and primary care team.

 

Expert comment

Nneka Agbasi, modern matron with specialist interest in diabetes, from North London’s Care Home Assessment Team, says:

‘Managing diabetes well is a significant aspect of care provided in care homes.

‘Managing COVID-19 in residents with diabetes means dealing with diabetes emergencies and the symptoms of the virus. Healthcare professionals supporting carers have found it challenging, especially as care homes are not allowing many into their homes, to shield their residents from the virus. So support and consultations during this pandemic have been done remotely via phone or video calls.

‘Nurses and carers in homes are relying on GPs, community matrons, diabetes specialist nurses and other healthcare professionals to support them in managing residents living with diabetes effectively. This detailed easy-to-read short guidance document will help nursing and residential care home staff as it provides advice on COVID-19 and diabetes management.

‘What is really useful is that it details management of hyperglycaemia and hypoglycaemia for residents living with diabetes who have COVID-19.’

 

Key points for nurses

  • Staff should maintain a written record of a resident’s blood glucose, medications, temperature, food chart and body weight.
  • Have a daily foot care surveillance plan in place for all residents with diabetes to ensure good foot health.
  • Usual management of each resident with diabetes should aim to ensure that they receive plenty of oral fluids to maintain good hydration, maintain daily appropriate exercise and have a nutritional plan with regular meals.
  • Residents should receive their usual diabetes treatment, have regular twice daily capillary blood glucose testing with the aim to keep the level between 7 and 12 mmol/L, and have the opportunity to have their wishes documented in any anticipated future emergency.
  • Residents with diabetes and COVID-19 who are generally unwell, very thirsty, look dehydrated with deep breathing, and blood sugar of 11 mmol/L or more, may have diabetic ketoacidosis – check urine for raised ketones if strips available. Those who are very dehydrated, confused or more drowsy than usual, and with blood sugar of or greater than 30 mmol/L, may have hyperosmolar hyperglycaemia state.

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