DCW73-Managing Service Users Living with Diabetes Policy
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Registration Number: {{org_field_registration_no}}
Managing Service Users Living with Diabetes Policy
1. Purpose
The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, and person-centred care for service users living with diabetes. Diabetes is a chronic condition that requires ongoing management, lifestyle adjustments, and coordinated healthcare interventions to prevent complications. This policy ensures compliance with Care Inspectorate Wales (CIW) regulations, national healthcare standards, and best practices in diabetes management.
Our objectives are to:
- Promote independence and self-care for service users living with diabetes.
- Prevent diabetes-related complications through monitoring, medication management, and lifestyle support.
- Provide training for staff to recognise symptoms and manage diabetes effectively.
- Ensure compliance with medication administration and dietary guidelines.
- Collaborate with healthcare professionals, families, and carers to provide holistic care.
Regulatory alignment (Wales): This policy must be read alongside, and implemented in line with, the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended), and the Welsh Ministers’ statutory guidance for care home and domiciliary support services. The Registered Manager and Responsible Individual must have regard to the statutory guidance when applying this policy and when assuring safe, effective diabetes support within the service.
2. Scope
This policy applies to:
- Service users diagnosed with Type 1, Type 2, or gestational diabetes.
- Family members, carers, and advocates involved in diabetes care planning.
- All employees, including care workers, managers, and administrative staff.
- The Registered Manager and Responsible Individual, ensuring compliance.
- Healthcare professionals, including GPs, diabetes nurses, dietitians, and pharmacists.
3. Legal and Regulatory Framework
This policy aligns with:
- Regulation and Inspection of Social Care (Wales) Act 2016.
- Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017 (as amended) and the Welsh Ministers’ statutory guidance for care home and domiciliary support services (last updated 27 March 2024).
- Social Services and Well-being (Wales) Act 2014.
- Mental Capacity Act 2005 (consent, capacity assessment, best-interests decision-making).
- Equality Act 2010 (including reasonable adjustments and accessible information).
- Medicines legislation and professional guidance relevant to medicines support (including the Human Medicines Regulations 2012 and safe delegation/administration requirements).
- Infection prevention and control requirements relevant to domiciliary care (including safe handling and disposal of sharps/clinical waste).
- Social Care Wales Codes/practice guidance (including the professional duty of candour) and the All Wales Guidelines for Delegation (latest version).
- National best practice guidance (e.g., NICE) and local health board diabetes pathways where applicable.
4. Understanding Diabetes and Its Impact
Diabetes is a chronic condition affecting blood glucose levels due to insufficient insulin production or insulin resistance. It requires lifestyle adjustments, medication, and ongoing monitoring.
4.1 Types of Diabetes
- Type 1 Diabetes – An autoimmune condition requiring lifelong insulin therapy.
- Type 2 Diabetes – A metabolic disorder often managed through diet, exercise, and medication.
- Gestational Diabetes – A temporary form of diabetes that occurs during pregnancy.
4.2 Common Symptoms
- Increased thirst and frequent urination.
- Unexplained weight loss or fatigue.
- Blurred vision and slow-healing wounds.
- Tingling or numbness in hands and feet.
How we manage this efficiently:
- All staff receive diabetes awareness training.
- Care workers monitor symptoms and escalate concerns promptly.
- Diabetes care plans are personalised to individual needs.
5. Individualised Diabetes Care Plans
Every service user with diabetes will have a tailored care plan developed in collaboration with healthcare professionals.
5.1 Contents of a Diabetes Care Plan
Each diabetes care plan must include:
- A summary of the service user’s diabetes type and medical history.
- Blood glucose monitoring schedules and target ranges.
- Dietary requirements and nutritional preferences.
- Medication or insulin administration instructions.
- Physical activity recommendations and lifestyle adaptations.
- Emergency protocols for hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar).
- Consent and capacity: the individual’s consent for diabetes support tasks (and, where relevant, a Mental Capacity Act capacity assessment and best-interests decision record).
- Delegated clinical tasks: where any diabetes-related healthcare task is delegated (e.g., blood glucose monitoring, insulin administration, ketone testing, glucagon), the care plan must include the delegating professional/service, written instructions/protocols, competency sign-off requirements, review date, and clear escalation routes.
- Escalation criteria: explicit thresholds for when to contact the GP/community diabetes team/111/999 (including persistent hypo, severe hypo, suspected DKA, repeated hyperglycaemia, vomiting, reduced consciousness, seizure, or “rapidly worsening” presentation).
How we manage this efficiently:
- Care plans are reviewed regularly and updated when changes occur.
- A key worker is assigned to ensure consistency in diabetes management.
- Digital care records track health trends and interventions.
6. Blood Glucose Monitoring and Record-Keeping
Regular monitoring of blood glucose levels is essential for preventing complications.
6.1 Safe Blood Glucose Testing
Care workers must only undertake capillary blood glucose testing where they have been trained, assessed as competent, and authorised in the individual’s care plan. Testing must follow infection prevention and control practice, including:
- hand hygiene before and after the procedure and appropriate use of PPE (e.g., gloves);
- single-use lancets only (no re-use and no shared lancing devices);
- cleaning/disinfection of the glucose meter in line with manufacturer instructions and according to the service’s infection control procedures;
- safe management of blood spillages in line with infection control procedures;
- immediate disposal of lancets/needles into an approved sharps container and disposal of contaminated waste in the correct clinical waste stream, in line with service infection control and waste arrangements.
6.2 Documentation and Monitoring Trends
- Blood glucose readings must be recorded in daily logs.
- Any abnormal readings must be reported to a healthcare professional immediately.
- Trends in blood glucose levels should be reviewed regularly to adjust care plans.
How we manage this efficiently:
- Digital monitoring systems ensure real-time updates for staff.
- Regular review meetings identify potential health concerns early.
Records and follow-up: All readings must be recorded contemporaneously, including actions taken and who was informed. Where readings fall outside the individual’s agreed parameters, staff must record escalation, advice received, and resulting actions. Records must be stored and shared in accordance with confidentiality and data protection requirements.
7. Nutrition and Meal Planning
Diet plays a crucial role in managing diabetes. {{org_field_name}} ensures service users receive nutritional support by:
- Encouraging balanced meals with low sugar and complex carbohydrates.
- Supporting individuals with meal planning and portion control.
- Adapting meals based on dietary restrictions and cultural preferences.
How we manage this efficiently:
- Meal plans are tailored to individual health goals.
- Care staff are trained to identify foods suitable for diabetics.
8. Medication and Insulin Administration
8.1 Oral Medication Management
- Care workers must follow strict protocols for administering diabetes medication.
- All medication must be documented in the Medication Administration Record (MAR).
- Missed or incorrect doses must be reported immediately.
8.2 Insulin Administration
- Insulin injections should only be administered by trained and authorised staff.
- Needles and syringes must be disposed of in sharps containers.
- Dosages must be confirmed before administration to prevent errors.
- Staff must not alter insulin doses, timing, or sliding-scale regimes unless this is explicitly authorised in a current written instruction by the prescriber/diabetes team and reflected in the care plan.
- Insulin must be stored, transported, and disposed of in line with manufacturer instructions and the service’s medicines and infection control procedures, including safe sharps disposal and timely replacement of expired/opened products.
How we manage this efficiently:
- Ongoing competency assessments for medication administration.
- A secure and compliant medication management system.
8.3 Delegated diabetes healthcare tasks (including insulin)
Where a healthcare professional delegates a diabetes-related task to service staff (for example insulin administration, ketone testing, or administration of emergency medicines such as glucagon), {{org_field_name}} will ensure:
- there is a written, individual-specific instruction/protocol (including dose, timing, parameters, and escalation criteria);
- staff complete training and competency assessment for that specific task and individual;
- competency is documented, reviewed, and refreshed in line with the delegating professional’s requirements and service policy;
- staff do not undertake tasks beyond their competence and have access to supervision and (where relevant) clinical oversight; and
- clear accountability and escalation routes are agreed with the delegating service (e.g., community nursing/diabetes team).
The service will follow the All Wales Guidelines for Delegation and any local health board governance requirements for delegated healthcare tasks.
9. Recognising and Managing Diabetic Emergencies
9.1 Hypoglycaemia (Low Blood Sugar) Symptoms and Actions
- Shakiness, sweating, dizziness, and confusion.
- Immediate treatment with fast-acting carbohydrates (e.g., glucose tablets, fruit juice).
- Call 999 immediately if the person is unconscious, having a seizure, unable to swallow safely, or not improving after agreed initial treatment steps in the care plan, and continue to monitor airway/breathing/circulation until help arrives.
9.2 Hyperglycaemia (High Blood Sugar) Symptoms and Actions
- Increased thirst, frequent urination, fatigue, and nausea.
- Encouraging hydration and checking blood sugar levels.
- Escalation to healthcare providers if levels remain high.
How we manage this efficiently:
- A structured emergency response protocol is in place.
- All staff are trained to respond quickly to diabetic emergencies.
9.3 Suspected Diabetic Ketoacidosis (DKA) / severe hyperglycaemia
Staff must treat possible DKA/severe hyperglycaemia as a medical emergency risk. Where the individual has Type 1 diabetes (or is otherwise at risk) and presents with persistent high readings plus symptoms such as vomiting, abdominal pain, rapid/deep breathing, severe drowsiness/confusion, or suspected dehydration, staff must follow the individual’s care plan and escalation criteria urgently. This will normally include contacting 111/GP/diabetes team urgently and calling 999 immediately if the person is severely unwell, has reduced consciousness, seizures, or rapidly worsening symptoms. Where ketone testing is part of the individual’s agreed plan, staff must follow the written protocol and record actions taken.
10. Preventing Diabetes-Related Complications
Diabetes can lead to long-term health issues, including nerve damage, foot ulcers, kidney disease, and cardiovascular problems. {{org_field_name}} supports prevention by:
- Encouraging routine check-ups with GPs and diabetes specialists.
- Promoting proper foot care and wound monitoring.
- Encouraging physical activity to improve insulin sensitivity.
How we manage this efficiently:
- Regular care plan reviews to adjust interventions.
- Early detection and referral for specialist care when needed.
11. Staff Training and Competency in Diabetes Care
11.1 Mandatory Training Includes:
- Recognising diabetes symptoms and emergency response.
- Safe medication administration and insulin handling.
- Nutritional guidelines and meal planning for diabetics.
11.2 Competency Assessments
- All staff must demonstrate competency before providing diabetes-related care.
- Annual refresher training ensures best practices are maintained.
- The service will maintain a written record of all diabetes-related training, competency assessments, supervision and refresher activity for each staff member, and will make this evidence available for governance and inspection purposes.
- Where staff undertake delegated healthcare tasks, training/competence must be specific to the task and the individual. Staff must also be supported to work in an open and transparent way when things go wrong (duty of candour), including reporting incidents promptly and contributing to learning and improvement.
How we manage this efficiently:
- A designated diabetes lead supports staff with training and guidance.
12. Governance, incident reporting, duty of candour and CIW notifications
All diabetes-related incidents (including medication errors, missed insulin, severe hypoglycaemia/hyperglycaemia episodes, emergency service attendance, hospital admission, safeguarding concerns, or any event that could affect safe service delivery) must be reported immediately via the service incident reporting process, documented in the individual’s records, and escalated to the Registered Manager/Responsible Individual.
The service will act in an open and transparent way with the individual and/or their representative when things go wrong, provide information about what happened and outcomes of any investigation, and offer an apology where appropriate, in line with the duty of candour.
Where an event meets CIW notification requirements (for example, serious accident or injury, infectious disease outbreak, allegation of abuse, police-reported incident, or events that could prevent the service from operating safely), the Responsible Individual/Registered Manager will ensure CIW is notified without delay via CIW Online and in the required form.
13. Related Policies
- Medication Management Policy (DCW21)
- Risk Management and Assessment Policy (DCW18)
- Emergency and First Aid Policy (DCW25)
- Infection Prevention and Control Policy (including sharps/clinical waste)
- Incident Reporting, Duty of Candour and Learning from Events Policy/Procedure
- Safeguarding Policy and Whistleblowing Policy
- Confidentiality and Data Protection Policy
14. Policy Review
This policy will be reviewed annually or sooner if required due to legislative changes, business needs, or CIW updates. The Registered Manager and Responsible Individual are responsible for ensuring compliance. This policy will be reviewed immediately following any relevant change to Welsh legislation, Welsh Government statutory guidance, CIW expectations, or All-Wales delegation/medicines guidance, and the updated version will be communicated to staff and made available in an accessible format on request.
Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}
Reviewed on: {{last_update_date}}
Next Review Date: {{next_review_date}}
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