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CHW73-Managing Service Users Living with Diabetes Policy

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Managing Service Users Living with Diabetes Policy

1. Purpose

The purpose of this policy is to ensure that {{org_field_name}} provides safe, effective, person-centred and legally compliant care and support for individuals living with diabetes. This policy sets out how the service will assess, plan, deliver, monitor, record and review diabetes-related care in accordance with the Regulation and Inspection of Social Care (Wales) Act 2016, the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017, as amended, the Welsh Government statutory guidance for providers and responsible individuals, CIW expectations, NICE guidance and relevant diabetes best practice.

The policy supports individuals to achieve their personal outcomes, maintain independence where safe to do so, reduce avoidable complications, and receive timely support from appropriate healthcare professionals. It covers blood glucose monitoring, insulin and diabetes medicines, nutrition and hydration, foot care, skin integrity, oral health, physical activity, hypoglycaemia, hyperglycaemia, acute illness, escalation, emergency response, record keeping, staff training and audit.

2. Scope

This policy applies to all staff members at {{org_field_name}}, including care workers, nurses, kitchen staff, and external healthcare professionals involved in the care of residents with diabetes. It covers procedures for assessing, monitoring, treating, and preventing diabetes-related complications while ensuring that residents maintain their independence and well-being. This policy also applies to families and advocates, ensuring they are informed, involved, and supported in their loved ones’ diabetes management when necessary.

This policy applies to all individuals living with Type 1 diabetes, Type 2 diabetes, steroid-induced diabetes, gestational diabetes where relevant, and any individual requiring monitoring or treatment because of impaired blood glucose control. It applies whether diabetes care is provided directly by {{org_field_name}}, self-managed by the individual, delegated by a healthcare professional, or provided in partnership with GPs, district nurses, diabetes specialist nurses, pharmacists, dietitians, podiatrists, optometrists, dentists, emergency services, family members, representatives or advocates.

3. Legal and Regulatory Framework

{{org_field_name}} will ensure that diabetes care is delivered in accordance with the following legal, regulatory and best practice requirements, as applicable:

The Registered Manager will ensure this policy is reviewed at least annually, or sooner where there are changes to Welsh legislation, CIW requirements, NICE guidance, Local Health Board procedures, medicines safety alerts, safeguarding requirements or diabetes best practice.

4. Principles of Diabetes Management

Person-Centred Care and Individualised Plans

Provider Assessment and Admission

Before agreeing to provide care and support, {{org_field_name}} will consider whether the service can safely meet the individual’s diabetes-related care and support needs. This will include reviewing the individual’s care and support plan, health assessments, medicine records, insulin requirements, blood glucose monitoring needs, nutritional needs, mobility, cognition, communication needs, risks of hypoglycaemia or hyperglycaemia, foot care needs, skin integrity, equipment needs and any specialist healthcare input required.

Where the individual does not have an existing care and support plan, {{org_field_name}} will complete a provider assessment before or at the start of the service, unless the admission is urgent. Where admission is urgent, an initial personal plan will be completed within 24 hours and the provider assessment will be completed within 7 days.

The service will not accept or continue a placement where the individual’s diabetes-related needs cannot be met safely, even after reasonable adjustments and appropriate healthcare liaison. Where the service can no longer meet the individual’s assessed needs, the Registered Manager will notify the individual, their representative where appropriate, the service commissioner and relevant healthcare professionals in writing.

Blood Glucose Monitoring and Medication Administration

Insulin and Injectable Diabetes Medicines

Insulin and injectable diabetes medicines are high-risk medicines and must be managed in accordance with the Medication Management and Administration Policy, the individual’s prescription, MAR chart, diabetes plan and relevant clinical instructions.

Staff must only administer or support insulin or injectable diabetes medicines where they have:

Insulin must be stored safely and in accordance with manufacturer instructions. The service must have arrangements for checking expiry dates, opening dates, storage temperatures, stock levels, missed doses, refused doses, dose omissions, delayed administration, medicine errors and safe disposal of needles and sharps.

Staff must never administer insulin if the prescription, dose, timing, resident identity, blood glucose instruction or clinical direction is unclear. In such circumstances, staff must seek advice immediately from the nurse in charge, GP, diabetes specialist nurse, pharmacist, NHS 111 Wales, out-of-hours service or emergency services, depending on the level of risk.

Delegated Healthcare Tasks

Where a diabetes-related task is delegated by a registered healthcare professional, the delegation must be individual-specific, risk assessed, recorded, and supported by clear written instructions. Staff must not undertake delegated healthcare tasks unless they have received training, have been assessed as competent, understand the limits of the delegation, and know when to stop and seek clinical advice.

Delegated tasks may include, where appropriate, blood glucose monitoring, support with insulin administration, use of diabetes technology, foot observation, nutrition-related monitoring or other diabetes-related care. The registered healthcare professional remains responsible for deciding whether delegation is appropriate, and {{org_field_name}} remains responsible for ensuring staff do not work outside their competence.

Dietary Management and Nutritional Support

Preventing and Managing Hypoglycaemia (Low Blood Sugar)

Each individual at risk of hypoglycaemia must have an individual hypoglycaemia plan. This must include their usual symptoms, agreed blood glucose threshold for action, preferred treatment where safe, when to recheck blood glucose, when to give longer-acting carbohydrate, when to contact a healthcare professional, and when to call emergency services.

Staff must recognise that hypoglycaemia may present as sweating, shaking, hunger, pallor, headache, dizziness, confusion, irritability, behaviour change, drowsiness, weakness, slurred speech, falls, seizure or loss of consciousness. Some individuals, particularly older people or those with long-standing diabetes, may have reduced awareness of hypoglycaemia.

Where the individual is conscious, able to swallow safely and the personal plan confirms this is appropriate, staff must follow the individual’s hypoglycaemia plan and provide fast-acting carbohydrate, such as glucose tablets, glucose gel or a sugary drink. Blood glucose must be rechecked in accordance with the individual’s plan and local clinical guidance.

Staff must call emergency services immediately if the individual is unconscious, having a seizure, unable to swallow safely, not recovering as expected, has repeated hypoglycaemia, has sustained an injury, or where staff are concerned about their condition. Staff must not give food or drink by mouth to an unconscious person or a person who cannot swallow safely.

All hypoglycaemic episodes must be recorded, reported to the person in charge, reviewed for cause and recurrence, and escalated to the GP, diabetes specialist nurse or relevant healthcare professional where required. Recurrent or severe hypoglycaemia must trigger a review of the personal plan, medicines, meal timing, monitoring arrangements and risk assessment.

Preventing and Managing Hyperglycaemia (High Blood Sugar)

Each individual at risk of hyperglycaemia must have an individual plan which states their agreed blood glucose parameters, symptoms of concern, action to take, when to encourage fluids, when to check ketones if instructed, and when to seek clinical advice.

Staff must recognise that hyperglycaemia may present as increased thirst, frequent urination, tiredness, blurred vision, headache, dry mouth, weight loss, confusion, drowsiness, dehydration, recurrent infection, slow wound healing or deterioration in general condition.

Staff must seek urgent clinical advice where hyperglycaemia is persistent, unexplained, associated with acute illness, infection, vomiting, dehydration, reduced consciousness, abdominal pain, rapid breathing, ketones, missed insulin, steroid treatment, or where the individual appears unwell.

For individuals with Type 1 diabetes, or any individual identified by a healthcare professional as being at risk of diabetic ketoacidosis, the personal plan must include ketone monitoring arrangements and urgent escalation instructions. Staff must treat suspected diabetic ketoacidosis as a medical emergency.

All significant hyperglycaemic episodes must be recorded, reported, reviewed and escalated in accordance with the individual’s plan. Recurrent hyperglycaemia must trigger a review of medicines, diet, hydration, infection risk, monitoring arrangements and healthcare input.

Acute Illness, Steroids and Sick-Day Arrangements

Acute illness can destabilise diabetes. Staff must be alert to infection, fever, vomiting, diarrhoea, reduced oral intake, dehydration, pain, pressure damage, wounds, steroid treatment, changes in mental state, falls or sudden deterioration.

Where a healthcare professional has provided sick-day rules or acute illness instructions, these must be recorded in the personal plan and followed. Staff must seek clinical advice promptly where the individual is unwell, unable to eat or drink, vomiting, dehydrated, has persistent high or low blood glucose readings, has ketones, has missed insulin or diabetes medicines, or appears unusually drowsy, confused or breathless.

Staff must not stop insulin or diabetes medicines unless instructed by an authorised prescriber or relevant healthcare professional, except where immediate emergency action is required and clinical advice is being sought.

Foot Care and Prevention of Diabetes-Related Complications

Annual Diabetes Reviews and Health Appointments

{{org_field_name}} will support individuals living with diabetes to access routine and specialist healthcare appointments, including GP reviews, diabetes specialist nurse input, medication reviews, HbA1c monitoring, blood pressure checks, cholesterol checks, kidney checks, weight or BMI monitoring, diabetic eye screening, foot checks, podiatry, dental care, dietetic advice and other appointments recommended by healthcare professionals.

Staff will record appointment dates, outcomes, recommendations and actions in the individual’s records and update the personal plan where care needs, medicines, monitoring arrangements or risks change.

Oral Health and Diabetes

Staff must support individuals living with diabetes to maintain good oral hygiene and access dental care. Any mouth pain, gum problems, loose teeth, oral infection, poor denture fit, reduced eating, swallowing concerns or change in food intake must be recorded and reported. Where oral health concerns may affect nutrition, hydration, diabetes control or quality of life, advice must be sought from a dentist, GP or relevant healthcare professional.

Physical Activity and Lifestyle Support

Physical activity must be planned safely and in line with the individual’s ability, preferences, falls risk, mobility plan, nutritional intake, blood glucose risks and healthcare advice. Where activity may increase the risk of hypoglycaemia, the personal plan must state the precautions required before, during and after activity.

5. Mental Capacity, Consent and Best Interests

Individuals will be presumed to have capacity to make decisions about their diabetes care unless there is evidence otherwise. Staff must support individuals to make their own decisions wherever possible, including decisions about food, medicines, blood glucose monitoring, healthcare appointments, activity and self-management.

Where there is concern that an individual lacks capacity to make a specific diabetes-related decision, a decision-specific mental capacity assessment must be completed in accordance with the Mental Capacity Act 2005. Where the individual lacks capacity, any decision must be made in their best interests, involve relevant representatives and professionals where appropriate, and be the least restrictive option.

Any refusal of diabetes care, food, fluids, medicines, blood glucose monitoring or healthcare appointments must be respected where the individual has capacity. Staff must record the refusal, explain the risks in an accessible way, report concerns to the person in charge, and seek healthcare advice where refusal may place the individual at risk of harm.

6. Welsh Language, Communication and Accessible Information

Diabetes information, explanations and care planning discussions must be provided in a way the individual can understand. Staff must consider the individual’s preferred language, Welsh language needs, communication needs, sensory impairment, cognitive impairment, learning disability, mental health needs and any need for advocacy or representative support.

Where an individual’s first language or preferred language is Welsh, the service will take reasonable steps to actively offer and support communication in Welsh. Diabetes care instructions, signs of hypoglycaemia or hyperglycaemia, emergency actions and personal plan information must be communicated in a format that supports the individual’s understanding and involvement.

7. Records and Documentation

Staff must keep accurate, timely and clear records of diabetes-related care. Records must include, where applicable:

Records must be factual, dated, signed or electronically attributable, and stored securely in accordance with confidentiality and data protection requirements.

8. CIW Notifications, Safeguarding and Duty of Candour

The Registered Manager and Responsible Individual must ensure that diabetes-related incidents are reviewed to determine whether notification to CIW, safeguarding referral, commissioner notification, family or representative communication, duty of candour action, or professional advice is required.

CIW must be notified through CIW Online where required by regulation or CIW process. This may include serious injury, death, hospital admission, significant medicine error, serious deterioration, safeguarding concern, allegation of neglect, event affecting the safe operation of the service, or any incident that presents a significant risk to the individual’s health, safety or well-being.

Diabetes-related incidents must be managed openly and transparently. Where something has gone wrong, the individual and, where appropriate, their representative must receive a clear explanation, an apology where appropriate, information about action taken, and support to raise a concern or complaint.

Any suspected neglect, omission of essential diabetes care, repeated medicine errors, failure to escalate deterioration, unexplained injury, avoidable pressure damage, financial abuse affecting access to diabetes care, or wilful disregard of diabetes care needs must be managed under the Safeguarding Adults from Abuse and Improper Treatment Policy and the Wales Safeguarding Procedures.

9. Staff Training, Competence and Responsibilities

Staff will receive diabetes training appropriate to their role and the needs of individuals using the service. Training will include, as relevant to the role:

Kitchen staff will receive specialised training on diabetic-friendly meals to ensure meal plans align with individual residents’ needs.

Care workers and nurses will be trained in proper monitoring techniques, medication administration, and emergency response.

Staff must document all diabetes-related care and report concerns promptly to the Registered Manager or designated healthcare professional.

Regular staff competency assessments will be conducted to ensure continued adherence to best practice diabetes care.

Staff must not undertake blood glucose monitoring, insulin administration, injectable diabetes medicines, ketone monitoring, use of continuous glucose monitoring equipment or any delegated diabetes-related task unless they have been trained, assessed as competent and authorised to do so.

Competence must be reviewed at induction, during supervision, following incidents, after changes in diabetes equipment or clinical guidance, and at least annually where the task remains part of the staff member’s role.

The Registered Manager will maintain records of diabetes training, competency assessments, supervision discussions, delegated task authorisations and refresher training.

Agency staff must receive essential information before providing care to an individual living with diabetes. This must include the individual’s personal plan, emergency actions, medicine arrangements, escalation process, record keeping requirements and the limits of the agency worker’s role.

10. Related Policies

11. Monitoring and Review

This policy will be reviewed annually or sooner if required due to legislative changes, CIW updates, or emerging best practices in diabetes care. Regular care audits, feedback from residents, and staff training reviews will be conducted to ensure compliance with CIW and NICE guidelines.

The Registered Manager will ensure diabetes care is monitored through regular audit and governance arrangements. Audits will include, where applicable:

Audit findings will be reviewed by the Registered Manager and Responsible Individual. Any trends, omissions, repeated incidents or areas of risk will result in an action plan with named responsibility, timescales, follow-up and evidence of completion.

Learning from diabetes-related incidents, complaints, safeguarding concerns, audits, healthcare professional feedback and CIW inspection findings will be used to improve care and will be shared with staff through supervision, handovers, team meetings and policy updates.

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}}
Copyright © {{current_year}} – {{org_field_name}}. All rights reserved.

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